Correct license text Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any ...medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Affected articles * https://doi.org/10.1186/s13054-021-03670-x * https://doi.org/10.1186/s13054-021-03671-w * https://doi.org/10.1186/s13054-021-03672-9 * https://doi.org/10.1186/s13054-021-03673-8 * https://doi.org/10.1186/s13054-021-03674-7 * https://doi.org/10.1186/s13054-021-03675-6 * https://doi.org/10.1186/s13054-021-03676-5 * https://doi.org/10.1186/s13054-021-03677-4 * https://doi.org/10.1186/s13054-021-03678-3 * https://doi.org/10.1186/s13054-021-03679-2 Author information Authors and Affiliations Consortia Critical Care Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative Correction Open access Published:05 April 2024 Correction: Selected articles from the annual update in Intensive Care and Emergency Medicine 2021 Critical Care Critical Care volume 28, Article number: 110 (2024) Cite this article 279 Accesses Metrics details The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 The Original Article was published on 31 August 2021 Correction: Crit Care 25, 310 (2021). https://doi.org/10.1186/s13054-021-03670-x, Crit Care 25, 318 (2021). https://doi.org/10.1186/s13054-021-03671-w, Crit Care 25, 317 (2021). https://doi.org/10.1186/s13054-021-03672-9, Crit Care 25, 309 (2021). https://doi.org/10.1186/s13054-021-03673-8, Crit Care 25, 316 (2021). https://doi.org/10.1186/s13054-021-03674-7, Crit Care 25, 315 (2021). https://doi.org/10.1186/s13054-021-03675-6, Crit Care 25, 313 (2021). https://doi.org/10.1186/s13054-021-03676-5, Crit Care 25, 314 (2021). https://doi.org/10.1186/s13054-021-03677-4, Crit Care 25, 312 (2021). https://doi.org/10.1186/s13054-021-03678-3, Crit Care 25, 311 (2021). https://doi.org/10.1186/s13054-021-03679-2. Correct license text Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
Toxidrome Recognition and Response Ciottone, Gregory R.; Longo, Dan; Taichman, Darren
The New England journal of medicine,
04/2023, Volume:
388, Issue:
17
Journal Article
Peer reviewed
This short, animated video provides an overview of how first responders use knowledge of toxidromes and mitigation techniques to deal with a fictional terrorist attack.
Leave against medical advice (LAMA) is defined as 'a decision to leave the hospital before the treating physician recommends discharge', and is associated with higher rates of readmission, longer ...subsequent hospitalization, and worse health outcomes. In addition to this, they also contribute to poor healthcare resource utilization. We conducted a single-center audit to establish patient demographics and contributing factors of patients leaving against medical advice from our emergency department (ED). We benchmarked our data against locally available clinical policy guidelines. We interrogated our electronic health record system (known as Salamtak®), which is a Cerner-based platform (Cerner Corporation, Kansas City, MO 64138) for patients who signed LAMA from ED from 2018 to 2023. We selected a convenience pilot sample of 120 subjects. Based on a literature review, we identified patient demographics (age, gender, nationality, socioeconomic status, marital status, religion), possible contributing factors (time of attendance, insurance status, length of ED stay), and patient outcomes (reattendances within 1 week and mortality) to evaluate. Based on locally available guidance, we formulated six criteria to audit with a standard set at 100% for each. A team of emergency medicine residents collected data that was anonymized on an Excel spreadsheet (Microsoft Excel, Microsoft Corporation. (2018). Basic descriptive statistics were used to collate results. About 93 patients (77.5%) were 16 years and above, and 27 patients (22.5%) were below 16 years. There was a slight preponderance of males (64 patients, 53.3%) than females (56 patients, 46.6%). The majority of LAMA cases presented in the evening and night (97 patients, 80.8%). About 57 (47.5%) patients had an ED length of stay of 3 hours or more. The average ED length of stay for these patients was 3.4 hours. About 73 patients (60.3%) were insured. Out of 120 patients, only 12 (10%) had a mental capacity assessment documented. The commonest reason for signing LAMA was a social reason in 45 (37.5%) cases. In the remaining cases, the causes were a combination of family, financial, waiting, or other/undocumented reasons). When faced with a decision to LAMA, the involvement of a Public Relationship Officer (PRO) was only documented to be consulted in seven (5.8%) cases. About 14 cases were re-attended within 1 week (11.6%) and no mortalities were reported in any of the reattendances. LAMA is a not-so-rare phenomenon often occurring in EDs, and often a cause of trepidation for healthcare workers. Treating this as an aberrant behavior on the part of the patient, or laying the responsibility for this action on the healthcare provider is primitive, counter-productive, and not patient-centric. Familiarity with local guidelines around this contentious area is essential. Revised nomenclature like 'premature discharge' may be less stigmatizing for the patient. Where possible, a harm reduction approach should be used and frontline healthcare workers must be prepared with an escalation plan. In the United Arab Emirates, familiarity with Wadeema's Law as a child protection measure is essential.Leave against medical advice (LAMA) is defined as 'a decision to leave the hospital before the treating physician recommends discharge', and is associated with higher rates of readmission, longer subsequent hospitalization, and worse health outcomes. In addition to this, they also contribute to poor healthcare resource utilization. We conducted a single-center audit to establish patient demographics and contributing factors of patients leaving against medical advice from our emergency department (ED). We benchmarked our data against locally available clinical policy guidelines. We interrogated our electronic health record system (known as Salamtak®), which is a Cerner-based platform (Cerner Corporation, Kansas City, MO 64138) for patients who signed LAMA from ED from 2018 to 2023. We selected a convenience pilot sample of 120 subjects. Based on a literature review, we identified patient demographics (age, gender, nationality, socioeconomic status, marital status, religion), possible contributing factors (time of attendance, insurance status, length of ED stay), and patient outcomes (reattendances within 1 week and mortality) to evaluate. Based on locally available guidance, we formulated six criteria to audit with a standard set at 100% for each. A team of emergency medicine residents collected data that was anonymized on an Excel spreadsheet (Microsoft Excel, Microsoft Corporation. (2018). Basic descriptive statistics were used to collate results. About 93 patients (77.5%) were 16 years and above, and 27 patients (22.5%) were below 16 years. There was a slight preponderance of males (64 patients, 53.3%) than females (56 patients, 46.6%). The majority of LAMA cases presented in the evening and night (97 patients, 80.8%). About 57 (47.5%) patients had an ED length of stay of 3 hours or more. The average ED length of stay for these patients was 3.4 hours. About 73 patients (60.3%) were insured. Out of 120 patients, only 12 (10%) had a mental capacity assessment documented. The commonest reason for signing LAMA was a social reason in 45 (37.5%) cases. In the remaining cases, the causes were a combination of family, financial, waiting, or other/undocumented reasons). When faced with a decision to LAMA, the involvement of a Public Relationship Officer (PRO) was only documented to be consulted in seven (5.8%) cases. About 14 cases were re-attended within 1 week (11.6%) and no mortalities were reported in any of the reattendances. LAMA is a not-so-rare phenomenon often occurring in EDs, and often a cause of trepidation for healthcare workers. Treating this as an aberrant behavior on the part of the patient, or laying the responsibility for this action on the healthcare provider is primitive, counter-productive, and not patient-centric. Familiarity with local guidelines around this contentious area is essential. Revised nomenclature like 'premature discharge' may be less stigmatizing for the patient. Where possible, a harm reduction approach should be used and frontline healthcare workers must be prepared with an escalation plan. In the United Arab Emirates, familiarity with Wadeema's Law as a child protection measure is essential.
Abstract Background The landscape of the emergency medicine workforce has changed dramatically over the last few decades. The growth in emergency medicine residency programs has significantly ...increased the number of emergency medicine specialists now staffing emergency departments (EDs) throughout the country. Despite this increase in available providers, rising patient volumes, an aging population, ED overcrowding and inefficiency, increased regulation, and other factors have resulted in the continued need for additional emergency physicians. Objectives To review current available data on patient volumes and characteristics, the overall physician workforce, the current emergency physician workforce, the impact of physician extenders and scribes on the practice of emergency medicine, and project emergency physician staffing needs into the future. Discussion and Projections We project that within the next 5 to 10 years, there will be enough board-certified or -eligible emergency physicians to provide care to all patients in the U.S. EDs. However, low-volume rural EDs will continue to have difficulty attracting emergency medicine specialists without significant incentives. Conclusions There remains a shortage of board-certified emergency physicians, but it is decreasing every year. The use of physicians from other specialties to staff EDs has long been based on the theory that there is a long-standing shortage of available American Board of Emergency Medicine/American Osteopathic Board of Emergency Medicine physicians, both now and in the future. Our investigation shows that this is not supported by current data. Although there will always be regional and rural physician shortages, these are mirrored by all other specialties and are even more pressing in primary care.
TSP and atmospheric .sup.210Pb concentrations were observed at Tsukuba, Japan during July 2001 to March 2005. TSP concentrations ranged from 14.5 to 152.4 microg m.sup.-3. .sup.210Pb concentrations ...ranged from 0.04 to 0.86 mBq m.sup.-3 which was low in summer and high in winter to spring. Although TSP concentrations changed annually, .sup.210Pb concentrations had almost the same concentration level and seasonal variation. The correlation coefficient between .sup.210Pb concentration and NO.sub.3.sup.- concentration was slightly higher than for other ion species. This result indicated that both had been attached to the same particle size and transported to the sampling site.
