Find research datasets worth reusing

opencc-zeroDec 2017View details →

Data from: Implementation of electronic charting is not associated with significant change in physician productivity in an academic emergency department

Objectives: To compare physician productivity and billing before and after implementation of electronic charting in an academic ED. Materials and Methods: This retrospective, blinded, observational study compared the 6 months pre-implementation (January to June 2012) with the 6 months post-implementation one year later (January to June 2013). Thirty-one ED physicians were recruited, with each physician acting as his/her own control in a before-after design. Productivity was measured via total number of encounters and "productivity index" defined as worked relative value units divided by the clinical full-time equivalent. Values for charges, encounters and productivity index were determined during each study period and separately for procedures, observational stays, and critical care. Results: No differences were found for total productivity index per month (758 [628,876] pre-group vs. 756 [673,886] post-group; p=NS). There was, however, a 9% decrease in total encounters per month (136 [101,163] pre-group vs. 126 [99,159] post-group; p=0.02). Significant decreases were seen across all observation stay categories. Conversely, significant increases were seen across all critical care categories. There was no difference in total charges per month. Discussion: This is one of few studies to demonstrate minimal disruption in physician productivity after transitioning to electronic documentation. The reasons for these findings are likely multifactorial. Conclusion: In this study, implementation of electronic charting was not associated with decreases in productivity or billing for total ED care, but may be associated with increases for critical care and decreases for observational stays.

opencc-zeroDec 2018View details →

Data from: Is high-sensitivity troponin, alone or in combination with copeptin, sensitive enough for ruling out NSTEMI in very early presenters at admission? A post-hoc analysis performed in emergency departments

Objectives: Copeptin and high-sensitivity cardiac troponin (HS-cTn) assays improve the early detection of NSTEMI. Their sensitivities may however be reduced in very early presenters. Setting: We performed a post-hoc analysis of three prospective studies that included patients who presented to the Emergency Department for chest pain onset (CPO) of less than 6 hours. Participants: 449 patients were included, in whom 12% had NSTEMI. CPO occurred <2h from ED presentation in 160, between 2-4h in 143, and >4h in 146 patients. The prevalence of NSTEMI was similar in all groups (9%, 13% and 12%, respectively, p=0.281). Measures: Diagnostic performances of HS-cTn and copeptin at presentation were examined according to CPO. The discharge diagnosis was adjudicated by 2 experts, including cTnI. HS-cTn and copeptin were blindly measured. Results: Diagnostic accuracies of cTnI, cTnI+copeptin and HS-cTnT (but not HS-cTnT+copeptin) lower through CPO categories. For patients with CPO<2h, the choice of a threshold value of 14 ng/L for HS-cTnT resulted in 3 false negative (Sensitivity 80% [95%CI: 51-95]; specificity 85% [78-90]; 79% of correctly ruled-out patients) and that of 5 ng/L in 2 false negative ( Sensitivity 87% [59-98]; specificity 58% [50-66]; 52% of correctly ruled-out patients). The addition of copeptin to HS-cTnT induced a decrease of misclassified patients to 1 in patients with CPO<2h (Sensitivity 93% [66-100]; specificity 41% [33-50]). Conclusion: A single measurement of HS-cTn, alone or in combination with copeptin at admission, seems not safe enough for ruling out NSTEMI in very early presenters (with CPO<2h). Trial registrations: French Health Ministry (no. DC-2009-1052), French Local Ethic comity « Comité de Protection des Personnes Ile-de-France » III (Hôpital Cochin) et VI (CHU Pitié-Salpétrière).

opencc-zeroDec 2011View details →

Data from: A randomised trial comparing the clinical effectiveness of different emergency department healthcare professionals in soft tissue injury management

OBJECTIVE: To evaluate the clinical effectiveness of soft tissue injury management by emergency nurse practitioners (ENPs) and extended scope physiotherapists (ESPs) compared to the routine care provided by doctors in a UK emergency department (ED). DESIGN: Randomised, pragmatic trial of equivalence. SETTING: One adult ED in England. PARTICIPANTS: 372 patients were randomised; 126 to the ESP group, 123 to the ENP group and 123 to the doctor group. Participants were adults (older than 16 years) presenting to the ED with a peripheral soft tissue injury eligible for management by any of the three professional groups. Patients were excluded if they had any of the following: injury greater than 72 hours old; systemic disease; dislocated joints; recent surgery; unable to give informed consent (eg, dementia), open wounds; major deformities; opiate analgesia required; concurrent chest/rib injury; neurovascular deficits and associated fracture. INTERVENTIONS: Patients were randomised to treatment by ESPs, ENPs or routine care provided by doctors (of all grades). MAIN OUTCOME MEASURES: Upper-limb and lower-limb functional scores, quality of life, physical well-being, preference-based health measures and the number of days off work. RESULTS: The clinical outcomes of soft tissue injury treated by ESPs and ENPs in the ED were equivalent to routine care provided by doctors. CONCLUSIONS: As all groups were clinically equivalent it is other factors such as cost, workforce sustainability, service provision and skill mix that become important. This result validates the role of the ENP, which is becoming established as an integral part of minor injuries care, and demonstrates that the ESP should be considered as part of the clinical skill mix without detriment to outcomes. ISRCTN-ISRCTN trials register number 70891354.

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National-Level Webinar on BLOCKCHAIN held on July 17, 2020 organised by Computer Engineering Department during National-Level Webinar Series on EMERGING AREAS OF TECHNOLOGY

National-Level Webinar on BLOCKCHAIN held on July 17, 2020 organised by Computer Engineering Department during National-Level Webinar Series on EMERGING AREAS OF TECHNOLOGY

opencc-by-4.0Nov 2024View details →

opencc-zeroJan 2022View details →

Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study

Objective: To analyze and compare the clinical outcomes between patients ≥80 years and patients 65-79 years, presented to our Emergency Department (ED) with the two most common Gastric Emergencies (GE) clinical presentation, i.e. gastric bleeding and gastric perforation. Design: Single-center retrospective cohort study. Participants: A total of 1011 patients were enrolled: 421 patients aged ≥80 years were compared to a group of 590 patients aged 65-79 years. Primary and secondary outcome measures: The primary outcome was to compare the overall mortality. Secondary outcomes included major complications, in-hospital length of stay (LOS), and need for surgical procedures. Results: Patients ≥80 years with GE had different presentation at Emergency Department compared to younger patients: they had higher gastrointestinal bleeding (24.9% vs. 16.3%; p = 0.001), anemization (14.5% vs. 8.8%; p= 0.005), and shock (10.9% vs. 5.1%; p = 0.001) rates. Median LOS, cumulative major complications and mortality rates were similar among the two groups. Multivariate analysis identified shock, gastric malignancy, and gastric fistula as independent predictors for survival. Conclusions: Patients ≥80 years with GE did not have a higher mortality rate and cumulative major complications as compared to younger elderly patients. Invasive treatments were not associated to a different prognosis in this age group.

opencc-zeroDec 2013View details →

Data from: Analysis and prediction of effects of the Manchester Triage System on patient waiting times in an emergency department by means of agent-based simulation

A simulation of complex clinical processes is a challenging task and suitable methods need to be found which can capture the influence of relevant factors and their relationships. The Manchester triage system (MTS) is widely used in German emergency departments (ED), however the impact on patient waiting times remain difficult to predict. The purpose of this work is the assessment of MTS particularly with regard to the waiting times of different degrees of severity. The methodology of agent based simulation was found suitable for the ED domain and the agent based simulation tool SeSAm was chosen due to its intuitive user interface and easy adaption of the simulation models. Altogether four agent classes could be implemented based on the information derived from a process model. The model permits a dynamic simulation of the ED processes and a reliable assessment of patient waiting times. In addition, the implementation of a triage nurse allowed the simulation of the triage process and a direct comparison to the current state without a standardized triage procedure. Essential influencing factors (e.g. number of patients, manning level) were implemented and their effects on the ED processes and patient waiting times assessed. The simulation runs delivered correct results based on the underlying process model and the collected statistical data. The process flow and the waiting times of an ED could be mapped exactly. In all simulation runs the waiting times of high triage levels (MTS-levels 1 and 2) could be reduced. Especially patients of MTS-level 2 in the waiting area of the ED benefit significantly from the implementation of a standardized triage procedure and the associated permanent monitoring.

opencc-zeroOct 2021View details →

Machine learning techniques for mortality prediction in emergency departments: a systematic review

This systematic review aimed to assess the performance and clinical feasibility of ML algorithms in prediction of in-hospital mortality for medical patients using vital signs at emergency departments. Design: A systematic review was performed. Setting: The databases including Medline (PubMed), Scopus, and Embase (Ovid) were searched between 2010 and 2021, to extract published articles in English, describing ML-based models utilizing vital signs variables to predict in-hospital mortality for patients admitted at emergency departments. CHARMS checklist was used for study planning and data extraction. The risk of bias for included papers was assessed using the PROBAST tool. Participants: Admitted patients to the ED Main outcome measure: In-hospital mortality. Results: Fifteen articles were included in the final review. We found that eight models including logistic regression, decision tree, K-nearest neighbors, support vector machine, gradient boosting, random forest, artificial neural networks, and deep neural networks have been applied in this domain. Most studies failed to report essential main analysis steps such as data preprocessing and handling missing values. Fourteen included studies had a high risk of bias in the statistical analysis part, which could lead to poor performance in practice. Although the main aim of all studies was developing a predictive model for mortality, nine articles did not provide a time horizon for the prediction. Conclusion: This review provided an updated overview of the state-of-the-art and revealed research gaps; based on these, we provide eight recommendations for future studies to make the use of ML more feasible in practice. By following these recommendations, we expect to see more robust ML models applied in the future to help clinicians identify patient deterioration earlier.

Routine Application of Point-of-care PCR Test to Identify and Direct Therapy for Acute Respiratory Infection in the Emergency Department Trial

ClinicalTrials.gov study NCT06780566. IPD Sharing: UNDECIDED. Countries: 1. Publications: 0.

Predictive Model for Multidrug Resistance in Patients Admitted to the Emergency Department With Sepsis

ClinicalTrials.gov study NCT07167173. IPD Sharing: NO. Countries: 0. Publications: 83.

Efficacy of Haloperidol vs. Metoclopramide for Treatment of Acute Headaches and Migraines in the Emergency Department

ClinicalTrials.gov study NCT02972502. IPD Sharing: NO. Countries: 1. Publications: 0.

Blood Pressure in the Emergency Department

ClinicalTrials.gov study NCT03954119. IPD Sharing: UNDECIDED. Countries: 0. Publications: 1.

The Effect of Distraction Techniques Used in Intramuscular (IM) Injections on Pain in Adolescents Presenting to the Emergency Department With Dysmenorrhea: A Randomized Controlled Study

ClinicalTrials.gov study NCT06842329. IPD Sharing: NO. Countries: 1. Publications: 0.

Loading Vancomycin Doses in the Emergency Department

ClinicalTrials.gov study NCT01162733. IPD Sharing: Not stated. Countries: 1. Publications: 0.

Utility of Non-invasive Carboxyhemoglobin and Total Hemoglobin Measurement in the Emergency Department

ClinicalTrials.gov study NCT03017742. IPD Sharing: NO. Countries: 1. Publications: 0.

Emergency Department (ED) Drug Interaction in Emergency Department Patients

ClinicalTrials.gov study NCT01859715. IPD Sharing: Not stated. Countries: 1. Publications: 0.

controlledIPD-YESFeb 2026View details →

Examining the Effectiveness and Implementation of the Emergency Department Patient-Activated Transition to Care At Home Tool

ClinicalTrials.gov study NCT06668636. IPD Sharing: YES. Countries: 1. Publications: 0.

Heart Risk 6 Scale in Emergency Department Acute Heart Failure Patients

ClinicalTrials.gov study NCT06664073. IPD Sharing: UNDECIDED. Countries: 0. Publications: 3.