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“Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday.
Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized.
The study’s findings raise important questions about how emergency rooms contribute to high health care costs in the United States and what their role will be in the future as the nation undergoes fundamental changes in health care delivery……………..
The report by the RAND Corporation………..was done for a consortium of emergency medicine physician organizations. RAND, which says it was chosen for its independence, says the sponsors had no say in the report’s findings……”
Sigrun A. Johannesdottir, BSc; Erzsébet Horváth-Puhó, MSc, PhD; Olaf M. Dekkers, MD, PhD, MSc, MA; Suzanne C. Cannegieter, MD, PhD; Jens Otto L. Jørgensen, MD, DMSc; Vera Ehrenstein, DSc, MPH; Jan P. Vandenbroucke, MD, PhD; Lars Pedersen, MSc, PhD; Henrik Toft Sørensen, MD, PhD, DMSc
Systemic glucocorticoids increased VTE risk among present (adjusted IRR, 2.31; 95% CI, 2.18-2.45), new (3.06; 2.77-3.38), continuing (2.02; 1.88-2.17), and recent (1.18; 1.10-1.26) users but not among former users (0.94; 0.90-0.99). The adjusted IRR increased from 1.00 (95% CI, 0.93-1.07) for a prednisolone-equivalent cumulative dose of 10 mg or less to 1.98 (1.78-2.20) for more than 1000 to 2000 mg, and to 1.60 (1.49-1.71) for doses higher than 2000 mg. New use of inhaled (adjusted IRR, 2.21; 95% CI, 1.72-2.86) and intestinal-acting (2.17; 1.27-3.71) glucocorticoids also increased VTE risk.
Gershon A et al “Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease” JAMA Intern Med 2013; DOI: 10.1001/jamainternmed.2013.1016.
Of 191 005 eligible patients, 53 532 (28.0%) had a hospitalization or an emergency department visit for a cardiovascular event. Newly prescribed long-acting inhaled β-agonists and anticholinergics were associated with a higher risk of an event compared with nonuse of those medications (respective adjusted odds ratios, 1.31 [95% CI, 1.12-1.52; P < .001] and 1.14 [1.01-1.28; P = .03]). We found no significant difference in events between the 2 medications (adjusted odds ratio of long-acting inhaled β-agonists compared with anticholinergics, 1.15 [95% CI, 0.95-1.38; P = .16]).
FDA approves Nymalize—first nimodipine oral solution for use in certain brain hemorrhage patients
New oral formulation may help reduce potentially fatal medication errors
On May 10, the U.S. Food and Drug Administration approved Nymalize, a new nimodipine oral solution, to treat patients experiencing symptoms resulting from ruptured blood vessels in the brain (subarachnoid hemorrhage). Nimodipine previously was available only as a liquid-filled gel capsule.
Subarachnoid hemorrhage is serious, life threatening bleeding that occurs in the subarachnoid space – the area between the brain and the thin tissues that cover the brain. Nimodipine is a medication given in a critical care setting to treat neurologic complications from subarachnoid hemorrhage.
Over the years, the FDA has received reports of serious and sometimes fatal consequences from intravenous (IV) injection of the liquid contents of oral nimodipine capsules. IV administration of nimodipine meant for oral use can result in death, cardiac arrest, severe decreases in blood pressure and other heart-related complications. In August 2010, the agency reminded health care1 professionals about the risks of IV administration of nimodipine from oral capsules and in 2006 a Boxed Warning was added to the drug to warn against such use.
“Having an oral version of this product may help reduce the medication errors we’ve seen from erroneous intravenous administration of the contents of oral capsules,” said Russell Katz, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “Nymalize is a liquid that is administered orally, or via nasogastric tube or gastric tube, and there is no need for a needle to be used, which is what caused past medication errors.”
Based on the potential of the oral formulation, Nymalize, to decrease or eliminate medication errors, the application received fast track designation and priority review2. Fast track and priority review are two programs the FDA uses to make drugs rapidly available.
The approval of Nymalize is based on clinical studies evaluating the use of nimodipine oral capsules in patients with subarachnoid hemorrhage. The most common adverse event observed in the studies was decreased blood pressure. A patient’s blood pressure should be carefully monitored during treatment.
Nymalize is made by Atlanta-based Arbor Pharmaceuticals Inc.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
George Washington University School of Public Heal. “ICU Admissions From Emergency Departments Nearly Double.” Medical News Today. MediLexicon, Intl., 16 May. 2013. Web.
17 May. 2013. http://www.medicalnewstoday.com/releases/260564.php
A study released by George Washington University School of Public Health and Health Services (SPHHS) researchers offers an in-depth look at hospitals nationwide and admissions to intensive care units (ICU). The study, published in the journal Academic Emergency Medicine, finds a sharp increase – nearly 50 percent – in ICU admissions coming from U.S. emergency departments.
CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, Hunt BJ, Morales C, Perel P, Prieto-Merino D, Woolley T.
Lancet. 2011 Mar 26;377(9771):1096-101, 1101.e1-2. doi: 10.1016/S0140-6736(11)60278-X.
CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S.
Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14.
QuickStats: Average Annual Rate of Eye-Related Emergency Department Visits for Injuries and Medical Conditions,* by Age Group — United States, 2007–2010
Weekly
May 10, 2013 / 62(18);374
* Per 10,000 population, based on 4-year annual average.
† 95% confidence interval.
During 2007–2010, an average of 2.4 million eye-related visits were made to emergency departments (EDs) each year. During this period, 43.7 visits per 10,000 persons were the result of medical conditions, and 37.6 visits per 10,000 persons were the result of injuries. Significant differences in the reason for eye-related ED visits were observed by age group. Children and persons aged ≥65 years were more likely to visit the ED for an eye-related medical condition than an eye injury. The eye-related visit rate for a medical condition was highest among those aged ≤18 years (63.3 per 10,000 persons) and lowest among those aged ≥65 years (27.3).
Reported by: Linda F. McCaig, MPH, lmccaig@cdc.gov, 301-458-4365; Esther Hing, MPH.
Alternate Text: The figure above shows the average annual rate of eye-related emergency department visits for injuries and medical conditions, by age group in the United States during 2007-2010. During 2007-2010, an average of 2.4 million eye-related visits were made to emergency departments (EDs) each year. During this period, 43.7 visits per 10,000 persons were the result of medical conditions, and 37.6 visits per 10,000 persons were the result of injuries. Significant differences in the reason for eye-related ED visits were observed by age group. Children and persons aged ≥65 years were more likely to visit the ED for an eye-related medical condition than an eye injury. The eye-related visit rate for a medical condition was highest among those aged ≤18 years (63.3 per 10,000 persons) and lowest among those aged ≥65 years (27.3).
“……Members of the ER staff chat on earpiece radios, measure “door to doctor” time from a keystroke at a portable intake stand, and carry titles such as “pivot nurse” and “scribe.”
……The goal was to reduce ER wait times — which the hospital calls “door to doctor” — from nearly 80 minutes to 10 to 15. Results so far have been dramatic: The average since opening the department early in April is 10 minutes….”
Pediatric Hydrocarbon-Related Injuries in the United States: 2000–2009
Heath A. Jolliff, Erica Fletcher, et al.
Pediatrics. 2013 May 6.
Abstract
The comparison of the two data sets illustrates a similar trend in hydrocarbon-related injuries in children. Although cases have declined, most likely due to existing prevention efforts, hydrocarbons are still a large source of preventable exposure and injury in children.
“…..Prothrombin complex concentrate (PCC) is an inactivated concentrate of factors II, IX, and X, with variable amounts of factor VII.
……..Health care professionals must remain aware of the differences in products and interpret how three- versus four-factor products may affect patients, and interpret literature accordingly. The clinician must be cognizant of how to progress when treating a bleeding patient, propose a supported dosing scheme, and address the need for appropriate factor VII supplementation. At this point, PCC cannot be recommended for first-line therapy in patients with traumatic hemorrhage, and should be reserved for refractory bleeding until more data are available.”
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