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Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce. Objective: To assess whether PFA, compared to psychoeducation (PsyEd), an attention placebo control, reduces PTSD and depressive symptoms three months post-intervention. Methods: In two emergency departments, 166 recent-trauma adult survivors were randomised to a single session of PFA (n = 78) (active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd (n = 88). PTSD and depressive symptoms were assessed at baseline (T0), one (T1), and three months postintervention (T2) with the PTSD Checklist (PCL-C at T0 and PCL-S at T1/T2) and the Beck Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/ substance consumption and interpersonal conflicts, and use of psychotropics, psychotherapy, sick leave, and complementary/alternative medicine were also explored. Results: 86 participants (51.81% of those randomised) dropped out at T2. A significant proportion of participants in the PsyEd group also received PFA components (i.e. contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing PTSD (p = .148) or depressive symptoms (p = .201). However, we found a significant dose– response effect between the number of delivered components, session duration, and PTSD symptom reduction. No significant difference in self-reported adverse effects was found. At T2, a smaller proportion of participants assigned to PFA reported increased consumption of alcohol/substances (OR = 0.09, p = .003), interpersonal conflicts (OR = 0.27, p = .014), and having used psychotropics (OR = 0.23, p = .013) or sick leave (OR = 0.11, p = .047). Conclusions: Three months post-intervention, we did not find evidence that PFA outperforms PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further research is needed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. Methods: A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. Results: A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. Conclusions: The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, the number of emergencies related to child mental health problems has increased significantly. Our aim is to describe the children with aggressive behavior attended in our emergency department and to analyze possible risk factors related to the most severe episodes. Materials and methods: Retrospective study conducted between January 2011-December 2020 at La Paz Children Hospital. Children under 16 years diagnosed with aggressive behavior were included, excluding selfharm. Episodes that required pharmacological or physical restraint were classified as severe. Results: A total of 114 episodes were recorded (78.1% male; median age 13.2 years). Psychiatric history was present in 93.8%, 18.4% with attention deficit hyperactivity disorder. Episode duration was less than 24 hours in 81.6%. Aggression was mainly directed against third parties (69.3%). Among the triggers, the presence of domestic conflicts accounted for 46.5% of the cases, 18.8% of which were related to the use of cell phones. Thirty-five episodes (30.7%) were considered severe. None of the variables analyzed showed statistically significant association with severity. Conservative measures were used to manage the episode in 74.6% of the cases, pharmacological containment in 27.7% and physical restraints in 6.1%. Conclusion: Emergencies due to aggressive behavior were more frequent in boys and patients with history of psychological or psychiatric disorders. In most cases, they were solved with conservative measures. Cases requiring pharmacological treatment and/or physical restraint were not associated with any risk factor that could predict the severity of the violent behavior. [ABSTRACT FROM AUTHOR]

Context: Toyota Production System is a way to discover opportunities for improvement, adaptation and change, through lean tools, in companies that are in conditions of constant change. Aim: The objective of this study was to apply the lean principles of the Toyota Production System to improve attention times in the emergency department of the Hospital Universitario San Ignacio in Bogota (Colombia). Methods: A mixed design was used in this study: First, a situational diagnosis of the processes of the emergency service of the Hospital was established, later the institutional behavior patterns (attention cycle times and waiting times) were statistically determined and lastly, improvement strategies were proposed to be implemented in the short and long term. Results: Detailed knowledge of the service's operation was achieved. This study enabled the recognition of 13 general processes in the care route that varied according to the triage type, and areas with a greater flow of patients: information, triage, admissions, consulting room, sampling, and billing. Extended wait times were found in consulting room (109 min), sampling (29 min), x-rays(77 min), medical reassessments (160 min) and billing (18 min). Likewise, 23 activities that did not add value to the process were identified. Multiple improvement strategies were proposed with a special focus on three specific areas: admissions, sampling, and billing. Conclusions: The implementation of the lean principles in the health sector provide the guidelines for an adequate improvement plan of the emergency service, allowing for opportunities such as inclusions of just-in-time activities (continuous flow and kanban), standard work and levelling in the attention process. [ABSTRACT FROM AUTHOR]

Copyright of Revista Psicologia, Diversidade e Saúde is the property of Revista Psicologia, Diversidade e Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Drug administration is crucial to achieve effective therapeutic drug outcomes. In medical emergencies, it is particularly convenient to use drugs that could be administered as an alternative to traditional routes (as oral or intravenous routes), that are not always suitable in these situations. Thus, sublingual and buccal routes offer an alternative to traditional routes, when a rapid onset of action is required. The main objective of this narrative review is to summarize the evidence for the use of sublingual and buccal drug administration in medical emergencies. The evidence obtained has been divided into four common scenarios found in the emergency department and intensive care units: cardiovascular emergencies, acute pain, agitation, and epileptic status. Moreover, the main advantages and disadvantages of sublingual and buccal routes are presented, as the future perspectives in the drug delivery field to overcome the limitations of these routes., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the characteristics of patients diagnosed with acute heart failure (AHF) in emergency departments (EDs) who develop cardiogenic shock (CS) not associated with ST-segment elevation acute coronary syndrome (STACS)., Methods: Information for patients diagnosed with AHF in 23 Spanish EDs and registered between 2009 and 2019 were included for analysis if the patients developed symptoms consistent with CS. We described baseline clinical characteristics related to cardiac decompensation and CS, as well as 30-day mortality., Results: A total of 15 920 cases of AHF were diagnosed; 179 of the patients developed CS (prevalence, 1.1%; 95% CI, 0.2%-3.2%). The median age was 82 years, and 53% were women. The most common causes of SC were valve disease and coronary disease. Prior episodes of AHF had occurred in 76%. More than 40% presented with severely deteriorated baseline functional and respiratory status. Treatment for CS was started in the ED in 75%, CS was refractory in 22%, and palliative measures were taken in 13%. Patients who developed CS had lower mean arterial pressure and worse New York Heart Association classifications at baseline, valve disease, and non-STACS. They had been transferred in an advanced life support ambulance, had severe hyponatremia, and less often had lower extremity edema than patients who did not develop CS. Thirty-day mortality was 38.5% (95% CI, 31.3%-45.7%); 21 of these patients died in the ED (12% of those with CS). Mortality was related to age 80 years or older (adjusted [aHR], 1.977; 95% CI, 1.169-3.343), hypertension (aHR, 2.123; 95% CI, 1.035-4.352), anemia (aHR, 2.262; 95% CI, 1.029-4.970), signs of low cardiac output (aHR, 1.877; 95% CI, 1.150-3.062), and a glomerularfiltration rate less than 30 mL/min/1.73 m2 (aHR, 1.758; 95% CI, 1.051-2.939)., Conclusions: CS occurring outside a context of STACS is uncommon in ED patients with AHF and is related to poorer functional class. More of these patients have valve disease, hyponatremia, and non-STACS as a precipitant. Nearly 40% die in hospital. Almost a third die in the ED.

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: during medical care it is crucial to obtain the correct diagnosis. However, diagnostic error, defined as one that occurs late, is inaccurate or ignored, is quite frequent, costly and damaging. Clinical case: 18-year-old male went to the emergency room with acute abdominal pain. He received a diagnosis of renoureteral colic without being corroborated by complementary studies. Subsequently he presented hemodynamic deterioration that culminated in the patient's death. Conclusion: in this case, the diagnostic error prevented the appropriate treatment from starting in a timely manner, allowing the free evolution of the disease. [ABSTRACT FROM AUTHOR]

The hospital emergency department (ED) has become the gateway to the health system during the first COVID-19 wave. The objective of this study is to describe the behaviour of claims in the first year of the pandemic, comparing them with the previous year. Method: Retrospective descriptive study of the complaints addressed to the ED of the Nuestra Señora de Candelaria University Hospital Complex (CHUNSC) during the years 2019 and 2020. The variables studied were: the number of claims received at the CHUNSC and at the ED and of the latter: year, month, dimensions, reasons, professional category, sex, relationship of the claimant and the number of emergencies attended. Results: 347 claims from the ED and 6259 from the CHUNSC were analyzed, with the average for 2019 being higher than that of 2020. The most requested dimension in the ED is health care assistance and the reason for dissatisfaction for the provision of care. The professional category with more claims is health care staff and the user himself, is the one who claims the most. Conclusions: the number of claims has decreased in the first year of the pandemic but the dimension has not changed, nor the reason in relation to the previous year. [ABSTRACT FROM AUTHOR]

Presentamos el caso de una mujer de 92 años, que sufre un problema de salud agudo y acude a los servicios de urgencias de 2 centros sanitarios. La falta de acceso de los profesionales sanitarios a la historia clínica/farmacológica de la paciente, origina cambios en la medicación y una prescripción en cascada que tiene como consecuencia el deterioro de la salud en una paciente estable. Cuando un paciente acude a distintos profesionales para resolver un problema de salud, la falta de un sistema común de repositorio de esa información con acceso directo de los profesionales lastra la resolución de los problemas de salud.

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivos: Evaluar el proceso de conciliación de la medicación en el Servicio de Urgencias y analizar los problemas relacionados con la medicación identificados, su gravedad potencial y las intervenciones farmacéuticas realizadas durante este proceso. Métodos: Estudio observacional prospectivo, realizado en el Servicio de Urgencias de un hospital de tercer nivel. Se recogieron los datos correspondientes durante tres meses (abril-junio 2020). Se elaboraron criterios de priorización, para poder seleccionar a los pacientes con mayor riesgo de sufrir errores de conciliación. El proceso de conciliación se llevó a cabo mediante: Historia Clínica Electrónica, historial farmacoterapéutico de atención primaria y prescripción electrónica en el Servicio de Urgencias. Se consideraron errores de conciliación todas las discrepancias no justificadas por el médico y se valoraron su gravedad potencial según National Coordinating Council for Medication Error Reporting and Prevention. Resultados: Se incluyeron 23 pacientes, 13 fueron hombres. La edad media fue de 77,8 años (DE 11,2). Durante el proceso de conciliación se encontraron 116 discrepancias, de éstas 56 (48,3%) precisaron aclaración. Se detectaron 36 errores de conciliación, éstos fueron por: omisión medicamento (n=18; 50%), error de dosis (n=13; 36,1%) o error en la frecuencia de administración (n=5; 13,9%). La aceptación de estas intervenciones de conciliación fue del 92,6%. Además, se realizaron 22 intervenciones farmacéuticas con una aceptación del 100%. Conclusiones: La realización de un proceso de conciliación de la medicación en el Servicio de Urgencias ha evitado errores de medicación, la mayoría de ellos con relevancia clínica y ha mejorado la atención farmacoterapéutica de estos pacientes.

Introduction: There is no current data on the prevalence of urinary tract infection (UTI) in infants and toddlers with high fever. We conducted this study to assess the point prevalence of UTI in children aged less than 2 years presenting with high fever to the emergency department. Methods: We conducted a prospective, multicentre, observational study including febrile children aged less than 2 years in whom urinalysis was performed to rule out UTI over a 1-year period in seven paediatric emergency departments in Spain. Boys younger than 1 year and girls younger than 2 years of age were eligible for the study if they had a rectal temperature greater than 39 °C, were not taking antibiotics, and there was no identifiable source of fever. The diagnosis of UTI was based on the presence of leukocyturia and positive urine culture results. Results: We included a total of 1675 patients. Two hundred sixty infants (15.5%; 95% CI, 13.8–17.3%) received a diagnosis of UTI. The point prevalence of UTI was 32.9% (95% CI, 26.6–39.9%) in febrile boys aged less than 6 months and 19.3% (95% CI, 16.1–22.9%) in febrile girls aged less than 12 months. The point prevalence of UTI was 13% (95% CI, 10.8–15.6%) in children with a duration of fever of less than 24 h, compared to 17.5% (95% CI, 15.2–20.1%) in those with a longer duration of fever (P = .014). Conclusions: The point prevalence of UTI in infants and toddlers with fever without source greater than 39 °C was higher in our study compared to previous studies of UTI prevalence, especially in male infants aged less than 6 months and female infants aged less than 12 months. Our findings suggest that clinicians need to carefully assess for UTI in infants with unexplained fever greater than 39 °C. Resumen: Introducción: No existen datos actuales de prevalencia de infección de orina (ITU) en lactantes con fiebre elevada en nuestro medio. Se realizó este estudio para evaluar la prevalencia puntual de ITU en lactantes con fiebre elevada en urgencias. Método: Estudio prospectivo, multicéntrico, observacional incluyendo lactantes con fiebre a los que se realizó análisis de orina para descartar ITU en un periodo de un año en siete servicios de urgencia pediátricos españoles. Se incluyeron niños menores de un año y niñas menores de 2 años con fiebre sin focalidad > 39 °C y sin antibioterapia previa. El diagnóstico de ITU se basó en la presencia de leucocituria y urocultivo positivo. Resultados: Un total de 1675 pacientes fueron incluidos. Doscientos sesenta lactantes (15,5%, 95% IC 13,8-17,3) fueron diagnosticados de ITU. La prevalencia puntual de ITU fue 32,9% (95% IC 26,6-39,9) en niños febriles menores de 6 meses y 19,3% (95% IC 16,1-22,9) en niñas febriles menores de 12 meses. La prevalencia puntual de ITU fue 13% (95% IC 10,8-15,6) en lactantes con fiebre de menos de 24 horas de evolución versus 17,5% (95% IC 15,2-20,1) en aquellos con más horas de evolución de fiebre (p < 0,014). Conclusiones: La prevalencia puntual de ITU en lactantes con fiebre sin focalidad > 39 °C en nuestro medio es superior a la referida previamente, especialmente en niños39 °C.

Introduction: Several authors question the performance of systematic renal ultrasound after first urinary tract infection (UTI) in young children, given the high sensitivity of prenatal ultrasounds to detect major malformations and the low prevalence of clinical relevant findings. The aims of this study are to evaluate the yield of renal ultrasound performed after the first UTI in patients aged less than 2 years and to analyse potential risk factors (RF) of altered renal ultrasound. Patients and methods: Retrospective study, including patients aged less than 2 years diagnosed with UTI in the Emergency Department between July 2013 and December 2014. Patients with an underlying nephro-urological pathology, previous UTIs and those without prenatal or post-infection renal ultrasound were excluded. Altered renal ultrasound was defined as the presence of dilated urinary tract or structural abnormalities. Potential RF analysed were: male, age less than 3 months, presence of fever and microorganism other than Escherichia coli. Univariate and multivariate logistic regression were performed. Results: A total of 306 patients were included. Altered renal ultrasound was found in 35 cases (11.4%; 95% CI 8.3–15.5): 24 (68.6%) urinary tract dilation, and 11 (31%) structural abnormalities. Among the cases with altered ultrasound, 68.6% were male, 51.4% were younger than 3 months, 74.3% were febrile, and 31.4% were caused by microorganisms other than E. coli, compared to 45% (P = .009), 31.7% (P = .021), 78.2% (P = .597) and 10% (P = .001) of cases with normal ultrasound. In the multivariate analysis, age less than 3 months (OR 2.1; 95% CI 1.0–4.3, P = .05) and microorganism other than E. coli (OR 3.8; 95% CI 1.7–8.7, P = .002) remained as RF. Conclusions: The yield of renal ultrasound after the first UTI is low. Its indication should be individualised according to the presence of RF: age less than 3 months and microorganism other than E. coli. Resumen: Introducción: Diversos autores cuestionan la realización sistemática de una ecografía renal en los lactantes con una primera infección del tracto urinario (ITU), dada la alta sensibilidad de las ecografías prenatales para la detección de malformaciones mayores y la baja prevalencia de hallazgos clínicamente significativos. Los objetivos de este trabajo son valorar el rendimiento diagnóstico de la ecografía renal realizada después de la primera ITU en pacientes menores de 2 años y analizar posibles factores de riesgo (FR) de presentar una ecografía renal alterada. Pacientes y métodos: Estudio retrospectivo. Se incluyen los pacientes menores de 2 años diagnosticados de ITU en Urgencias entre julio de 2013 y diciembre de 2014. Se excluyen aquellos con enfermedad nefrourológica, ITU previas y sin ecografía renal prenatal o postinfección. Se considera ecografía renal alterada la presencia de dilatación de las vías urinarias y/o anomalías estructurales. Los posibles FR evaluados son: sexo masculino, edad inferior a 3 meses, fiebre y microorganismo distinto a Escherichia coli. Se realiza estudio univariante y por regresión logística multivariante. Resultados: Se incluyen 306 pacientes. Presentan ecografía renal alterada 35 (11,4%; IC 95% 8,3-15,5): 24 (68,6%) dilatación de las vías urinarias y 11 (31%) alteraciones estructurales. De las ecografías alteradas, el 68,6% corresponden a varones, el 51,4% a una edad inferior a 3 meses, el 74,3% a ITU febriles y el 31,4% por microorganismo distinto a E. coli, respecto al 45% (p = 0,009), el 31,7% (p = 0,021), el 78,2% (p = 0,597) y el 10% (p = 0,001) de las ecografías normales. En el análisis multivariante se mantienen como FR la edad inferior a 3 meses (OR 2,1; IC 95% 1,0-4,3; p = 0,05) y un microorganismo distinto a E. coli (OR 3,8; IC 95% 1,7-8,7; p = 0,002). Conclusiones: El rendimiento de la ecografía renal después de la primera ITU es bajo. Se debería individualizar su indicación según la presencia de FR: edad inferior a 3 meses y microorganismo distinto a E. coli.

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: The classification of the heart rate in emergencies requires electrocardiography or monitor, so cellular technology could be a more accessible alternative. The prompt classification of the rhythm in the Emergency department can save lives. OBJECTIVE: To evaluate the accuracy of the electrocardiographic readings obtained with a conventional vs cellular electrocardiogram. MATERIALS AND METHODS: Prospective cohort study, conducted at the Emergency Medical Service of Culiacan Civil Hospital, Mexico. 12 lead electrocardiography and cellular electrocardiography were performed on all patients who requested medical attention from November 2018 to January 2019. They were classified according to the rhythm reported and then compare the rhythms by type of electrocardiogram. RESULTS: One-hundred patients were analyzed, 48 men and 52 women; aged between 20 and 90 years with an average of 39.4 ± 2.0 years. Three independent cardiologists determined rhythm, characteristics of the segments and overall diagnostic impression and among them the value of general Kappa was 0.81 (p = .000). 100% N95 concordance (p = 0.00) for the detection of rhythm with wireless cellular electrocardiography, finding no difference with the standard that is the 12-lead electrocardiogram. CONCLUSIONS: The electrocardiography of a shunt using a cardiochip is capable of clinically meaningful recording and translating the heart rate. [ABSTRACT FROM AUTHOR]

Objectives: To quantify and analyze mortality in patients who die within 30 days of discharge home from a hospital emergency department (ED)., Material and Methods: All patients older than 14 years of age who were discharged home from the ED of a tertiary care hospital over a 5-year period were included. We collected age, sex, and other demographic variables, as well as the Charlson Comorbidity Index (CCI). The outcome variables of interest were 7-day and 30-day mortality and cause of death. Deaths were classified as expected and directly related to the emergency, expected but not directly related, unexpected and directly related, and unexpected and not directly related. A death was classified as an adverse event if it was directly related to a problem of diagnosis or management in the ED, underestimation of severity, or complications of a procedure., Results: Of 519312 patients attended in the ED, 453 599 were discharged home. Of those discharged, 148 died at home within 7 days (32.63 deaths/100 000 discharges) and 355 died within 30 days (78.48 deaths/100 000 discharges). One hundred thirteen deaths (31.8%) were expected and related to the emergency 24.91/100 000), 169 (47.6%) were expected but unrelated 37.26/100 000), 4 (1.1%) were unexpected and related 1.10/100000), and 69 (19.4%) were unexpected and unrelated 15.21/100000). Deaths were considered adverse events related to ED care in 24.2% of the cases. Underestimation of severity was responsible for the highest proportion (10.7%) of such deaths. The median age of patients who died was 83 years, and the median Charlson comorbidity index (CCI) was 6. The most common cause of death was a malignant tumor (23.0%), followed by congestive heart failure (20.2%) and atherosclerotic cardiovascular disease (13.2%). Unexpected deaths related to ED care were significantly related to a higher proportion of adverse events related to diagnosis (P = .001), management (P = .004), and underestimation of severity (P .001)., Conclusion: Early deaths after discharge home from a hospital ED occured in patients of advanced age with concomitant conditions. The main clinical settings were neoplastic and cardiovascular disease. Seven-day and 30-day mortality rates directly related to the emergency visit were low. Adverse events related to ED care played a role in about a quarter of the deaths after discharge.

Introduction: Acute respiratory infections (ARI) are a common cause of inappropriate antibiotic prescription (ATB) in pediatrics. FebriDx® is a rapid diagnostic test that differentiates between viral and bacterial infections. The objective is to analyse the impact of FebriDx® on ATB prescription when managing febrile ARI., Methods: Prospective study carried out in patients aged 1-<18 years with febrile ARI in the emergency department. FebriDx® was performed and the impact on management was evaluated at follow-up., Results: A total of 216 patients were included. Clinical assessment and FebriDx® result coincided coincided in 174 (80.5%) cases. A modification of the initial therapeutic plan was made in 22 (52.4%) of the 42 discordant ones (10.2% of the overall patients). In pneumonia the impact was 34.5%; in all cases it involved not prescribing ATB., Conclusions: FebriDx® could be a useful tool in the management of pediatric patients with febrile ARI to optimize ATB prescription., (Copyright © 2024 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To explore the safety and effectiveness of electric cardioversion to treat atrial fibrillation in a hospital emergency department (ED)., Methods: Retrospective observational study in a hospital ED. We reviewed episodes of atrial fibrillation in patients aged 18 years orolder treated with cardioversion in our ED or referred for scheduling of cardioversion. Clinical outcome measures were conversion to sinus rhythm, immediate adverse effects (hypotension, arrythmia, or bronchial aspiration), revisiting within 90 days for atrial fibrillation, and complications (stroke, major bleeding, heart failure, or death). We studied factors associated with recurrence and adverse effects according to sex., Results: Cardioversion was used in 365 episodes (median patient age, 67 years); 38.6% were women. Cardioversion was applied in the ED in 75.1% of the episodes, and 24.9% were referred for scheduled cardioversion. Sinus rhythm was restored in 90.7% of the episodes. Emergency cardioversion was more effective than a scheduled procedure (odds ratio [OR], 4.258; 95% CI, 2.046-8.859; P < .001). No serious immediate adverse effects were reported, but 16.7% of the patients revisited for atrial fibrillation within 90 days. Factors associated with revisits were heart failure (hazard ratio [HR], 2.603; 95% CI, 1.298-5.222; P = .007), sleep apnea (HR, 2.598; 95% CI, 1.163-5.803; P = .020), and, in women, hypertension (HR, 3.706; 95% CI, 1.051-13.068; P = .042). Eleven patients developed late adverse events, including stroke (n = 2), major bleeding (n = 1), heart failure (n = 5), and death (n = 3)., Conclusions: Cardioversion is a useful, effective, and safe treatment for atrial fibrillation in the ED, although there are frequent recurrences. Factors associated with recurrence differ according to sex.

Objectives: To study the impact of a restrictive calcium replacement protocol in comparison with a liberal one in patients with septic shock., Material and Methods: Multicenter retrospective before-after study that estimated the impact of implementing a restrictive calcium replacement protocol in patients with septic shock. Patients admitted to an intensive care unit between May 2019 and April 2021 were assigned to liberal calcium replacement, and those admitted between May 2021 and April 2022 were assigned to a restrictive protocol. The primary outcome measure was 28-day mortality. Patients were matched with propensity scores., Results: A total of 644 patients were included; liberal replacement was used in 453 patients and the restrictive replacement in 191. We paired 553 patients according to propensity scores, 386 in the liberal group and 167 in the restrictive group. Mortality did not differ significantly between the groups at 28 days (35.3% vs 32.3%, respectively; hazard ratio, 0.97; 95% CI, 0.72-1.29) or after resolution of septic shock (81.5% vs 83.8%; hazard ratio, 0.89; 95% CI, 0.73-1.09). Nor did scores on the Sepsis-related Organ Failure Assessment scale differ (2.1 vs 2.6; P = 0.20)., Conclusion: The implementation of a restrictive calcium replacement protocol in patients with septic shock was not associated with a decrease in 28-day mortality in comparison with use of a liberal protocol. However, we were able to reduce calcium replacement without adverse effects.

Objetivo. En esta investigación se evalúa la calidad en el proceso de atención al usuario del servicio de urgencias del hospital público de Yopal en Casanare, Colombia. Metodología. Esta investigación es de tipo descriptivo, exploratorio, apoyada en varias técnicas de investigación, iniciando con un cuestionario–encuesta, donde se realiza un análisis cuantitativo y cualitativo de la calidad de atención al usuario, la capacidad de la planta física, la comodidad, seguridad y confiabilidad del servicio; además se aplica la técnica de observación directa, análisis e interpretación de fenómenos, acontecimientos y hechos que prevalecen en el área. Resultados. Con este proyecto se pudo determinar la satisfacción o conformidad de los usuarios del servicio de urgencias y la aplicación de los protocolos de atención bajo estándares de calidad, cuál es el trato dado por los trabajadores y profesionales de la salud hacia los usuarios, las necesidades de capacitación al personal de atención, y posibles mejoras o modificaciones a los protocolos, cambios o recomendaciones para mejorar la calidad de atención. Conclusiones. El Hospital de Yopal no tiene capacidad suficiente en el área de urgencias para atender la alta demanda proveniente de los habitantes de Yopal y los municipios aledaños, la constante queja de los usuarios que dicen ser mal atendidos, el supuesto incumplimiento en su labor hacia los enfermos y familiares en la mayoría de las áreas del hospital, falta de personal profesional para la atención en el servicio de urgencias, largas jornadas de espera de los usuarios enfermos.

Objective. To determine the relation between the moderating fee and the frequency of consultations to emergency services in patients with asthma who belong to the contributory insurance regime in Colombia. Methods. A retrospective cohort - analytical observational study was conducted which included contributors over the age of 18 with a diagnosis of asthma, users of the contributory regime who were registered in the database for calculating the Capitation Unit between the years 2012 and 2014; the patients were recruited during 2013 and the cohort was followed for one year from the admission date; the consultation frequency at the emergency service was used as the outcome variable, the influence of the principal confounding variables was evaluated, and a model of negative binomial regression for data analysis was applied. Results. 54 516 asthmatic patients with their comorbidities were included, of which 13.69% consulted emergency services. After controlling by the Charlson index and age of emergency consultation, the risk of consulting emergency services is 1.1 times more frequent in level 3 of the moderating fee with respect to level 1. Conclusions. It is suggested that moderating fee could behave as an access barrier to health services in asthmatic patients. It is recommended that studies to evaluate this hypothesis more precisely be carried out. [ABSTRACT FROM AUTHOR]

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Introduction: Frequent attenders to the emergency department affect quality of care and imply resource overuse. Data regarding child and adolescent psychiatric frequent attendance to the emergency department is scarce, although their number of visits is growing. Objective: To characterize child and adolescent frequent attenders in the psychiatric emergency department of Hospital Clínic de Barcelona during the year 2017. Methods: Retrospective observational study, case-control design. We selected all minors who attended our psychiatric emergency department in 2017 that belonged to our catchment area. We collected sociodemographic and clinical data through automatic extraction and manual review of electronic medical records. Frequent attendance was established as =5 visits/year. We performed a descriptive analysis of frequent attenders and a bivariate analysis comparing frequent attenders versus non-frequent attenders. Results: Our sample included 550 children and adolescents, of which 3.8% (n=21) were frequent attenders. There were significantly more foreigners among frequent attenders (28.6% vs 13.1%, p=0.04), without other differences between groups. Among frequent attenders, conduct disorders were the most prevalent main diagnoses (33.3%), all had at least one psychotropic medication prescribed (antipsychotics in 95.2%) and social vulnerability factors were present for most of them (family conflict in 61.8%, 48% living in residential care institutions). Conclusions: Child and adolescent frequent attendance to the psychiatric emergency department is a reality. They are a socially vulnerable and highly medicated subgroup, with a preponderance of conduct problems. They are in need of a comprehensive and multidisciplinary approach, were social services are a key feature. [ABSTRACT FROM AUTHOR]

Las urgencias psiquiátricas pueden presentarse en diversos escenarios clínicos, incluyendo la consulta ambulatoria, el servicio de urgencias, o el hospital general. Por este motivo, es importante que tanto psiquiatras como médicos de otras especialidades estén capacitados para su reconocimiento y manejo inicial. Especialmente en el contexto del hospital general, es importante considerar la relación entre enfermedades médicas y psiquiátricas, desde los síntomas físicos que pueden presentarse producto de un trastorno psiquiátrico, hasta los síntomas psiquiátricos que son el resultado de enfermedades orgánicas, medicamentos o abuso de sustancias. Adicionalmente, en este artículo se entregan elementos para el manejo de algunas urgencias psiquiátricas particularmente relevantes, tales como la ideación suicida, la agitación psicomotora o el delirium, donde las intervenciones iniciales pueden ser de gran importancia para la evolución y el pronóstico del paciente.

El delirium es reconocido como un problema de alta relevancia, especialmente en personas mayores, desde el servicio de urgencia y durante toda la estadía hospitalaria. Se asocia a mayor riesgo de morbilidad, dependencia funcional, deterioro cognitivo y mortalidad, además de una mayor estadía hospitalaria y costos. Su presencia implica desafíos en el manejo, toma de decisiones, diagnóstico y terapéutica. Se recomienda su tamizaje desde el momento de la atención de urgencia y durante la hospitalización, así como la implementación de protocolos de prevención y manejo, que han demostrado beneficio mediante un abordaje integral multidimensional. A pesar de su impacto, aún persisten altas tasas de subdiagnóstico y los sistemas de salud han sido lentos en la implementación de las recomendaciones. Actualmente el manejo adecuado del delirium es un desafío para mejorar la calidad asistencial.

Objetivo: Identificar la asociación entre la edad de inicio del consumo de alcohol con el patrón de consumo y el consumo problemático en pacientes lesionados.Método: Estudio transversal en lesionadosatendidos en el servicio de urgencias de dos hospitales públicos y que reportaron consumo de alcohol alguna vez en la vida. Variables: sexo, edad de inicio, consumo de alcohol antes de la lesión, patrón de consumo en el último año y consumo problemático. Resultados: Se incluyeron 354 pacientes, la media de edad de inicio del consumo de alcohol fue 17±4 años. Se observaron diferencias significativas entre la edad de inicio con: sexo (p=0.006), consumo de alcohol antes de la lesión (p=0.001) y consumo problemático (p=0.001). Conclusión: En el presente estudio se observó que a menor edad de inicio del consumo de alcohol mayor consumo problemático y un patrón de consumo alto y consuetudinario. Es necesario establecer estrategias específicas de intervención para la reducción del consumo de alcohol a edades tempranas.

Introduction and Objective: A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes., Patients and Methods: Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes., Results: The cohort included 553 patients (80 years [73-85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441-0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470-5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES., Conclusions: Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To study differences in the emergency department treatment of acute poisoning according to biological sex of patients and to assess adherence to care quality indicators., Material and Methods: Retrospective observational study including all cases of acute poisoning diagnosed in patients over the age of 14 years treated in a tertiary care hospital emergency department over a period of 4 years. We analyzed demographic variables, substance type and reason for acute poisoning, degree of adherence to quality indicators, and discharge destination., Results: A total of 1144 cases were included; 710 patients (62.1%) were female and 434 (37.9%) were male. The proportion of deliberate self-poisoning was higher in females (52.3% vs 41.4% in males; P .001); unintentional poisoning was less frequent in females (in 24.9% vs in 30.3% of males; P = .047). Benzodiazepine poisoning was more frequent in females (in 49.6% vs 41.2%; P = .007). Street drug and alcohol poisoning was less common in females. Adherence to quality indicators was high (> 85%) for both sexes., Conclusion: The epidemiologic profile of poisoning is different in females and males. General emergency department adherence to quality indicators can be considered optimal. We detected no qualitative sex-related differences in the care of patients with acute poisoning.

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Copyright of Ciberrevista Enfermeriadeurgencias.com is the property of Sociedad Espanola de Enfermeria de Urgencias y Emergencias and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)