Examining ED Antibiotic Trends in Acute Exacerbations of COPD

From the AJMC:

Current guidelines for chronic obstructive pulmonary disease (COPD) call for using antibiotics in the emergency department (ED) when presented with acute exacerbations of COPD (AECOPD). A recent study sought to determine the rate at which patients with AECOPD are treated with antibiotics and also looked at the proportions of antibiotic classes prescribed, trends of antibiotic treatment, and identified independent predictors of antibiotic therapy.

Doctor moms struggle with discrimination, too

From Reuters:

Doctor moms regularly run up against discrimination, sometimes subtle and sometimes blatant, a new survey finds.

“Experiences of discrimination resonate and relate with the experiences of women in other fields, but some are unique to the structure of medicine,” said Dr. Eleni Linos of the University of California, San Francisco. “And some (have) downstream consequences that could affect not only the woman herself and her family and career, but also the health care system and the patients she cares for.”

Emergency Nurses Association-Backed Human Trafficking Bill Clears Congress

Press Release:

The U.S. Senate and House of Representatives on Thursday passed legislation strongly supported by the Emergency Nurses Association which provides healthcare workers with critical training for identifying and treating victims of human trafficking.

The Stop, Observe, Ask, and Respond to Health and Wellness Act, which now is ready to be signed into law by the president, aims to improve care for those ensnared in the global human trafficking epidemic by establishing a pilot program that better equips emergency nurses and other health care workers with tools that not only help identify victims, but improve the approach to treatment, facilitates communication between victims and law enforcement, and creates opportunities to better connect victims with social services.

These steps are designed to improve upon statistics which show 95 percent of emergency department personnel have not received human trafficking training, while only one percent of hospitals across the United States have strategies for treating human trafficking victims. Additional research reveals that as many as 88 percent of all trafficking victims receive medical treatment while being trafficked. Approximately 63 percent of those individuals received that care in an emergency department.

“Emergency nurses are in a unique position to help victims of human trafficking,” said ENA President Jeff Solheim, MSN, RN, CEN, CFRN, FAEN, FAAN. “We recognize that for many human trafficking victims, we may be the one of the few people who can potentially rescue them from a horrific situation. This training provides ED nurses, and all health care professionals, tools that can truly make an impact on the lives of those who need it most.”

The International Labour Organization estimates there are 21 million human trafficking victims around the world, with nearly one-quarter of them children. The U.S. Department of Justice has reported that as many as 15,000 foreign nationals are trafficking into the United States each year.

The SOAR Act was a priority piece of legislation discussed by ENA members on Capitol Hill in May as part of the association’s annual Day on the Hill event in Washington, D.C.

ENA offered its thanks to Reps. Steve Cohen, D-Tenn., and Adam Kinzinger R-Ill., as well as Sens. Heidi Heitkamp, D-N.D., and Susan Collins, R- Maine., for their leadership in introducing the bill and their efforts to move it through Congress.

About the Emergency Nurses Association
The Emergency Nurses Association is the premier professional nursing association dedicated to defining the future of emergency nursing through advocacy, education, research, innovation, and leadership. Founded in 1970, ENA has proven to be an indispensable resource to the global emergency nursing community. With more than 43,000 members worldwide, ENA advocates for patient safety, develops industry-leading practice standards and guidelines, and guides emergency healthcare public policy. ENA members have expertise in triage, patient care, disaster preparedness, and all aspects of emergency care. Additional information is available at www.ena.org.

Anonymous patient data may not be as private as previously thought

From Reuters:

For years, researchers have been studying medical conditions using huge swaths of patient data with identifying information removed to protect people’s privacy. But a new study suggests hackers may be able to match “de-identified” health information to patient identities.


Emergency rooms are flooded with mental health patients who have nowhere else to go

From WITF:

About half of frequent emergency department patients have a mental health diagnosis, according to a recent Journal of the American Medical Association report. Across the country, emergency rooms are often where people go when they’re having a mental health crisis.

“A lot of times people don’t know where to turn, but they know if they go to their local ER that they’re going to get people who are going to show care to them and are going to point them in the right direction,” said Kenneth “KC” Johnson at WellSpan Good Samaritan hospital in Lebanon.

2018 Healthiest States Report

From America’s Health Rankings:

Hawaii regains the title of healthiest state this year, after dropping to No. 2 in 2017. This is Hawaii’s ninth year in the No. 1 spot since 1990 when the health rankings were first published. The state has been No 1. four of the past five years. Massachusetts is No. 2, Connecticut No. 3, Vermont No. 4 and Utah No. 5. These same states ranked in the top five in 2017.

Iowa is #16

ER visits for physical ailments tied to self-harm risk

From Reuters:

Teens and young adults who visit emergency rooms for injuries or physical illnesses may be more likely to harm themselves afterward, a U.S. study suggests.

Emergency room (ER) visits for mental health disorders or substance misuse have long been linked to an increased risk for self-harm and suicidal thoughts and behaviors among teens and young adults. The current study focused on teens and young adults, ages 15 to 29, who visited an ER for more common reasons: physical illnesses and injuries. It found that these individuals were much more likely to harm themselves after being treated for a wide range of conditions including epilepsy, back pain, headaches and dental problems.

The first weeks after leaving the ER may be when young people are most vulnerable. Half the episodes of self-harm occurred within 42 days of discharge.

(Updated) State-by-state breakdown of 93 rural hospital closures

From Becker’s:

Of the 26 states that have seen at least one rural hospital close since 2010, those with the most closures are located in the South, according to research from the North Carolina Rural Health Research Program. Listed below are the 93 rural hospitals that closed between Jan. 1, 2010, and Dec. 17, 2018, as tracked by the NCRHRP. For the purposes of its analysis, the NCRHRP defined a hospital closure as the cessation in the provision of inpatient services. As of Dec. 17, 2018, all of the facilities listed below had stopped providing inpatient care. However, some of them still offered other services, including outpatient care, emergency care, urgent care or primary care.


Handling Unaccompanied Minors in the Emergency Department

From Physicians Weekly:

Illness and injury may strike children at any time or place. Young patients may present to the emergency department (ED) without legal a guardian. Perhaps they are coming from school or daycare, or extracurricular activities or jobs. Perhaps they are immigrants without legal guardians. Maybe they are simply adolescents driving themselves to the ED or are runaway youths seeking care. One can imagine minors presenting without a guardian from mass casualties or disasters, or any other number of scenarios. This raises the question of how medical evaluation and treatment should be delivered to a minor patient in the ED. What are the legal implications of managing these patients? Who can provide legal consent? Can minors refuse care? What is the role of confidentiality when adolescents seek care?

The American College of Emergency Physicians (ACEP) updated its policy on this concern, as legal and technological implications have evolved. A crucial driver of emergency care delivery is the Emergency Medical Treatment and Labor Act (EMTALA), mandating that any hospital receiving federal funding must offer a medical screening examination to anyone seeking evaluation, and must stabilize any emergency medical condition identified, specifically including minors. Hospitals should not delay evaluation and emergency treatment based on consent issues with the assumption that if there was a guardian present, he or she would consent to treatment if in the best interest of the child.

Study: Opioids don’t work well for chronic pain and are overused

From NBC:

Opioids are not only overused and killing Americans in record numbers; they don’t even work that well for many types of pain, researchers found in a new study released Tuesday.

Other drugs and treatments such as physical therapy or ice may work better for non-cancer pain, the researchers found. Yet when opioids fail to control pain, doctors often simply raise the dosage. This can help lead to a cycle of dependence and addiction.