Tele-emergency services can successfully extend emergency care in rural hospitals

From News-Medical:

New research from the University of Iowa supports the claim that tele-emergency services can successfully extend emergency care in rural hospitals. The study was published in the February edition of Health Affairs.

“Tele-emergency improves patient care through integrated services that deliver the right care at the right time and the right place,” says Keith Mueller, professor in the UI’s College of Public Health and the study’s lead author. “Our country’s health care system is in a massive state of change, and it’s through services such as this that we’ll be able to address patient need and assist in the financial concerns of smaller medical care units.”

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

From the Canadian Journal of Emergency Medicine:

Background:

Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known.

Methods:

Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. Outcomes were obtained by linking with a regional ED and a provincial vital statistics database and adjusted for the following: estimated glomerular filtration rate, do-not-resuscitate status, history of coronary artery disease, Canadian Triage and Acuity Scale, and left ventricular hypertrophy on electrocardiography. The primary outcome was a composite of death or admission to hospital within 1 year.

Results:

Our total cohort (n  =  344) consisted of 172 TP and 172 TN patients. In the univariate analysis, TP patients had a higher rate of the primary outcome (OR 3.2, 95% CI 2.1–5.0, p < 0.001) and both of its components (p < 0.001). After adjusting for covariates, positive troponin remained an independent predictor of the primary outcome (OR 2.1, 95% CI 1.3–3.4, p  =  0.005) and inpatient admission (OR 2.0, 95% CI 1.2–3.4, p  =  0.006). There was no significant difference in death (OR 1.3, 95% CI 0.6–2.9, p  =  0.5) after adjustment.

Conclusions:

A positive troponin assay during ED stay in discharged patients is an independent marker for risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.

Variation in Suicide Occurrence by Day and during Major American Holidays

From the Journal of Emergency Medicine:

Background

Due to temporal variations in completed suicides, it has been suggested that impulsivity and environmental factors may influence suicide.

Study Objective

Our intent was to determine if particular days of the week, seasons, or holidays were associated with increased attempted and completed suicides by poisoning.

Methods

All calls recorded in the National Poison Database System coded as “suspected suicide” from 2006 through 2010 were included. Exposures were evaluated by day, season, and holidays, and compared to control dates.

Results

There were 1,065,067 exposures (63% female) related to suicide attempts, with completions in 0.4% of cases. Sundays and Mondays for adults, and Mondays and Tuesdays for age < 19 years were the most common. Spring and fall had higher numbers of exposures than summer and winter. New Year’s Day had a higher number of exposures, whereas Independence Day, Thanksgiving, and Christmas had fewer exposures.

Conclusions

The beginning of the week, spring and fall, and New Year’s Day were associated with higher numbers of ingestions with suicidal intent. This has implications for clinicians advising potential victims and providing emergency care for these patients.

Iowa universities refuse to pay health subsidies

From the News Times:

A nonprofit that subsidizes insurance policies for Iowans with health risks is suing the state’s three public universities, claiming they are refusing to pay millions in legally required fees.

The Iowa Individual Health Benefit Reinsurance Association says the universities’ nonpayment could lead to higher assessments for other government agencies that are members and higher costs for patients. The lawsuit, filed in November, seeks to force the schools to pay overdue assessments estimated at $1.5 million and rising, plus late fees and legal costs.