Drugged driving surpasses drunken driving among drivers killed in crashes

From CNN:

Driving under the influence of drugs was deadlier in 2015 than driving while drunk, a new report found. Still, some safety experts caution that drunken driving remains a bigger problem and say that drugged driving needs more research.

Positive drug tests were more common than the presence of alcohol among the fatally injured drivers who were tested in 2015, according to the report (PDF)released Wednesday by the Governors Highway Safety Association and the Foundation for Advancing Alcohol Responsibility, a nonprofit funded by alcohol distillers.

Rate of opioid abuse, overdoses climbs among middle aged, elderly

From Becker’s:

According to data from the CDC cited by WSJ, Americans between ages 45 and 64 accounted for almost half — 44 percent — of deaths attributed to overdoses in 2013 and 2014, and the proportion of adults age 50 and older seeking opioid addiction treatment has increased significantly over recent decades.

Although many drug overdose deaths are attributed to illicit street drugs, prescription opioids pose a growing problem, the CDC reported in December.

Rural Doctors’ Training May Be In Jeopardy

From Kaiser Health News:

Under the Teaching Health Center Graduate Medical Education program, which is part of the Affordable Care Act, the federal government dispenses grants to community health centers to train medical residents. The goal of the program is to address the shortage of primary care physicians in rural and poor urban areas.

But under current law, the federal government will stop funding the program, which serves nearly 750 primary care residents in 27 states and Washington, D.C., at the end of September. Without congressional action, it might be shut down.

 

Estimation of the severity of breathlessness in the emergency department: a dyspnea score

From the BMC:

Background

Dyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients’ rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters.

Methods

We performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients’ subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups).

Results

All of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77–0.99, sensitivity 65–100%, specificity 64–99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p < 0.001), though the scatter was very large.

Conclusions

A new DSS was validated which score is suitable to compare the severity of dyspnea among different patients and different illnesses. The simplified version of the score (its value ≥7 points without correction factors) can be useful at the triage or in pre-hospital care.

The HEART Score Is Safe to Use in the Emergency Department

From the NEJM:

The HEART score — based on History, Electrocardiogram, Age, Risk factors, and Troponin level — provides risk stratification and disposition recommendations (inpatient admission, observation, or discharge) for emergency department (ED) patients presenting with chest pain. It has been externally validated and is used by some hospitals as part of their risk-stratification algorithms. However, its effect on use of healthcare resources is not known.

In a Dutch study, nine EDs switched from usual care to use of the HEART score in random order. Discharged patients were followed up with troponin testing the same or next day. The primary outcome was incidence of major adverse cardiac events (MACE) within 6 weeks. Adherence with the score’s recommendations and resource use were also evaluated.

Roughly 3650 patients were included in the analysis. The incidence of MACE was 1.3% lower with HEART care than with usual care. The incidence of MACE among the 715 patients classified as low-risk by HEART was 2.0%, including one death from unknown causes. There were no significant differences in the use of healthcare resources between HEART care and usual care, likely because 41% of patients classified as low-risk (and thus appropriate for discharge) received additional observation, second troponin measurement, and stress testing instead.

Call an Ambulance — for Care

From H&HN:

Meeting in Chicago under the aegis of the American College of Emergency Physicians a little over four years ago, a consortium of 10 EMS-affiliated physicians and health care strategists from around the country, including Beck, proposed a new model for delivery of appropriate, around-the-clock, comprehensive, planned or unplanned care outside the hospital, using interprofessional medical teams.

They called it mobile integrated health care practice, or MIHP. The P has since been dropped as confusing. But as MIH, it’s an idea that is already recording encouraging results.

“It makes a big difference for the patients to have an advanced practice provider go to their home after they’ve been discharged and look around,” he says. “In almost all cases, something’s not right. Patients are given a number to call if they have problems, and we have a multi-triage system to decide whether they can wait or need an ambulance immediately. Their discharge summary lists the physician who’s responsible and, if appropriate, that’s where we take them.”

Says Beck: “Some hospitals are trying to manage the present. They’re caught up in working their way through the challenges of the near term. Others have a strategy that’s more outward looking. They’re pursuing value-focused care. For them, mobile integrated health is coming into focus pretty quickly. It’s a new iteration of a familiar set of players … and a pretty exciting new set of menu choices for hospitals and health systems that are thinking holistically.”

Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department

From the Annals of Internal Medicine:

Background:The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown.

Objective:

To measure the effect of use of the HEART score on patient outcomes and use of health care resources.

Design:

Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT01756846)

Setting:

Emergency departments in 9 Dutch hospitals.

Patients:

Unselected patients with chest pain presenting at emergency departments in 2013 and 2014.

Intervention:

All hospitals started with usual care. Every 6 weeks, 1 hospital was randomly assigned to switch to “HEART care,” during which physicians calculated the HEART score to guide patient management.

Measurements:

For safety, a noninferiority margin of a 3.0% absolute increase in MACEs within 6 weeks was set. Other outcomes included use of health care resources, quality of life, and cost-effectiveness.

Results:

A total of 3648 patients were included (1827 receiving usual care and 1821 receiving HEART care). Six-week incidence of MACEs during HEART care was 1.3% lower than during usual care (upper limit of the 1-sided 95% CI, 2.1% [within the noninferiority margin of 3.0%]). In low-risk patients, incidence of MACEs was 2.0% (95% CI, 1.2% to 3.3%). No statistically significant differences in early discharge, readmissions, recurrent emergency department visits, outpatient visits, or visits to general practitioners were observed.

Limitation:

Physicians were hesitant to refrain from admission and diagnostic tests in patients classified as low risk by the HEART score.

Conclusion:

Using the HEART score during initial assessment of patients with chest pain is safe, but the effect on health care resources is limited, possibly due to nonadherence to management recommendations.