Health Belief Model intervention to increase compliance with emergency department patients

From APA Psycnet:

The effects on compliance of clinical and telephone intervention, based on the health belief model (HBM [e.g., I. M. Rosenstock, 1974]), were investigated for 842 emergency department (ED) hospital patients. Compliance was defined operationally as follow-through on a recommended referral originating in the ED. Ss were randomly assigned to 1 of 4 intervention groups, with all nursing care, interventions, and follow-up telephone calls being done by the research nurse. The HBM clinical, telephone, and combination clinical/telephone interventions were strongly associated with increased compliance in the 11 presenting problems. Availability of child care, knowledge of presenting problem, nature and duration of the illness, and demographic variables were also related to compliance. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Teva’s generic EpiPen launch stalls months after approval

From Reuters:

“The generic version of EpiPen Auto-Injector is currently available and we are continuing to build supply,” Teva said in an emailed statement. “We are actively manufacturing and shipping product throughout the country.”

The company did not say why its drug was in short supply.

Israel-based Teva, the world’s largest generic drugmaker, received U.S. approval for its version of EpiPen in August after several years of delay. At the time, the company pledged its “full resources to this important launch in the coming months.”

Medical students teach high schoolers to do CPR

From Reuters:

Medical students in Boston are teaching local high school students about CPR, and the younger students say they feel better prepared to help in cases of cardiac arrest, should the need arise.

The PumpStart program was started by students from the Boston University School of Medicine (BUSM) as a volunteer effort for doctors in training to visit nearby high schools and spread awareness about CPR.

ER doctors agree it’s time to tackle surprise emergency room bills

From Vox:

As these surprise bills have gotten more media attention, both Sens. Maggie Hassan (D-NH)and Bill Cassidy (R-LA) have released bills to end surprise charges like that one. Now, the American College of Emergency Physicians — which represents emergency room doctors — is releasing its own six-point plan on how to tackle the issue.


As small hospitals ally with big ones, do patients benefit?

From the Washington Post (hat tip: Deb):

To expand their reach, flagship hospitals including Mayo, the Cleveland Clinic and Houston’s MD Anderson Cancer Center have signed affiliation agreements with smaller hospitals around the country. These agreements, which can involve different levels of clinical integration, typically grant community hospitals access to experts and specialized services at the larger hospitals while allowing them to remain independently owned and operated. For community hospitals, a primary goal of the brand name affiliation is stemming the loss of patients to local competitors.

In return, large hospitals receive new sources of patients for clinical trials and for the highly specialized services that distinguish these “destination medicine” sites. Affiliations also boost their name recognition — all without having to establish a physical presence.

The surgeon who removed his own appendix

From Boing Boing:


On April 29, 1961, Dr. Leonid Rogozov was in Antarctica in a blizzard when his stomach began to hurt. Badly. The only physician on the Soviet Antarctic Expedition, Rogozov realized his appendix needed to come out before it burst and killed him. Rogozov’s only choice was to take the matter into his hands. He roped in a meteorologist and a driver to assist

Arizona Man Who Learned CPR From ‘The Office’ Saves Woman’s Life

From Rolling Stone:

After smashing the car window with a rock to gain access to the woman, and with no cellphone on hand, Scott attempted to resuscitate on the woman. “I’ve never prepared myself for CPR in my life,” Scott said. “I had no idea what I was doing.”

Thankfully, Scott had seen the episode of The Office that dealt with CPR training and knew to perform chest compressions to the cadence of “Stayin’ Alive”; the Arizona Daily Star notes that Scott actually sang the Bee Gees track out loud while performing CPR.

Soon after, the woman drew a breath and threw up, at which point Scott rolled her onto her side. Paramedics arrived on the scene 10 minutes later and told Scott that, without his life-saving actions, the situation might have ended more direly. The woman was released from the hospital later that day. Tucson Fire Department wouldn’t release any additional details about the incident.

The E-Scooter Craze Is Sending Lots of People to the ER, Often With Head Injuries

From Gizmodo:

…researchers behind the current study, published Friday in JAMA Network Open, were all based at the University of California, Los Angeles, giving them a up-close look at the trend as it took off.

They decided to examine medical records from the emergency departments of two hospitals affiliated with UCLA, including one in Santa Monica. They singled out cases that took place between September 1, 2017 to August 31, 2018, using search terms such as “scooter,” “Bird,” and “Lime,” to find them.

All told, there were 249 people who visited these emergency rooms with injuries associated with e-scooters within that year. The vast majority, 91 percent, had gotten hurt while riding, usually by falling. And some got seriously hurt.

“Although only six percent of patients were admitted to the hospital, nearly 1 in 3 patients arrived by ambulance. 80 percent had an imaging test (x-rays or CT-scans), and fractures and head injuries were common among ED patients,” lead author Tarak Trivedi, an emergency medicine physician at Ronald Reagan UCLA Medical Center, told Gizmodo via email.

Access to Federally Qualified Health Centers and Emergency Department Use Among Uninsured and Medicaid-insured Adults: California, 2005 to 2013

From SAEM:

Background: While improved access to safety net primary care providers, like federally qualified health centers (FQHCs), is often cited as a route to alleviate potentially preventable emergency department (ED) visits, no studies have longitudinally established the impact of improving access to FQHCs on ED use among Medicaidinsured and uninsured adults. We aimed to determine whether improved access to FQHCs was associated with lower ED use by uninsured and Medicaid-insured adults.

Methods: Using data from the Uniform Data System, U.S. Census Bureau, and California Office of Statewide Health Planning & Development, we conducted a longitudinal analysis of 58 California counties from 2005 to 2013. For each county-year observation, we employed three measures of FQHC access: geographic density of FQHCs (delivery sites per 100 square miles), FQHCs per county resident (delivery sites per 100,000 county
residents), and the proportion of Medicaid-insured or uninsured residents ages 19 to 64 years that utilized FQHCs. We then used a fixed-effects model to examine the impact of changes in the measures of FQHC access on ED visit rates by Medicaid-insured or uninsured adults in each county.

Results: Increasing geographic density of FQHCs was associated with a 26% to 35% decrease in ED use by uninsured but not Medicaid-insured patients. Increasing numbers of clinics per county resident and higher percentages of Medicaid-insured and uninsured adults seen at FQHCs were not associated with reduced rates of ED use among either uninsured or Medicaid-insured adults.

Conclusions: We were unable to detect a consistent association between our measures of FQHC access and ED use by Medicaid-insured and uninsured nonelderly California adults, underscoring the importance of investigating additional drivers to reduce ED use among these vulnerable patient populations.

Duration of Electrocardiographic Monitoring of Emergency Department Patients with Syncope

From Circulation:

Background: The optimal duration of cardiac rhythm monitoring following emergency department (ED) presentation for syncope is poorly described. We sought to describe the incidence and time to arrhythmia occurrence to inform decisions regarding duration of monitoring based on ED risk-stratification.

Methods: We conducted a prospective cohort study enrolled adult (≥ 16 years) patients presenting within 24-hours of syncope at 6 EDs. We collected baseline characteristics, time of syncope and ED arrival, and the Canadian Syncope Risk Score (CSRS) risk category. We followed subjects for 30-days and our adjudicated primary outcome was serious arrhythmic conditions (arrhythmias, interventions for arrhythmias and unexplained death). After excluding patients with an obvious serious condition on ED presentation and those with missing CSRS predictors, we used Kaplan-Meier analysis to describe the time to serious arrhythmic outcomes.

Results: 5,581 patients (mean age 53.4 years, 54.5% females, 11.6% hospitalized) were available for analysis, including 346 (6.2%) for whom the 30-day follow-up was incomplete and were censored at the last follow-up time. 417 (7.5%) patients suffered serious outcomes of which 207 (3.7%; 95% CI 3.3%, 4.2%) were arrhythmic (161 arrhythmias, 30 cardiac device implantations, 16 unexplained death). Overall, 4123 (73.9%) were classified as CSRS low-risk, 1062 (19.0%) medium and 396 (7.1%) high-risk. The CSRS accurately stratified subjects as low (0.4% risk for 30-day arrhythmic outcome), medium (8.7% risk) and high-risk (25.3% risk). One-half of arrhythmic outcomes were identified within 2-hours of ED arrival in low-risk and within 6-hours in medium and high-risk patients and the residual risk after these cut-points were 0.2% for low-risk, 5.0% medium and 18.1% high-risk patients. Overall, 91.7% of arrhythmic outcomes among medium and high-risk patients including all ventricular arrhythmias were identified within 15-days. None of the low-risk patients suffered ventricular arrhythmia or unexplained death while 0.9% medium-risk and 6.3% of high-risk patients suffered them (p<0.0001).

Conclusions: Serious underlying arrhythmia was often identified within the first 2-hours of ED arrival for CSRS low-risk patients, and within 6-hours for CSRS medium- and high-risk patients. Outpatient cardiac rhythm monitoring for 15-days for selected medium-risk patientsand all high-risk patients discharged from the hospital should also be considered.