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1
Goldstein, Erik. "The Politics of the State Visit." Hague Journal of Diplomacy 3, no. 2 (2008): 153–78. http://dx.doi.org/10.1163/187119108x323646.
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AbstractState visits are one of the oldest forms of diplomatic contact between the leaders of states. Redolent of the pomp of previous ages, the modern era has seen a vertical rise in the frequency of state visits. This article examines the mechanics of the state visit and considers their purpose in contemporary diplomacy, as well as some of their unintended consequences.
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Mehrotra, Ateev, Haiden A. Huskamp, Alok Nimgaonkar, Krisda H. Chaiyachati, Eric Bressman, and Barak Richman. "Receipt of Out-of-State Telemedicine Visits Among Medicare Beneficiaries During the COVID-19 Pandemic." JAMA Health Forum 3, no. 9 (September 16, 2022): e223013. http://dx.doi.org/10.1001/jamahealthforum.2022.3013.
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ImportanceEarly in the COVID-19 pandemic, states implemented temporary changes allowing physicians without a license in their state to provide care to their residents. There is an ongoing debate at both the federal and state levels on whether to change licensure rules permanently to facilitate out-of-state telemedicine use.ObjectiveTo describe out-of-state telemedicine use during the pandemic.Design, Setting, and ParticipantsThis cross-sectional study of telemedicine visits included all patients with traditional Medicare from January through June 2021.Main Outcomes and MeasuresTelemedicine visits from January through June 2021 where the patient’s home address and the physician’s practice address were in different states.ResultsIn describing which patients and specialties were using out-of-state telemedicine, we focused on the period between January to June 2021. We chose this period because it was after the turmoil of the early pandemic, when vaccines became widely available and the health care system had stabilized, but before many of the temporary licensing regulations began to lapse by mid-2021. In the first half of 2021, there were 8 392 092 patients with a telemedicine visit and, of these, 422 547 (5.0%) had 1 or more out-of-state telemedicine visits. Those who lived in a county close to a state border (within 15 miles) accounted for 57.2% of all out-of-state telemedicine visits. Among the out-of-state visits in this time period, 64.3% were with a primary care or mental health clinician. For 62.6% of all out-of-state visits, a prior in-person visit occurred between the same patient and clinician between March 2019 and the visit. The demographics and conditions treated were similar for within-state and out-of-state telemedicine visits, with several notable exceptions. Among those with a telemedicine visit, people in rural communities were more likely to receive out-of-state telemedicine care (33.8% vs 21.0%), and there was high of out-of-state telemedicine use for cancer care (9.8% of all telemedicine visits for cancer care).Conclusions and RelevanceThe findings of this cross-sectional study suggest that licensure restrictions of out-of-state telemedicine would have had the largest effect on patients who lived near a state border, those in rural locales, and those who received primary care or mental health treatment.
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Nitsch, Volker. "State Visits and International Trade." World Economy 30, no. 12 (December 2007): 1797–816. http://dx.doi.org/10.1111/j.1467-9701.2007.01062.x.
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Brousseau, David, Julie A. Panepinto, Pamela Owens, and Claudia Steiner. "Acute Care Visits in Sickle Cell Disease: a Population-Based Multi- State Study." Blood 112, no. 11 (November 16, 2008): 165. http://dx.doi.org/10.1182/blood.v112.11.165.165.
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Abstract Background: The number of times a patient will seek acute care in the emergency department or require hospitalization for sickle cell related illness has not been described in a population-based manner. Twenty years ago, rates of acute care visits for 3,578 patients who were part of the Cooperative Study of Sickle Cell Disease were reported, eloquently describing patterns of acute care utilization for people followed at select centers. In that study, only 1% of patients had more than six visits per year and 5% of the population (who made three to 10 visits per year) accounted for almost one-third of all visits. The objective of this study is to describe the emergency department and hospital utilization for patients with sickle cell related conditions over a two- year period. This study will be the first to provide a complete assessment of the utilization patterns of patients with sickle cell disease, one that is multi-state, inclusive of all ages, all insurance types, and includes patients that are followed at community, academic and tertiary care centers. Methods: We conducted a retrospective cohort study using 2005 and 2006 State Emergency Department and State Inpatient Databases that include encrypted personlevel identifiers to allow linkage of record level information. The data are from the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. Data for all sickle cell related emergency department visits and hospitalizations within the following seven states (Arizona, California, Florida, Missouri, South Carolina, Tennessee, and New York) were extracted for each patient. To be eligible, a patient had at least one sickle cell specific visit, defined as a visit with a principal diagnosis of sickle cell crisis or a secondary diagnosis of sickle cell disease with a principal diagnosis that was sickle cell related (e.g. pneumonia, stroke, fever). All sickle cell related visits were linked by unique personal identifiers, thus clustering visits by patient and allowing population-based statewide assessments of utilization. An emergency department visit on the same day as an inpatient hospitalization was counted only as an inpatient hospitalization to avoid over counting care-seeking visits. The distribution of acute care visits for each patient (presented as numbers of emergency department visits and hospitalizations over the two-year period) was determined for the entire cohort, then stratified as child versus adult. Results: A total of 24,668 patients with sickle cell disease made 86,535 acute care visits during the two-year study period, 33,520 (38.7%) were emergency department visits and 53,015 (61.3%) were inpatient visits. Of the 24,668 patients, 8,895 (36.1%) were less than 18 years of age; 15,773 were adults. 52.8% of the entire cohort made one visit in the two year period. 1,320 (5.4%) patients had more than 12 visits over the two-year time period; 3,210 (13.0%) made 6–20 visits over two years, and accounted for 31,752 (36.7%) acute care visits. An additional 579 (2.4%) patients had more than 20 visits over two years, accumulating 18,701 (21.6%) acute care visits. Children were less likely to have more than 12 visits over the two years (1.9%) compared to adults aged 18–45 (8.1%) and were also less likely to be in the high utilization group of 6–20 visits over two years (9.9% of children compared to 15.8% of those 18–45 years old). Conclusions: A significant proportion of patients with sickle cell disease seek acute care multiple times in an emergency department setting or through hospitalization. Our population-based study demonstrates an increased proportion of high utilizers compared to previous work, especially among adult patients. Our findings likely reflect the difference in healthcare utilization in the broader community as compared to that within a cooperative study in academic settings. It suggests that some patients, adults in particular, may have limited access to urgent care in a primary care setting and would benefit from better access and more aggressive preventive care. Further work on patterns of and reasons for utilization, especially emergency department care, in this high-utilizer group, would be helpful in targeting and improving overall care for these patients.
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Derix, Simone. "Facing an “Emotional Crunch”: State Visits as Political Performances During the Cold War." German Politics and Society 25, no. 2 (June 1, 2007): 117–39. http://dx.doi.org/10.3167/gps.2007.250208.
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This article argues that state visits are highly symbolic political performances by analyzing state visits to Berlin in the 1950s and 1960s. The article concentrates on how state visits blended in the Cold War's culture of suspicion and political avowal. Special emphasis is placed on the role of mass media and on the guests' reactions and behavior. State visits to Berlin illuminate the heavy performative and emotional burden placed on all participants. Being aware of the possibilities for self-presentation offered by state visits, West German officials incorporated state visitors into their symbolic battle for reunification. A visit to Berlin with extensive media coverage was, therefore, of prime importance for the German hosts. Despite their sophisticated visualization strategies, total control of events was impossible. Some visitors did not want to play their allotted role and avoided certain sites in Berlin, refused to be accompanied by journalists or cancelled their trips altogether.
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Panizo Alonso, Julio Manuel. "Las visitas de Estado en el mundo (II) // State visits around the world (II)." REVISTA ESTUDIOS INSTITUCIONALES 3, no. 4 (May 25, 2016): 25. http://dx.doi.org/10.5944/eeii.vol.3.n.4.2016.18377.
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Las Visitas de Estado son una importante herramienta de desarrollo de la diplomacia. Por este motivo el ceremonial y el protocolo se ponen al servicio de la diplomacia para planificar al detalle todos y cada uno de los actos que transcurren a lo largo de estas visitas. Aunque hay grandes elementos en común en el desarrollo de este tipo de visitas, las peculiaridades locales hacen que tengan ese carácter particular que identifica los territorios, su cultura y sus costumbres. Este artículo es la segunda parteState visits are an important tool for diplomacy development. For that reason, ceremonial and protocol serve to diplomacy to plan in detail each and every act that take place throughout these visits. Although there are significant common elements in the development of this kind of visits, local peculiarities give them that specific character that identifies territories, their culture and customs. Second part.
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Christensen, Eric W., Chi-Mei Liu, Richard Duszak, Joshua A. Hirsch, Timothy L. Swan, and Elizabeth Y. Rula. "Association of State Share of Nonphysician Practitioners With Diagnostic Imaging Ordering Among Emergency Department Visits for Medicare Beneficiaries." JAMA Network Open 5, no. 11 (November 10, 2022): e2241297. http://dx.doi.org/10.1001/jamanetworkopen.2022.41297.
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ImportanceThe use of nonphysician practitioners (NPPs) in the emergency department (ED) continues to expand, yet little is known about associations between NPPs and ED imaging use.ObjectiveTo investigate whether the state share of ED visits for which an NPP was the clinician of record is associated with imaging studies ordered, given that state NPP share is associated with state-level NPP scopes of practice.Design, Setting, and ParticipantsThis cross-sectional study compared diagnostic imaging ordering patterns associated with ED visits based on 2005-2020 Medicare claims for a nationally representative 5% sample of fee-for-service beneficiaries. For all 50 states and the District of Columbia, the state NPP share of ED visits by year was used to represent state-specific practice patterns for NPPs and physicians and how those patterns have evolved over time. The analysis controlled for patient demographic characteristics, Charlson Comorbidity Index scores, ED visit severity, year, and principal diagnosis.ExposuresThe share of ED visits in each state in each year (state share) for which an NPP was the evaluation and management clinician.Main Outcomes and MeasuresThe main outcomes were the number and modality of imaging studies associated with ED visits. Analyses were by logistic regression and generalized linear model with γ-distribution and log-link function.ResultsAmong 16 922 274 ED visits, 60.0% involved women, and patients’ mean (SD) age was 70.3 (16.1) years. The share of all ED visits with an NPP as the clinician increased from 6.1% in 2005 to 16.6% in 2020. Compared with no NPPs, the presence of NPPs in the ED was associated with 5.3% (95% CI, 5.1%-5.5%) more imaging studies per ED visit, including a 3.4% (95% CI, 3.2%-3.5%) greater likelihood of any imaging order per ED visit and 2.2% (95% CI, 2.0%-2.3%) more imaging studies ordered per visit involving imaging.Conclusions and RelevanceIn this study, use of NPPs in the ED was associated with higher imaging use compared with the use of only physicians in the ED. Although expanded use of NPPs in the ED may improve patient access, the costs and radiation exposure associated with more imaging warrants additional study.
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Davis, Wendy. "SA Chapter visits new State Library." ANZTLA EJournal, no. 51 (April 30, 2019): 36. http://dx.doi.org/10.31046/anztla.v0i51.1234.
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Adekoya, Nelson. "Medicaid/State Children's Health Insurance Program Patients and Infectious Diseases Treated in Emergency Departments: U.S., 2003." Public Health Reports 122, no. 4 (July 2007): 513–20. http://dx.doi.org/10.1177/003335490712200413.
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Objective. Emergency departments (EDs) are a critical source of medical care in the U.S. Information is sparse concerning infectious disease visits among Medicaid entitlement enrollees nationwide. The objective of this study was to describe infectious diseases in terms of Medicaid/State Children's Health Insurance Program (SCHIP) as an expected source of payment. Methods. Data for 2003 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of nonfederal, short-stay, and general hospitals in the U.S. Data are collected annually and are weighted to generate national estimates. Results. Nationally in 2003, an estimated 21.6 million visits were made to hospital EDs for infectious diseases (rate = 76 visits/1,000 people). Medicaid/SCHIP was the expected source of payment for an estimated 6.7 million infectious disease-related visits (rate = 200 visits/1,000 people covered by Medicaid). Children aged <15 years made 39% of visits nationwide (nationwide rate = 139 visits/1,000 people). Of Medicaid visits, 63% were made by children <15 years of age (Medicaid enrollees rate = 255 visits/1,000 people). The rate of visits for Medicaid enrollees was comparable for females and males (198 visits vs. 201/1,000 people). The rate of visits for black Medicaid enrollees was 33% higher than for white Medicaid enrollees (255 vs. 192 visits/1,000 people). Upper respiratory tract infection (URTI) is the most frequent infectious condition recorded at ED visits. An estimated 47% of ED visits with an expected pay source of Medicaid relate to URTIs (93 visits/1,000 people), compared with 38% of ED visits in general (29 visits/1,000 people). Conclusion. Medicaid enrollee-specific ED visit rates for infectious diseases were higher by age group, gender, race, and region, compared with national rates. Because approximately half of visits relate to URTIs for a Medicaid payment group, URTIs should form the basis for development of appropriate control strategies.
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Fesler, Mark J., Crystal Weaver, Kimberly McCormick, and Andrew Dwiggins. "A Single Center Survey of Distress Amongst Stem Cell Transplant Recipients." Blood 124, no. 21 (December 6, 2014): 6006. http://dx.doi.org/10.1182/blood.v124.21.6006.6006.
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Abstract Introduction: According to the Commission on Cancer's 2012 program standards, patients diagnosed with cancer may experience psychological issues that can interfere with patient treatment plans and adversely affect outcomes. To address these issues, the Commission developed the following guidelines to accurately determine patient distress levels: 1) patients with cancer are offered screening for distress at least 1 time during a pivotal medical visit, 2) the mode of administration for the distress screening is to be determined by the program, and 3) facilities select the tool to be administered to screen for distress with preference being given to standardized, validated instruments. To meet this standard and plan future work in distress reduction for stem cell transplant recipients, the St. Louis University Blood and Marrow Transplant Program began implementing The State Trait Anxiety Inventory (STAI) with patients during pivotal medical visits. The STAI is a psychological inventory based on a 4-point Likert scale and consists of 40 questions on a self-report basis. The STAI differentiates between the temporary condition of "state anxiety" and the long-standing quality of "trait anxiety." The essential qualities evaluated by the STAI scale are feelings of apprehension, tension, nervousness, stress, and worry. Scores on the STAI scale increase in response to physical danger and psychological stress and decrease as a result of relaxation training. Average scores for working, male adults are 35.72 (state) and 34.89 (trait). Average scores for working, female adults are 35.20 (state) and 34.79 (trait). After implementing the STAI, it was realized that these screenings could be de-identified and analyzed in groups to determine if patterns emerged regarding patients' perceived anxiety levels throughout the bone marrow transplantation process. Method: The study team received Institutional Review Board approval to perform a retrospective examination of STAIs completed by patients throughout the bone marrow transplantation process at the St. Louis University Blood and Marrow Transplant Program from 03/11/2104 through 06/24/2014. A total of 30 inventories were collected, de-identified, and categorized by the following medical visits: arrival visit (the patient's first visit to the Blood and Marrow Transplant clinic), data review visit (the visit to review transplant related testing and sign consents), start of preparative regimen visit, day 0 visit, day +30 bone marrow biopsy visit for allogenic transplantation, day +30 bone marrow biopsy result visit for allogenic transplantation, and day +100 visit for auto transplantation. Averages for each medical visit category were determined by finding the mean score. Category averages were then compared to determine if a particular pivotal medical visit caused patients to experience an overall increase in anxiety level. Results: Results from the study indicate that patients experience the highest levels of anxiety during the early medical visits of the bone marrow transplantation process. Average state anxiety scores were 46 during the arrival visits, 41 during the data review visits, and 44 during the start of preparative regimen visits. Average trait anxiety scores were 38 during the arrival visits, 45 during the data review visits, and 39 during the start of preparative regimen visits. During the day 0 visits, patients' state anxiety scores decreased to an average of 36 and trait anxiety scores decreased to an average of 35. Day +30 and day +100 visits demonstrated even further decreases in state and trait anxiety scores. Conclusion: The surprising finding of this study was that patients demonstrated a higher level of distress in the period leading up to the transplant which gradually decreased once the preparative regimen was administered. The sample size for this study was small and could possibly skew results. However, this study does provide a starting basis for future study in bone marrow transplant recipient distress, and larger, multi-site studies are being planned to ensure the accuracy of the patterns, which emerged from this study. If patterns could be accurately identified and predicted, the study team may also be able to develop future studies to primitively lower patients' anxiety levels early in the bone marrow transplantation process and thus improve outcomes. Abstract 6006 Figure 1 Abstract 6006 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Ramsey, Scott David, Laura Elizabeth Panattoni, Li Li, Qin Sun, Catherine R. Fedorenko, Hayley Sanchez, Karma L. Kreizenbeck, and Veena Shankaran. "Disparity in telehealth and emergency department use among Medicaid and commercially insured patients receiving systemic therapy for cancer in Washington State following the COVID-19 Pandemic." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6546. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6546.
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6546 Background: Washington was the first US state to experience the COVID-19 pandemic. Transmission risks and patient fears of visiting oncology practices during its onset resulted in rapid adoption of telehealth services. We hypothesized that the pandemic would widen disparities in oncology practice visits between Medicaid and commercially insured patients, resulting higher rates of emergency department (ED) visits during initial treatment. Methods: Linking Washington State SEER records with Medicaid and commercial insurance enrollment and claims records, we compared adults age <65 with new solid tumor malignancies who received systemic treatment at academic and community oncology practices. Persons starting therapy March – June 2020 (COVID) were compared with those starting therapy March-June 2017-2019 (Pre-COVID). Poisson regressions were used to evaluate differences in oncology practice office visits and telehealth visits. Logistic regressions were used to evaluate the likelihood of at least one ED admission among patients starting systemic therapy pre- and post-COVID. Results: Among patients who met inclusion criteria (652 Commercial, 349 Medicaid), Medicaid enrollees had more advanced disease and more comorbidity versus commercial enrollees. In unadjusted analysis of E&M and telehealth service visit codes, office-based visits fell for both insurance groups (Table) while telehealth service visits (negligible pre-COVID) were higher for commercial versus Medicaid enrollees post-COVID. The proportion of persons with ≥ 1 ED visit during therapy fell for both insurance groups. In Poisson models, Medicaid enrollees had significantly fewer total visits (P=0.001) and fewer telehealth visits (p<0.001) compared commercial enrollees during the COVID period. In the logit models, ED visits trended lower for both groups after COVID (OR 0.53 95% CI 0.279 to 1.008). Among Medicaid enrollees, persons ages 40-49 and breast cancer patients were more likely to visit the ED. Among the commercially insured, persons with 2 or more comorbidities were more likely to visit the ED. The pre-post COVID change in likelihood of an ED visit was not significantly different between insurance groups (p=0.355). Conclusions: In Washington State, the COVID-19 pandemic created a substantial disparity in access to office-based and telehealth care for low-income patients receiving systemic therapy for new cancers. Reduced oncology practice visits among Medicaid patients did not widen existing disparities in utilization of emergency care.[Table: see text]
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Brousseau, David C., Claudia A. Steiner, Pamela Owens, Andrew Mosso, and Julie A. Panepinto. "Emergency Department Treat-and-Release Visits for Sickle Cell Disease: A sIgn of acute events to come." Blood 118, no. 21 (November 18, 2011): 169. http://dx.doi.org/10.1182/blood.v118.21.169.169.
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Abstract Abstract 169 Background: Patients with sickle cell disease have very high rates of rehospitalization, with rates as high as 40% for young adults. Many institutions have invested significant resources to utilize an inpatient hospitalization as a trigger to alter care and prevent further hospital utilization. While this focus on hospitalizations is important, there has been little attention given to return visits following treat-and-release emergency department (ED) visits. It has been shown that patients with sickle cell disease have high use of acute care resources, including the ED. Given that only half of ED visits by patients with sickle cell disease result in an inpatient stay, it may be possible to use an ED visit as a trigger for improved care rather than waiting for an inpatient hospitalization. We hypothesized that patients with sickle cell disease who were treated and released from the ED would have high rates of return for acute care utilization, both to the ED and the inpatient unit, within 14 days. We further hypothesized that young adults and those with public insurance would have the highest return for acute care utilization rates. Methods: We conducted a retrospective cohort study using 2005 and 2006 State Emergency Department Databases and State Inpatient Databases. The data are from the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. Data for all sickle cell-related ED visits and hospitalizations within the following eight states (AZ, CA, FL, MA, MO, SC, TN, and NY) were extracted for each patient. One-third of patients with sickle cell disease in the United States live within these states. All sickle cell related visits were linked via encrypted person-level identifiers to allow linkage of record level information, thus clustering visits by patient. Each treat-and-release ED visit served as an index visit; all subsequent ED treat-and-release visits and inpatient hospitalizations (whether through the ED or not) were tracked for periods of 7 and 14 days. ED treat-and-release visits within the seven days following a hospital discharge were excluded from being index visits. Results: A total of 12,109 patients with sickle cell disease made 39,775 ED treat-and-release visits during the two-year study period. Of the index ED treat-and-release visits, 4,162 (34.4%) children (ages 1–17 yrs) made 8,636 (21.7%) visits compared to 4,166 (34.4%) 18–30 year olds who made 17,070 (42.8%) ED treat-and-release visits. Overall, 16,731 (42.1%) of the ED treat-and-release visits had either an inpatient hospitalization or another ED treat-and-release visit within 14 days of the index ED visit; 39.7% of those return visits were inpatient hospitalizations meaning that 16.7% of ED treat-and-release visits are followed by an inpatient hospitalization within 14 days. Analyzing the 42.1% return visit rate by age and payer revealed that 49.0% of ED treat-and-release visits by 18 – 30 year old patients resulted in return visits compared to 24.7% of children and 38.6% of 46–64 year olds. 46.5% of ED treat-and-release visits by those with public insurance resulted in a return visit compared to 32.2% of visits by those with private insurance and 35.0% of those who were uninsured. As the timing of return visits might direct the intervention, we also evaluated 7 day return visits. Of the 16,731 return visits within 14 days, 12,561 (75.1%) occurred in the first 7 days; 41.1% of the 7 day return visits were inpatient hospitalizations meaning that 13% of ED treat-and-release visits were followed by an inpatient hospitalization within 7 days. Conclusions: A significant proportion of patients with sickle cell disease return for acute care following an ED treat-and-release visit, with young adults and those with public insurance having the highest rates of return visits. A high percentage of those return visits are hospitalizations. Given these findings, ED treat-and-release visits should serve as a trigger to focus enhanced outpatient comprehensive care on these patients in order to prevent a subsequent inpatient hospitalization and to ultimately improve care for patients with sickle cell disease. Disclosures: No relevant conflicts of interest to declare.
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Symum, Hasan, and José Zayas-Castro. "Impact of the COVID-19 Pandemic on the Pediatric Hospital Visits: Evidence from the State of Florida." Pediatric Reports 14, no. 1 (February 1, 2022): 58–70. http://dx.doi.org/10.3390/pediatric14010010.
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Although early evidence reported a substantial decline in pediatric hospital visits during COVID-19, it is unclear whether the decline varied across different counties, particularly in designated Medically Underserved Areas (MUA). The objective of this study is to explore the state-wide impact of COVID-19 on pediatric hospital visit patterns, including the economic burden and MUA communities. We conducted a retrospective observational study of pediatric hospital visits using the Florida State all-payer Emergency Department (ED) and Inpatient dataset during the pandemic (April–September 2020) and the same period in 2019. Pediatric Treat-and-Release ED and inpatient visit rates were compared by patient demographics, socioeconomic, diagnosis, MUA status, and hospital characteristics. Pediatric hospital visits in Florida decreased by 53.7% (62.3% in April–June, 44.2% in July–September) during the pandemic. The Treat-and-Release ED and inpatient visits varied up to 5- and 3-fold, respectively, across counties. However, changes in hospital visits across MUA counties were similar compared with non-MUA counties except for lower Treat-and-Release ED volume in April–May. The disproportional decrease in visits was notable for the underserved population, including Hispanic and African American children; Medicaid coverages; non-children’s hospitals; and diagnosed with respiratory diseases, appendicitis, and sickle-cell. Florida Hospitals experienced a USD 1.37 billion (average USD 8.3 million) decline in charges across the study period in 2020. Disproportionate decrease in hospital visits, particularly in the underserved population, suggest a combined effect of the persistent challenge of care access and changes in healthcare-seeking behavior during the pandemic. These findings suggest that providers and policymakers should emphasize alternative interventions/programs ensuring adequate care during the pandemic, particularly for high-risk children.
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Sokol, Rebeccah L., Alison L. Miller, and Joseph P. Ryan. "Well-Child Visits While in State Care." Pediatrics 146, no. 4 (September 4, 2020): e20201539. http://dx.doi.org/10.1542/peds.2020-1539.
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Curtis, Susanna A., Zipora Etzion, Neeraja Danda, Hillel W. Cohen, and Henny Heisler Billett. "Elevated Steady State WBC and Platelet Counts Are Associated with Frequent Emergency Room Use in Adults with Sickle Cell Disease." Blood 124, no. 21 (December 6, 2014): 4070. http://dx.doi.org/10.1182/blood.v124.21.4070.4070.
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Abstract Patients with sickle cell disease (SS/Sβ0) often utilize the emergency department (ED) for treatment of painful vaso-occlusive crisis and other sequalae of their disease. However there is significant variation in use, with a minority of patients making up the majority of visits. We studied whether objective steady state laboratory parameters might be associated with frequent ED use and whether hydroxyurea use modified this relationship. Methods: We identified all patients with sickle cell disesase seen at our medical center in 2012. Patients were identified as having sickle cell disease if hemoglobin (Hb) electrophoresis demonstrated sickle hemoglobin (HbS), fetal hemoglobin (HbF) and HbA2 but no Hemoglobin A, C, or other detectable hemoglobinopathies. ED, clinic, and inpatient admissions over the entire year were calculated and ED use was categorized as either 0-1, 2-5, or >6 visits a year. Steady state laboratory tests were defined as those not within a day of an ED visit or a week of a hospital admission. All 2012 steady state parameters retrieved for a given laboratory test for a given patient were averaged. “Active” laboratory tests, defined as those within one day of an ED visit, were averaged separately. HbF and weight were not separated by activity. Data were analyzed for normality; parametric values were assessed by mean and SD, non-parametric values were assessed as medians and interquartile ranges. Parametric and non-parametric bivariate tests of association were used as appropriate. Results: 432 adult sickle cell patients were identified, ages 18-87yrs; 54% were female. 181 patients had 0-1 ED visits within the year, 143 had 2-5 visits in the year and 96 had >6 visits for a total of 2259 visits. Patients who had >6 visits accounted for 1750 (77%) of the total visits for the year. When steady state labs were examined, high WBC and platelet counts were most strongly associated with frequent admissions. Steady state WBC of >12.0 x10^9/L were significantly more likely to have >6 visits/year (OR 2.6; 95% CI: 1.6-4.2, p=.0004). Platelet counts of >420 x10^9/L were also strongly associated with >6 ED visits (OR 2.6, 95% CI:1.5-4.4, p=.0007). LDH and AST were also shown to correlate significantly with ED (p=0.02 and 0.005 respectively) use while Hb and albumin were negatively associated (p<0.001 and 0.02 respectively). Hydroxyurea scripts were associated with increased ED visits (p<0.001); 38.1% of the population had been given a script for hydroxyurea within the year; patients with frequent ED use were 2.8x more likely to have been given a script for hydroxyurea within the year. These patients had higher MCV and Hb levels and lower, but still elevated, WBC and platelet counts per ED visit cohort stratification, a suggestion that hydroxyurea was being taken, but despite this, had similar significant associations with ED visits as the non-hydroxyurea group. MCV, MCHC, absolute reticulocyte count, weight, and %HbF did not demonstrate an association with ED visit frequency. When “active” parameters were examined, leukocytosis was present in all categories and WBC count could no longer predict a predisposed cohort; Hb level, LDH and AST were also no longer significant. Albumin and platelet count remained associated with ED visits. When older patients >40 yrs (n=124) were compared with <40yrs (n=308 ), high WBC and platelet counts remained significantly associated with high (>6) ED visits in both cohorts. Conclusions: Our data suggest that baseline WBC and platelet count are strongly associated with frequent ED utilization and may be better predictors than Hb, HbF, and other red cell or hemolytic parameters. Hydroxyurea use was not associated with fewer ED visits but those patients with frequent ED use still have relatively higher WBC and platelet counts than those with less frequent ED use, suggesting that hydroxyurea under-dosing may be an important issue. To what extent objective steady state parameters can identify a population that needs more aggressive baseline care and to what extent maximization of therapy can decrease frequent ED visits needs further study. Disclosures No relevant conflicts of interest to declare.
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Griffith, Jennifer, Laura C. Chambers, Benjamin D. Hallowell, Ashley Gaipo, Craig Mailloux, Janette Baird, Francesca L. Beaudoin, and Elizabeth A. Samuels. "Examination of the Accuracy of Existing Overdose Surveillance Systems." JAMA Network Open 6, no. 6 (June 28, 2023): e2320789. http://dx.doi.org/10.1001/jamanetworkopen.2023.20789.
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ImportanceHealth departments have used a variety of methods for overdose surveillance, and the Centers for Disease Control and Prevention (CDC) is implementing a standardized case definition to improve overdose surveillance nationally. The comparative accuracy of the CDC opioid overdose case definition vs existing state opioid overdose surveillance systems is unknown.ObjectiveTo evaluate the accuracy of the CDC opioid overdose case definition and existing Rhode Island Department of Health (RIDOH) state opioid overdose surveillance system.Design, Setting, and ParticipantsThis cross-sectional study of ED opioid overdose visits was conducted at 2 EDs in Providence, Rhode Island, at the state’s largest health system from January to May 2021. Electronic health records (EHRs) were reviewed for opioid overdoses identified by the CDC case definition and opioid overdoses reported to the RIDOH state surveillance system. Included patients were those at study EDs whose visit met the CDC case definition, was reported to the state surveillance system, or both. True overdose cases were confirmed by EHR review using a standard case definition; 61 of 460 EHRs (13.3%) were double reviewed to estimate classification accuracy. Data were analyzed from January through May 2021.Main Outcome and MeasureAccurate identification of an opioid overdose was assessed by estimating the positive predictive value of the CDC case definition and state surveillance system using results from the EHR review.ResultsAmong 460 ED visits that met the CDC opioid overdose case definition, were reported to the RIDOH opioid overdose surveillance system, or both (mean [SD] age, 39.7 [13.5] years; 313 males [68.0%]; 61 Black [13.3%], 308 White [67.0%], and 91 other race [19.8%]; and 97 Hispanic or Latinx [21.1%] among each patient visit), 359 visits (78.0%) were true opioid overdoses. For these visits, the CDC case definition and RIDOH surveillance system agreed that 169 visits (36.7%) were opioid overdoses. Of 318 visits meeting the CDC opioid overdose case definition, 289 visits (90.8%; 95% CI, 87.2%-93.8%) were true opioid overdoses. Of 311 visits reported to the RIDOH surveillance system, 235 visits (75.6%; 95% CI, 70.4%-80.2%) were true opioid overdoses.Conclusions and RelevanceThis cross-sectional study found that the CDC opioid overdose case definition more often identified true opioid overdoses compared with the Rhode Island overdose surveillance system. This finding suggests that using the CDC case definition for opioid overdose surveillance may be associated with improved data efficiency and uniformity.
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MAY, L., E. Y. KLEIN, E. M. MARTINEZ, N. MOJICA, and L. G. MILLER. "Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005–2011." Epidemiology and Infection 145, no. 4 (December 5, 2016): 746–54. http://dx.doi.org/10.1017/s0950268816002855.
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SUMMARYMore than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50% of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16·3% were associated with a recurrent ED visit. We found no trend in recurrent visits over time (χ2 trend = 0·68, P = 0·4). Race/ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/alcohol abuse or liver disease [odds ratio (OR) 1·4, 95% confidence interval (CI) 1·3–1·4], obesity (OR 1·3, 95% CI 1·2–1·4), and in infections that were drained (OR 1·1, 95% CI 1·1–1·1) and inversely associated with hospitalization after initial ED visit (OR 0·4, 95% CI 0·3–0·4). In conclusion, we found several patient-level factors associated with recurrent ED visits. Identification of these high-risk groups is critical for future ED-based interventions.
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Devine, Christopher J. "What if Hillary Clinton Had Gone to Wisconsin? Presidential Campaign Visits and Vote Choice in the 2016 Election." Forum 16, no. 2 (July 26, 2018): 211–34. http://dx.doi.org/10.1515/for-2018-0011.
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Abstract Hillary Clinton’s failure to visit the key battleground state of Wisconsin in 2016 has become a popular metaphor for the alleged strategic inadequacies of her presidential campaign. Critics who cite this fact, however, make two important assumptions: that campaign visits are effective, in general, and that they were effective for Clinton in 2016. I test these assumptions using an original database of presidential and vice presidential campaign visits in 2016. Specifically, I regress party vote share on each candidate’s number of campaign visits, at the county level, first for all counties located within battleground states, and then for counties located within each of six key battleground states: Florida, North Carolina, Ohio, Pennsylvania, Michigan, and Wisconsin. The results of this analysis do not clearly support either of the assumptions made by Clinton’s critics. In general, none of the presidential or vice presidential candidates – including Clinton – significantly influenced voting via campaign visits. However, Clinton is one of only two candidates – along with Mike Pence, in Ohio – whose campaign visits had a significant effect on voting in an individual state. Specifically, Clinton’s visits to Pennsylvania improved the Democratic ticket’s performance in that state by 1.2 percentage points. Also, there is weak evidence to suggest that Clinton might have had a similar effect on voting in Michigan. It is unclear from this evidence whether Clinton also would have gained votes, or even won, in Wisconsin had she campaigned in that state. But two conclusions are clear. First, Clinton’s visits to Democratic-leaning battleground states did not have the “backfiring” effect that her campaign reportedly feared. Second, Donald Trump did not win in Pennsylvania, Michigan, or Wisconsin as a direct result of his campaign visits to those decisive states.
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Coates, Ralph J., Alejandro Pérez, Atar Baer, Hong Zhou, Roseanne English, Michael Coletta, and Achintya Dey. "National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014." Disaster Medicine and Public Health Preparedness 10, no. 4 (February 17, 2016): 562–69. http://dx.doi.org/10.1017/dmp.2015.181.
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AbstractObjectiveWe examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP).MethodsWe used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting data with all ED visits in all 50 states and Washington, DC.ResultsApproximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented.ConclusionsNSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. (Disaster Med Public Health Preparedness. 2016;10:562–569)
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Shenkman, Elizabeth, Lise Youngblade, and John Nackashi. "Adolescents’ Preventive Care Experiences Before Entry Into the State Children’s Health Insurance Program (SCHIP)." Pediatrics 112, Supplement_E1 (December 1, 2003): e533-e541. http://dx.doi.org/10.1542/peds.112.se1.e533.
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Background. Adolescence has traditionally been thought of as a time of good health. However, adolescents comprise an important group with unique needs among State Children’s Health Insurance Program (SCHIP) enrollees. Throughout the 1990s, there was increasing evidence of unacceptably high morbidity and mortality among adolescents from injuries, suicide, sexually transmitted diseases, substance abuse, and other conditions associated with risk behaviors. The establishment of relationships with the health care system can ensure prompt treatment and help promote healthy behaviors, assuming that the adolescent feels comfortable seeking help for his or her health-related concerns. However, health care systems typically are not designed to ensure that adolescents receive the primary and preventive care that might ameliorate the negative consequences of health-damaging behaviors. Objectives. The purpose of this study was to examine the following hypotheses. 1) Adolescents with special health care needs, those engaging in risk behaviors, and those who were insured before program enrollment would be more likely than those who were healthy and those not engaging in risk behaviors to have a preventive care visit in the year preceding the interview. No differences would be observed in the odds of preventive care visits based on age, race/ethnicity, and gender. 2) No differences would be observed in the receipt of risk-behavior counseling for those with a preventive care visit based on the adolescents’ sociodemographic and health characteristics. 3) Adolescents who were older would be more likely to engage in risk behaviors than younger adolescents. There would be no differences in reports of risk behaviors based on gender, race/ethnicity, and children with special health care needs status. Methods. Adolescents 12 to 19 years old and newly enrolled in SCHIP were eligible for the study. Telephone interviews were conducted within 3 months after enrollment with parents of adolescents to obtain sociodemographic information and information about the adolescents’ health by using the Children with Special Health Care Needs screener. Interviews also were conducted with the adolescents themselves to obtain information about the adolescents’ risk behaviors and experiences with preventive care before SCHIP enrollment. Results. Interviews were completed with 1872 parents. In addition, a total of 918 interviews were completed with adolescents. Approximately 73% of adolescents reported engaging in at least one risk behavior. Approximately 69% reported having a primary care visit during the last year with 46% of those reporting that the visit was private. Of those reporting a primary care visit, between 41% and 53% reported receiving counseling along 1 of the 5 content dimensions of anticipatory guidance. Older adolescents were more likely to engage in risk behaviors than younger adolescents. Hispanic adolescents were ∼30% less likely than white non-Hispanic adolescents to report engaging in risk behaviors. In terms of having a preventive care visit, adolescents with a special need were twice as likely to have a visit when compared with their healthy counterparts. Hispanics and black non-Hispanics were half as likely to have a preventive care visit (odds ratios of 0.59 and 0.54, respectively) than white non-Hispanics. Those engaging in risk behaviors were almost 50% less likely to report private preventive care visits than those reporting no risk behaviors. Privacy during the preventive care visit was associated with a greater odds of receiving counseling for risk behaviors in general, sexual activity, and emotional health and relationships. Depending on the type of counseling, those with private preventive care visits were 2 to 3 times more likely to receive the counseling than those whose visits were not private. In addition, those engaging in risk behaviors were 1.45 to almost 2 times more likely to receive counseling than those not engaging in any risk behaviors. Conclusions and Implications. Based on our findings, health plans and providers involved in SCHIP are likely to serve adolescents who have had limited opportunities for private preventive care visits and counseling during such visits. The most underserved are likely to be black and Hispanic adolescents who may have had no preventive care at all compared with their white non-Hispanic counterparts. State agencies, health plans, and providers need to follow established guidelines for adolescent health care that emphasize the provision of counseling for risk behaviors for all adolescents, not just those engaging in risk behaviors or those with special health care needs. Moreover, providers need to seek opportunities to ensure privacy for the adolescents during their preventive care visits so that much-needed counseling can be provided. Particular attention needs to be given to adolescents from minority groups to encourage them to seek preventive care.
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Alhajeri, Salem S., Meznah S. Alazmi, and Anwar F. Alharshani. "The Degree of Educational Supervisors’ Commitment to the Ethics of Classroom Visits as Perceived by Kuwaiti Teachers." Journal of Educational and Psychological Studies [JEPS] 12, no. 1 (January 29, 2018): 96–112. http://dx.doi.org/10.53543/jeps.vol12iss1pp96-112.
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This study aimed to identify teachers' perceptions of the extent to which educational supervisors are committed to the ethics of classroom visits in public schools in the State of Kuwait. The study sample consisted of 682 teachers who were selected by random cluster sampling. To achieve the objectives of the study, the researchers used a questionnaire that comprised 42 items divided into three dimensions (before classroom visit, during classroom visits, and after classroom visits). The results of the study revealed that the degree of adherence to the ethics of classroom visits ranged from very high to high. There were statistically significant differences in the domain of before classroom visits due to gender, nationality and specialization However, there were no differences due to years in service.The study recommended a change from the culture of unannounced to announced classroom visits.
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Beaulieu, Eugene, Zeng Lian, and Shan Wan. "Presidential Marketing: Trade Promotion Effects of State Visits." Global Economic Review 49, no. 3 (July 2, 2020): 309–27. http://dx.doi.org/10.1080/1226508x.2020.1792329.
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Niemantsverdriet, M. S. A., T. T. Pieters, I. E. Hoefer, M. C. Verhaar, J. A. Joles, W. W. van Solinge, W. M. Tiel Groenestege, S. Haitjema, and M. B. Rookmaaker. "GFR estimation is complicated by a high incidence of non-steady-state serum creatinine concentrations at the emergency department." PLOS ONE 16, no. 12 (December 29, 2021): e0261977. http://dx.doi.org/10.1371/journal.pone.0261977.
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Background Acquiring a reliable estimate of glomerular filtration rate (eGFR) at the emergency department (ED) is important for clinical management and for dosing renally excreted drugs. However, renal function formulas such as CKD-EPI can give biased results when serum creatinine (SCr) is not in steady-state because the assumption that urinary creatinine excretion is constant is then invalid. We assessed the extent of this by analysing variability in SCr in patients who visited the ED of a tertiary care centre. Methods Data from ED visits at the University Medical Centre Utrecht, the Netherlands between 2012 and 2019 were extracted from the Utrecht Patient Oriented Database. Three measurement time points were defined for each visit: last SCr measurement before visit as baseline (SCr-BL), first measurement during visit (SCr-ED) and a subsequent measurement between 6 and 24 hours during admission (SCr-H1). Non-steady-state SCr was defined as exceeding the Reference Change Value (RCV), with 15% decrease or 18% increase between successive SCr measurements. Exceeding the RCV was deemed as a significant change. Results Of visits where SCr-BL and SCr-ED were measured (N = 47,540), 28.0% showed significant change in SCr. Of 17,928 visits admitted to the hospital with a SCr-H1 after SCr-ED, 27,7% showed significant change. More than half (55%) of the patients with SCr values available at all three timepoints (11,054) showed at least one significant change in SCr over time. Conclusion One third of ED visits preceded and/or followed by creatinine measurement show non-stable serum creatinine concentration. At the ED automatically calculated eGFR should therefore be interpreted with great caution when assessing kidney function.
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Yan, J. W., K. Gushulak, M. Columbus, K. Van Aarsen, A. Hamelin, G. A. Wells, and I. G. Stiell. "P131: Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus." CJEM 19, S1 (May 2017): S122. http://dx.doi.org/10.1017/cem.2017.333.
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Introduction: Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. Methods: We conducted a one-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days. Results: There were 833 ED visits for hyperglycemia in the one-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age <25 years (OR 2.6, 95% CI 1.5-4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit. Conclusion: This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.
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Maness, Philip, Dmitry Tumin, Rushina Cholera, David N. Collier, Luisa Bonilla-Hernandez, and Suzanne Lazorick. "Ethnicity and trends in pediatric specialty care clinic attendance at an academic medical center in the rural southeastern US." PLOS Global Public Health 3, no. 4 (April 13, 2023): e0001816. http://dx.doi.org/10.1371/journal.pgph.0001816.
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Following the 2016 US Presidential election, immigration enforcement became more aggressive, with variation by state and region depending on local policies and sentiment. Increases in enforcement created an environment of risk for decreased use of health care services among especially among Latino families. of Hispanic ethnicity and/or from Latin American origin (as a group subsequently referred to as Latino). For Latino children with chronic health conditions, avoidance of routine health care can result in significant negative health consequences such as disease progression, avoidable use of acute health care services, and overall increased costs of care. To investigate for changes in visit attendance during the periods before and since increased immigration enforcement, we extracted data on children followed by subspecialty clinics of one healthcare system in the US state of North Carolina during 2015–2019. For each patient, we calculated the proportion of cancelled visits and no-show visits out of all scheduled visits during the 2016–2019 follow-up period. We compared patient characteristics (at the 2015 baseline) according to whether they cancelled or did not show to any visits in subsequent years by clinic and patient factors, including ethnicity. Data were analyzed using multinomial logistic regression of attendance at each visit, including an interaction between visit year and patient ethnicity. Among 852 children 1 to 17 years of age (111 of Latino ethnicity), visit no-show was more common among Latino patients, compared to non-Latino White patients; while visit cancellation was more common among non-Latino White patients, compared to Latino patients. There was no significant interaction between ethnicity and trends in visit no-show or cancellation. Although differences in pediatric specialty clinic visit attendance by patient ethnicity were seen at study baseline, changing immigration policy and negative rhetoric did not appear to impact use of pediatric subspecialty care.
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Kelekar, Uma, Debasree Das Gupta, Amel Ben Abdesslem, Diep Tran, Jewel Shepherd, and Sidney Turner. "REPEAT AND SERIAL EMERGENCY DEPARTMENT (ED) OLDER ADULT USERS—A STATE-LEVEL ANALYSIS USING THE NYU-JHU ALGORITHM." Innovation in Aging 7, Supplement_1 (December 1, 2023): 721. http://dx.doi.org/10.1093/geroni/igad104.2336.
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Abstract Older adults account for 12-24% of all Emergency Department (ED) visits and studies have shown a 25-35% increase in older adult ED visits over time. While some studies have analyzed ED encounters over a single healthcare system, a year or a specific condition, research comparing the long-term frequent use of the ED across cohorts of older adults in the United States is limited. We address this gap by identifying characteristics associated with repeat (>1 visit during the time period) and serial/frequent (>=4/year) ED utilization for Maryland. Using the 2017-2019 State Emergency Department Databases (SEDD), we extracted ED visits among the elderly (>=60 years) population. By applying the modified New York University Algorithm by John Hopkins University (NYU-JHU-EDA), we classified ED visits into 11 categories, and we conducted bivariate and multivariate analyses to identify inter-age variations in the type of visits to the ED across single, repeat and serial users, after controlling for covariates. Of the total 5,331,843 ED visits between 2017 and 2019, 1,244,878 (~23%) were older adult visits. Relative to the 60–69-year-olds, those 80 and above had higher odds of being repeat users for emergent issues [OR=1.34, CI:1.07-1.67], primary-care treatable condition [OR=1.29, CI:1.03-1.62], and severe [1.30, CI: 1.03-1.64] and non-severe injuries [1.61, CI:1.28-2.01]. Relative to 60-69 year olds non-serial users, the oldest cohort demonstrated lower odds for psychiatric/alcohol and drug-related diagnoses [OR=0.63, CI:0.42, 0.95]. Our findings highlight the need to design age-group specific interventions to reduce the frequent ED utilization among the elderly in Maryland.
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Brathwaite, Danielle M., Catherine S. Wolff, Amy I. Ising, Scott K. Proescholdbell, and Anna E. Waller. "A Mixed-Methods Comparison of a National and State Opioid Overdose Surveillance Definition." Public Health Reports 136, no. 1_suppl (November 2021): 31S—39S. http://dx.doi.org/10.1177/00333549211018181.
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Objectives We assessed the differences between the first version of the Centers for Disease Control and Prevention (CDC) opioid surveillance definition for suspected nonfatal opioid overdoses (hereinafter, CDC definition) and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance definition to determine whether the North Carolina definition should include additional International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and/or chief complaint keywords. Methods Two independent reviewers retrospectively reviewed data on North Carolina emergency department (ED) visits generated by components of the CDC definition not included in the NC DETECT definition from January 1 through July 31, 2018. Clinical reviewers identified false positives as any ED visit in which available evidence supported an alternative explanation for patient presentation deemed more likely than an opioid overdose. After individual assessment, reviewers reconciled disagreements. Results We identified 2296 ED visits under the CDC definition that were not identified under the NC DETECT definition during the study period. False-positive rates ranged from 2.6% to 41.4% for codes and keywords uniquely identifying ≥10 ED visits. Based on uniquely identifying ≥10 ED visits and a false-positive rate ≤10.0%, 4 of 16 ICD-10-CM codes evaluated were identified for NC DETECT definition inclusion. Only 2 of 25 keywords evaluated, “OD” and “overdose,” met inclusion criteria to be considered a meaningful addition to the NC DETECT definition. Practice Implications Quantitative and qualitative trends in coding and keyword use identified in this analysis may prove helpful for future evaluations of surveillance definitions.
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Soh, Jaeseung, Yonsu Kim, Jay Shen, Mingon Kang, Stefan Chaudhry, Tae Ha Chung, Seo Hyun Kim, et al. "Trends of emergency department visits for cannabinoid hyperemesis syndrome in Nevada: An interrupted time series analysis." PLOS ONE 19, no. 5 (May 29, 2024): e0303205. http://dx.doi.org/10.1371/journal.pone.0303205.
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Cannabis-related emergency department visits have increased after legalization of cannabis for medical and recreational use. Accordingly, the incidence of emergency department visits due to cannabinoid hyperemesis syndrome in patients with chronic cannabis use has also increased. The aim of this study was to examine trends of emergency department visit due to cannabinoid hyperemesis syndrome in Nevada and evaluate factors associated with the increased risk for emergency department visit. The State Emergency Department Databases of Nevada between 2013 and 2021 were used for investigating trends of emergency department visits for cannabinoid hyperemesis syndrome. We compared patients visiting the emergency department due to cannabinoid hyperemesis syndrome with those visiting the emergency department due to other causes except cannabinoid hyperemesis and estimated the impact of cannabis commercialization for recreational use. Emergency department visits due to cannabinoid hyperemesis syndrome have continuously increased during the study period. The number of emergency department visits per 100,000 was 1.07 before commercialization for recreational use. It increased to 2.22 per 100,000 (by approximately 1.1 per 100,000) after commercialization in the third quarter of 2017. Those with cannabinoid hyperemesis syndrome were younger with fewer male patients than those without cannabinoid hyperemesis syndrome. A substantial increase in emergency department visits due to cannabinoid hyperemesis syndrome occurred in Nevada, especially after the commercialization of recreational cannabis. Further study is needed to explore factors associated with emergency department visits.
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Pankhurst, Richard. "Two Visits to Mugär Gädam, Šäwa." Aethiopica 4 (June 30, 2013): 169–78. http://dx.doi.org/10.15460/aethiopica.4.1.495.
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The article describes two field trips to a little-known craftsman’s gädam, or monastery, in northern Šäwa. This institution, which, like other such monasteries in the region, probably dates from the late seventeenth or early eighteenh century, seems to have come into existance as a result of the rise of the Šäwan state. This development apparently attracted Fälaša, or Judaic, craftsmen — weavers, blacksmiths and potters — from the Gondär area, who at some uncertain stage were converted to Christianity.The gädam today consists of monks and nuns, who practice the traditionally “marginalised occupations” of blacksmith, weaver, and potter. Though nominally Christian, they have retained several traits which seem more “Judaic” than those of the highland Christian population at large.
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Hua, Cassandra, Wenhan Zhang, Portia Cornell, Momotazur Rahman, David Dosa, and Kali Thomas. "State Variability in Emergency Department Visits among Assisted Living Residents With Dementia." Innovation in Aging 4, Supplement_1 (December 1, 2020): 716. http://dx.doi.org/10.1093/geroni/igaa057.2526.
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Abstract Emergency department (ED) visits are associated with poor outcomes; however, state variation in ED use among assisted living (AL) residents is not well understood. Using 2017 Medicare data, we identified a cohort of 88,880 beneficiaries with dementia residing in larger ALs (25+ beds) and calculated risk-adjusted rates of all-cause and injury-related ED use per 100 person years, by state, adjusting for demographics and chronic conditions. Risk-adjusted state rates of all-cause ED visits ranged from 129.5 visits/100 person-years (95%CI=114.6,148.2) in New Mexico to 246.1 visits/100 person-years (95%CI= 224.9,274.8) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 91.4 visits/100 person-years (95%CI=83.0,101.4) in New Mexico to 135.9 visits/100 person-years (95%CI=126.9,146.6) in Montana. Potential reasons for these state variations will be discussed. Part of a symposium sponsored by Assisted Living Interest Group.
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Tripathy, Dr Tridibesh, Dr Umakant Prusty, Dr Chintamani Nayak, Dr Rakesh Dwivedi, and Dr Mohini Gautam. "HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA." Journal of Advances in Social Science and Humanities 6, no. 5 (May 9, 2020): 1183–89. http://dx.doi.org/10.15520/jassh.v6i5.483.
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The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP.
The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.
The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.
A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.
Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.
Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.
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Esteban, Pedro L., Jordi Querolt Coll, Marina Xicola Martínez, Joan Camí Biayna, and Luis Delgado-Flores. "Has COVID-19 affected the number and severity of visits to a traumatology emergency department?" Bone & Joint Open 1, no. 10 (October 1, 2020): 617–20. http://dx.doi.org/10.1302/2633-1462.110.bjo-2020-0120.r1.
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Aims To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity. Methods Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years. Results The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%. Conclusion A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones. Cite this article: Bone Joint Open 2020;1-10:617–620.
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Wilson, Patrick B., Jaison L. Wynne, Alex M. Ehlert, and Zachary Mowfy. "Life stress and background anxiety are not associated with resting metabolic rate in healthy adults." Applied Physiology, Nutrition, and Metabolism 45, no. 8 (August 2020): 812–16. http://dx.doi.org/10.1139/apnm-2019-0875.
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This study examined associations between anxiety, stress, and resting metabolic rate (RMR). Thirty women and 23 men had RMR measured at two visits. Participants also had body composition assessed and completed several questionnaires: State–Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Anxiety Sensitivity Index (ASI)-3, and Perceived Stress Scale (PSS)-14. The state version of the STICSA was completed at both visits, while the other questionnaires were completed at visit one. RMR was expressed in kilocalories per day and relative to lean mass (RMRrelative). Participants were divided into low-, medium-, and high-anxiety groups based on STICSA trait scores, and RMR was compared among groups using one-way ANOVA. Changes between visits were evaluated using paired t tests and Wilcoxon signed-rank tests. RMR did not change from visit one to visit two (1589 to 1586 kcal/day, p = 0.86) even though STICSA state scores slightly declined (Z-statistic = –2.39, p = 0.017). RMRrelative values were 30.3 ± 3.7, 29.0 ± 1.9, and 29.9 ± 3.6 kcal/kg of lean mass among low, medium, and high trait anxiety groups, respectively (F = 0.70, p = 0.50). No RMR variable significantly correlated with PSS-14, ASI-3, or STICSA scores. This study provides evidence that trait anxiety and life stress do not impact RMR. Whether an association between these factors exists in anxiety disorders remains to be evaluated. Novelty Contrary to previous research, this study found no associations between anxiety and RMR. It is doubtful whether practitioners need to account for healthy subjects’ trait anxiety and stress when analyzing RMR data.
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Aleksanyan, Mark, Zhiwei Hao, Evangelos Vagenas-Nanos, and Patrick Verwijmeren. "Do state visits affect cross-border mergers and acquisitions?" Journal of Corporate Finance 66 (February 2021): 101800. http://dx.doi.org/10.1016/j.jcorpfin.2020.101800.
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Osawa, Itsuki, Tadahiro Goto, Yuko Asami, Noriharu Itoh, Yasuyuki Kaga, Yuji Yamamoto, and Yusuke Tsugawa. "Physician visits and medication prescriptions for major chronic diseases during the COVID-19 pandemic in Japan: retrospective cohort study." BMJ Open 11, no. 7 (July 2021): e050938. http://dx.doi.org/10.1136/bmjopen-2021-050938.
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ObjectivesThere have been concerns that patients with chronic conditions may be avoiding in-person physician visits due to fear of COVID-19, leading to lower quality of care. We aimed to investigate changes in physician visits and medication prescriptions for chronic diseases before and during the COVID-19 pandemic at the population level.DesignRetrospective cohort study.SettingNationwide claims data in Japan, 2018–2020.ParticipantsWorking-age population (aged 18–74 years) who visited physicians and received any prescriptions for major chronic diseases (hypertension, diabetes and dyslipidaemia) before the pandemic.Outcome measuresThe outcomes were the monthly number of physician visits, the monthly proportion of physician visits and the monthly proportion of days covered by prescribed medication (PDC) during the pandemic (April–May 2020, as the first state of emergency over COVID-19 was declared on 7 April, and withdrawn nationally on 25 May).ResultsAmong 10 346 patients who visited physicians for chronic diseases before the pandemic, we found a temporary decline in physician visits (mean number of visits was 1.9 in March vs 1.7 in April; p<0.001) and an increase in the proportion of patients who did not visit any physicians during the pandemic (15% in March vs 24% in April; p<0.001). Physician visits returned to the baseline in May (the mean number of visits: 1.8, and the proportion of patients who did not visit any physicians: 9%). We observed no clinically meaningful difference in PDC between before and during the pandemic (eg, 87% in March vs 87% in April; p=0.45). A temporary decline in physician visits was more salient in seven prefectures with a larger number of COVID-19 cases than in other areas.ConclusionsAlthough the number of physician visits declined right after the COVID-19 outbreak, it returned to the baseline one month later; patients were not skipping medications during the pandemic.
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O’Brien, Michele Renee, Kimberly Ness, Aimee Arlen, Rowena Schwartz, Jackie Foster, and Mark D. Sborov. "Integration of survivorship care in community oncology practice." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 33. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.33.
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33 Background: Each of the 12 million cancer survivors in the United States has unique needs, giving oncology providers the opportunity to address survivorship issues and optimize care. Minnesota Oncology, a community oncology practice, has implemented a survivorship program that evaluates patient specific issues through a series of clinic visits guided by results from the Functional Assessment of Chronic Illness Therapy (FACIT) quality of life assessment tool. Methods: Survivorship care is initiated at diagnosis. After determining the treatment plan, a one hour survivorship visit with a midlevel provider is dedicated to patient concerns and quality of life. Additionally, visits are scheduled at the time of treatment completion and 3-6 months later. The frequency and focus of visits is determined by the patient. Patients complete the FACIT assessment on an electronic tablet in the clinic, immediately prior to scheduled visits. This tool addresses physical, social, emotional and functional well-being, and takes 5-7 minutes to complete. A report of patient specific information is generated for providers to guide each visit, and ultimately to coordinate additional referrals for care. Patient satisfaction is measured at each visit and via a follow up survey. Results: A total of 152 patients (168 visits) have taken the FACIT survey from January 1 – June 30, 2012. Average FACIT general raw scores at baseline, treatment conclusion and 3-6 months following completion were 77.6 (n=121), 76.9 (n=37) and 82.3 (n=10), respectively. Median patient age was 59 (range 22-84). Breast cancer (n = 44) was the most common diagnosis seen and initial visit disease status was: stage I (n = 28), II (n = 37), III (n = 43), IV (n = 36). As a result of the surveys and/or clinic visits referrals to social work, dietician, rehab and counseling have occurred. Conclusions: Attention to survivorship issues is essential to provide comprehensive care to those affected by cancer. Early intervention should consider disease state along with patient specific factors. Following a standard method for addressing survivorship issues allows for cancer care referral coordination. Benefits of adopting a survivorship program include improvement in quality of care and patient satisfaction.
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Nene, Rahul, Jesse Brennan, Edward Castillo, Peter Tran, Renee Hsia, and Christopher Coyne. "Cancer-related Emergency Department Visits: Comparing Characteristics and Outcomes." Western Journal of Emergency Medicine 22, no. 5 (August 21, 2021): 1117–23. http://dx.doi.org/10.5811/westjem.2021.5.51118.
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Introduction: There is increasing appreciation of the challenges of providing safe and appropriate care to cancer patients in the emergency department (ED). Our goal here was to assess which patient characteristics are associated with more frequent ED revisits. Methods: This was a retrospective cohort study of all ED visits in California during the 2016 calendar year using data from the California Office of Statewide Health Planning and Development. We defined revisits as a return visit to an ED within seven days of the index visit. For both index and return visits, we assessed various patient characteristics, including age, cancer type, medical comorbidities, and ED disposition. Results: Among 12.9 million ED visits, we identified 73,465 adult cancer patients comprising 103,523 visits that met our inclusion criteria. Cancer patients had a 7-day revisit rate of 17.9% vs 13.2% for non-cancer patients. Cancer patients had a higher rate of admission upon 7-day revisit (36.7% vs 15.6%). Patients with cancers of the small intestine, stomach, and pancreas had the highest rate of 7-day revisits (22-24%). Cancer patients younger than 65 had a higher 7-day revisit rate than the elderly (20.0% vs 16.2%). Conclusion: In a review of all cancer-related ED visits in the state of California, we found a variety of characteristics associated with a higher rate of 7-day ED revisits. Our goal in this study was to inform future research to identify interventions on the index visit that may improve patient outcomes.
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Murphy, Michael p., Paul Fishman, Steven O. Short, Sean D. Sullivan, Bevan Yueh, and Ernest A. Weymuller. "Health Care Utilization and Cost among Adults with Chronic Rhinosinusitis Enrolled in a Health Maintenance Organization." Otolaryngology–Head and Neck Surgery 127, no. 5 (November 2002): 367–76. http://dx.doi.org/10.1067/mhn.2002.129815.
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OBJECTIVE: Our goal was to measure the impact of chronic rhinosinusitis (CRS) on the use and cost of health care by adults in a health maintenance organization (HMO). SETTING AND SUBJECTS: In the setting of the Group Health Cooperative, an HMO in Washington State, we conducted a study of all 218,587 adults (≥18 years) who used services during 1994. Using automated data, 20,175 adults were identified with one or more CRS diagnoses during 1994. OUTCOME MEASURES: We identified nonurgent outpatient visits, pharmacy fills, urgent visits, hospital days, and their associated costs (per adult per year). RESULTS: The marginal utilization associated with a diagnosis of CRS was 2.0 nonurgent outpatient visits, 5.1 pharmacy fills, 0.01 urgent visit, and −0.07 hospital day. The marginal total cost of CRS was $206. CONCLUSIONS: Adults with CRS had higher costs primarily because of increased nonurgent outpatient visit and pharmacy fill utilization. The overall direct cost of CRS in the United States in 1994 is estimated to have been $4.3 billion.
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Gadzinski, Adam John, Isabelle O. Abarro, Blair Stewart, and John L. Gore. "The impact of telemedicine on patient-reported outcomes in urologic oncology." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 200. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.200.
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200 Background: Nearly 20% of Americans live in rural communities. These individuals face barriers to accessing cancer care, including prevalent poverty and substantial travel burden to seeing cancer providers. We aimed to assess the impact of a rurally focused telemedicine program on patient outcomes in our urologic oncology outpatient clinic. Methods: We prospectively identified patients from rural Washington State, or who lived outside Washington, with a known or suspected urological malignancy being evaluated at the University of Washington Urology Clinic via an in person clinic or a telemedicine appointment. Patients were invited to complete a post-visit survey that assessed satisfaction, travel time, costs, and work absenteeism. We compared patient-reported outcomes between those seen as in-person versus telemedicine visits. Results: We invited 1453 eligible patients from August 2019–July 2020 to participate; 615 patients (42%) completed the survey. 198 patients had in person visits and 417 had telemedicine visits. Median age was 68, 89% were male, and 73% were white. 525 patients (85%) were from Washington; the remainder resided out-of-state. Patients were being evaluated for prostate cancer (62%), kidney cancer (14%), urothelial cancer (22%), and testis cancer (2%). Patient-reported outcomes are displayed in Table. Twenty-two patients coming for in-person visits (11%) paid ≥ $1000 in total travel costs. No differences were noted in patient satisfaction between in-person and telemedicine visit types. Conclusions: Patients traveling to our clinic from out-of-state and rural Washington incur significant travel time, costs, and time away from work to receive outpatient urologic cancer care. Telemedicine provides a medium for cancer care delivery that eliminates the significant travel burden associated with in-person clinic appointments. [Table: see text]
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Li, Li, Catherine R. Fedorenko, Karma L. Kreizenbeck, Veena Shankaran, and Scott David Ramsey. "Measuring substance use disorder (SUD) in commercial and Medicaid insured patients with cancer in Washington state." JCO Oncology Practice 19, no. 11_suppl (November 2023): 177. http://dx.doi.org/10.1200/op.2023.19.11_suppl.177.
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177 Background: Studies have shown that SUDs not only impact cancer risk, treatment, and survivorship but also increase ED and hospital use. We sought to characterize SUD within Medicaid enrollees diagnosed with cancer in Washington state, hypothesizing thatMedicaid enrollees were more likely to be diagnosed with SUDs than commercial enrollees, and that patients with an SUD experienced higher rates of emergency department (ED) visits or inpatient (IP) stays during initial cancer treatment. Methods: We linked Washington State cancer registry records with claims data from two large commercial insurers and Medicaid. Eligibility criteria included patients under 65 diagnosed with a solid tumor between 2013-2021 who started systemic therapy within 6 months of diagnosis. SUD diagnoses were identified using codes from CMS’s hierarchical condition category for SUD in the 6 months following diagnosis. Chi-square tests were used to compare demographic characteristics of those with and without a SUD diagnosis. Multivariate logistic regressions were used to evaluate the association between SUD and likelihood of at least one ED visit or IP stay, after controlling for payer, sex, race, ethnicity, age, marital status, stage, cancer group, area deprivation index, and diagnosis year. Results: Among the 10,709 patients (6,680 Commercial, 3,718 Medicaid, 311 Multiple) who received systemic therapy, 7.2% had a SUD diagnosis. SUD patients were less likely to be Asian and more likely to be male, living without a partner, diagnosed at a later cancer stage, and living in more deprived areas. Medicaid patients had significantly higher rates of SUD than commercial-insured patients (14.3% vs 3.3%). Overall, 46.6% of cancer patients had an ED visit or IP stay. Patients with SUD had greater use of ED or IP visits than patients without SUD (70.1% and 44.8%, respectively). In the first 6 months of systemic therapy patients with SUD were significantly more likely to visit the ED or be admitted to IP (OR 2.12, 95% CI 1.79 - 2.50) than cancer patients without SUD. Conclusions: More than 1 in 7 Medicaid cancer patients in WA state has an identified SUD. SUD is associated with significant excess risk for ED/IP admissions during treatment. Accurate identification of SUD in patients is necessary prior to strategies aimed at mitigation of unplanned ED visits and hospitalizations during cancer care. Further research is needed on interventions that effectively reduce the risk during treatment.[Table: see text]
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Long, Christine L., Sabrina Q. Mikan, and Debra A. Patt. "Optimization of telemedicine in advanced practice provider (APP) led oncology/hematology remote-only clinic." JCO Oncology Practice 19, no. 11_suppl (November 2023): 523. http://dx.doi.org/10.1200/op.2023.19.11_suppl.523.
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523 Background: To continue quality timely patient care telemedicine usage increased during the COVID-19 pandemic. A systematic review of the literature supports the use of telemedicine beyond the pandemic. The goal of this quality improvement (QI) project sought to identify barriers and promoters to sustain telemedicine visits for adult oncology/hematology patients seen in the Virtual Advanced Practice Provider (VAPP) clinic. A Telemedicine Toolkit (TT) was developed for providers to enhance and improve the provider/patient experience. Methods: Retrospectivedata retrieved from EMR/VAPP included details from 1,985 patient visits for March-August 2022 to investigate how to optimize the specialty care visit. Over a 10-day period, staff completed pre/posttest surveys to assess engagement and satisfaction with TT. Results: The data points from the statewide EMR and VSee platforms showed the patient median age was 62; age range seen 19-95. More females were seen at 65% (1290) than males at 35% (695); predominant race/ethnicity was white at 47.5% (943). The main diagnosis seen was breast at 28.86% (573), then lung at 7% (127), followed by colon at 6.90% (137). Visit type from high to low: the teaching visit at 44.5% (884), standard follow-up visit (toxicity checks and hospital follow-ups) at 32.9% (645), new genetics visits at 11.5% (228) and follow-up genetic visits at 7% (138), Advance care planning visits (ACP) at 3% (58), urgent care follow-up visit at 1% (24) and the high-risk/preventive care at 0.4% (8). Nearly 250 locations were served predominantly in central Texas. Patient devices used included iPhone/IOS at 48%, Windows OS at 27.5%, Android at 20.5%, and Mac OS at 4%. Conclusions: The VAPP clinic with a robust infrastructure, is now serving the entire state of Texas. The staff noted the TT to be intuitive and helpful. Sustainability of the TT through updates and continued staff education is essential. This project did not find a significant problem with Wi-Fi services and the most common reason for an aborted/canceled visit was the patient did not remember their Apple ID/Google password to be able to download the VSee application. Patient education prior to visits regarding Vsee needs would potentially reduce canceled/aborted visits.
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Kodila-Tedika, Oasis, and Sherif Khalifa. "Official Visits and Economic Freedom." Journal of Economic Integration 38, no. 2 (June 15, 2023): 219–46. http://dx.doi.org/10.11130/jei.2023.38.2.219.
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This study examines the effect of U.S. Presidents and Secretaries of State visits to a country on institutional quality, particularly on economic freedom. Hence, the study develops a model that predicts the conditions under which official visits can enhance the quality of institutions. We compile variables on official visits from 1960 to 2019 from the archives of the U.S. State Department to test the predictions of our model. In addition, we use the endogenous treatment model estimation to deal with potential endogeneity. The estimation results show that the official visits have a statistically significant negative effect on economic freedom, particularly in non-democratic countries with less political freedom. The estimation results are robust with different types of visits and samples. The study presents multiple explanations for these results, including the possibility of the following: First, some American administrations adopt a pragmatic approach aimed at achieving strategic objectives while overlooking practices that do not enhance institutional quality. Second, these official visits may improve other aspects of institutional quality that are more observable to the international community than economic freedoms. Third, American policymakers care more about achieving short-term objectives from their visits that can be presented as accomplishments to their electorate rather than institutional reforms that will only yield benefits to the United States in the long run. Finally, economic freedoms are associated with political freedoms per the Hayek-Friedman hypothesis.
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Deck, John H. N. "The Face of Pathology in Afghanistan in 2006–2007." Archives of Pathology & Laboratory Medicine 135, no. 2 (February 1, 2011): 179–82. http://dx.doi.org/10.5858/2008-0400-sor.1.
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AbstractThe current state of the practice of pathology in Afghanistan is described on the basis of visits made by the author to a nongovernmental organization hospital in Kabul, for 6 months between October 2006 and March 2007, and a second visit for 6 weeks at the end of 2007.
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Kapoor, Mudit, Deepak Agrawal, Shamika Ravi, Ambuj Roy, S. V. Subramanian, and Randeep Guleria. "Missing female patients: an observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India." BMJ Open 9, no. 8 (August 2019): e026850. http://dx.doi.org/10.1136/bmjopen-2018-026850.
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ObjectiveTo investigate gender discrimination in access to healthcare and its relationship with the patient’s age and distance from the healthcare facility.Design and settingAn observational study based on outpatient data from a large referral public hospital in Delhi, India.ParticipantsConfirmed clinical appointments.Primary and secondary outcome measuresEstimates from the logistic regression are used to compute sex ratios (male/female) of patient visits with respect to distance from the hospital and age. Missing female patients for each state—a measure of the extent of gender discrimination—is computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.ResultsOf 2377028 outpatient visits, excluding obstetrics and gynaecology patients, the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance. The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state furthest from Delhi. The sex ratios had a U-shaped relationship with age: 1.93 for 0–18 years, 2.01 for 19–30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31–44 and 45–59 years, respectively. We estimate there were 402 722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states.ConclusionWe found gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.
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Glushich, A. M. "Discovering a Young State: Foreign Sports Delegations in the USSR during the 1920s." MGIMO Review of International Relations 16, no. 6 (January 17, 2024): 183–206. http://dx.doi.org/10.24833/2071-8160-2023-6-93-183-206.
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In the 1920s, visits by foreign delegations to the USSR served as a crucial yet challenging avenue for showcasing the achievements of the nascent Soviet state. Drawing on previously unexplored materials from the Russian State Archive of Socio-Political History (F. 537, inv. 2), this article examines the strategies employed in hosting these guests. It explores the planning of their itineraries and leisure activities, aiming to understand how Soviet sports leaders, during the early stages of state formation, skillfully concealed various shortcomings (especially economic and infrastructural) and highlighted sports and cultural triumphs to craft a positive global image of the USSR through what was ostensibly a non-political institution.Soviet physical education leaders did not shy away from inviting foreign teams to the country; instead, they actively welcomed all interested parties who could manage the journey. An ideally orchestrated visit seamlessly integrated four key elements: sports (the competitions), culture (theater, cinema, sightseeing), daily life (direct interaction with Soviet workers), and team recreation. When executed well, these visits garnered positive international feedback, thereby enhancing the USSR's global prestige as the inaugural socialist state. This became the primary objective of Soviet sports diplomacy in the late 1920s, marking a significant stride in breaking through international isolation.However, these visits were not without limitations and challenges. The level of indoctrination varied significantly among delegations: while European proletarians often visited sites significant to the October Revolution, guests from the East were predominantly exposed to the country's cultural facets. Despite the Red Sports International's encouragement, delegations rarely ventured beyond major urban centers like Moscow, Leningrad, Kharkov, and Odessa, as provincial visits were not feasible. Furthermore, even in these key cities, visitors encountered organizational challenges such as transportation difficulties, inadequate economic support, and issues with food provision, which diminished the effectiveness of propaganda efforts. These shortcomings were largely attributable to the absence of a standardized protocol for receiving foreign guests during the first decade of Soviet sports diplomacy and the general uneven infrastructural development of the country.
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Zarrin, Haley, Carmen Vargas-Torres, Teresa Janevic, Toni Stern, and Michelle P. Lin. "Patient Sociodemographics and Comorbidities and Birth Hospital Characteristics Associated With Postpartum Emergency Department Care." JAMA Network Open 6, no. 3 (March 21, 2023): e233927. http://dx.doi.org/10.1001/jamanetworkopen.2023.3927.
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ImportancePostpartum emergency department (ED) visits may indicate poor access to care and risk for maternal morbidity.ObjectivesTo identify patient and hospital characteristics associated with postpartum ED visit rates.Design, Setting, and ParticipantsThis retrospective cohort study used data from the 2014 to 2016 New York State Inpatient Database and State Emergency Department Database. All obstetric discharges from acute care hospitals in New York State from January 1, 2014, through November 15, 2016, were included. Obstetric discharges in the inpatient database were linked to subsequent ED visits by the same patient in the ED database. Data were analyzed from February 2020 to August 2022.ExposuresPatient characteristics assessed included age, race, insurance, home zip code income quartile, Charlson Comorbidity Index score, and obstetric risk factors. Hospital characteristics assessed included safety net status, teaching status, and status as a hospital disproportionally serving racial and ethnic minority populations.Main Outcomes and MeasuresThe primary outcome was any ED visit within 42 days of obstetric discharge. Multilevel logistic regression with 2-level nested mixed effects was used to account for patient and hospital characteristics and hospital-level clustering.ResultsOf 608 559 obstetric discharges, 35 299 (5.8%) were associated with an ED visit within 42 days. The median (IQR) birth hospital postpartum ED visit rate was 6.3% (4.6%-8.7%). The mean (SD) age was 28.4 (9.1) years, 53 006 (8.7%) were Asian patients, 90 675 (14.9%) were Black patients, 101 812 (16.7%) were Hispanic patients, and 275 860 (45.3%) were White patients; 292 991 (48%) were insured by Medicaid, and 290 526 (47.7%) had private insurance. Asian patients had the lowest postpartum ED visit rates (2118 ED visits after 53 006 births by Asian patients [3.99%]), and Black patients had the highest postpartum ED visit rates (8306 ED visits after 90 675 births by Black patients [9.15%]). Odds of postpartum ED visits were greater for Black patients (odds ratio [OR], 1.31; 95% CI, 1.26-1.35; P &lt; .001) and Hispanic patients (OR, 1.19; 95% CI, 1.15-1.24; P &lt; .001) relative to White patients; those with Medicare (OR, 1.55; 95% CI, 1.39-1.72; P &lt; .001), Medicaid (OR, 1.37; 95% CI, 1.34-1.41; P &lt; .001), or self-pay insurance (OR, 1.50; 95% CI, 1.41-1.59; P &lt; .001) relative to commercial insurance; births that occurred at safety net hospitals (OR, 1.43; 95% CI, 1.37-1.51; P &lt; .001) and hospitals disproportionately serving racial and ethnic minority populations (OR, 1.14; 95% CI, 1.08-1.20; P &lt; .001); and births that occurred at hospitals with fewer than 500 births per year (OR, 1.25; 95% CI, 1.14-1.39; P &lt; .001) relative to those with more than 2000 annual births. Adjusted odds of postpartum ED visits were lower after birth at teaching hospitals (OR, 0.82; 95% CI, 0.74-0.91; P &lt; .001) and metropolitan hospitals (OR, 0.74; 95% CI, 0.65-0.85; P &lt; .001).Conclusions and RelevanceThis cohort study found that Black and Hispanic patients experienced higher adjusted odds of postpartum ED visits across all hospital types, particularly at safety net hospitals and those disproportionately serving racial and ethnic minority populations . These findings support the urgent need to mitigate structural racism underlying maternal health disparities.
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Yamamoto, Ayae, Lillian Gelberg, Yusuke Tsugawa, Gerald Kominski, and Jack Needleman. "4269 Frequent emergency department use among homeless individuals seen in emergent care: High risks of opioid-related diagnoses and adverse health services utilization outcomes." Journal of Clinical and Translational Science 4, s1 (June 2020): 133. http://dx.doi.org/10.1017/cts.2020.394.
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OBJECTIVES/GOALS: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes. METHODS/STUDY POPULATION: Based on the State Emergency Department Database and the State Inpatient Database, homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons). RESULTS/ANTICIPATED RESULTS: Higher rates of ED use were associated with Medicare coverage <65; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit (2.8% vs. 2.8% vs. 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.
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Elliott, Mark. "Human rights in the House of Lords: what standard of review?" Cambridge Law Journal 59, no. 1 (March 2000): 3–6. http://dx.doi.org/10.1017/s0008197300220011.
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THE applicants in R. v. Secretary of State for the Home Department, ex p. Simms [1999] 3 W.L.R. 328 were convicted murderers whose applications for leave to appeal had been refused but who continued to protest their innocence. To this end they gave interviews to investigative journalists, hoping that this would ultimately result in their cases being referred back to the Court of Appeal. However, paragraph 37 of the Prison Rules 1964 provides that professional visits by journalists to prisoners should not generally be allowed and that any journalist wishing to visit a prisoner qua relative or friend must undertake not to publish anything disclosed during the visit. Paragraph 37A stipulates that if, exceptionally, a journalist is permitted to make a professional visit, he must undertake to abide by any conditions prescribed by the prison governor. In the instant case the prison authorities, pursuant to a Home Office policy directing prison governors to impose a blanket ban on all visits by journalists in their professional capacity, refused to permit further visits unless paragraph 37 undertakings were forthcoming. Their Lordships accepted the applicants' argument that this constituted unlawful interference with their entitlement to free expression.
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Mongraw-Chaffin, Morgana, Meredith C. Foster, Rita R. Kalyani, Dhananjay Vaidya, Gregory L. Burke, Mark Woodward, and Cheryl A. M. Anderson. "Obesity Severity and Duration Are Associated With Incident Metabolic Syndrome: Evidence Against Metabolically Healthy Obesity From the Multi-Ethnic Study of Atherosclerosis." Journal of Clinical Endocrinology & Metabolism 101, no. 11 (August 23, 2016): 4117–24. http://dx.doi.org/10.1210/jc.2016-2460.
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Context:Although the health risks of obesity compared to normal weight have been well studied, the cumulative risk associated with chronic obesity remains unknown. Specifically, debate continues about the importance of recommending weight loss for those with metabolically healthy obesity.Objective:We hypothesized that relatively greater severity and longer duration of obesity are associated with greater incident metabolic syndrome.Design, Setting, Participants, and Measures:Using repeated measures logistic regression with random effects, we investigated the association of time-varying obesity severity and duration with incident metabolic syndrome in 2,748 Multi-Ethnic Study of Atherosclerosis participants with obesity (body mass index ≥30 kg/m2) at any visit. Obesity duration was defined as the cumulative number of visits with measured obesity and obesity severity by the World Health Organization levels I–III based on body mass index. Metabolic syndrome was defined using Adult Treatment Panel III criteria modified to exclude waist circumference.Results:Higher obesity severity (level II odds ratio [OR], 1.32 [95% confidence interval, 1.09–1.60]; level III OR, 1.63 [1.25–2.14] vs level I) and duration (by number of visits: two visits OR, 4.43 [3.54–5.53]; three visits OR, 5.29 [4.21–6.63]; four visits OR, 5.73 [4.52–7.27]; five visits OR, 6.15 [4.19–9.03] vs one visit duration of obesity) were both associated with a higher odds of incident metabolic syndrome.Conclusion:Both duration and severity of obesity are positively associated with incident metabolic syndrome, suggesting that metabolically healthy obesity is a transient state in the pathway to cardiometabolic disease. Weight loss should be recommended to all individuals with obesity, including those who are currently defined as metabolically healthy.
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Castro, Emil De. "O mundo perdido e sempre achado de Lúcio Cardoso." Revista do Centro de Estudos Portugueses 28, no. 39 (June 30, 2008): 95. http://dx.doi.org/10.17851/2359-0076.28.39.95-99.
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<p>Este texto relata as duas visitas que Lúcio Cardoso faz a Mangaratiba, no Estado do Rio de Janeiro.</p> <p>This text reports two visits which Lúcio Cardoso does the Mangaratiba, in the State of the Rio de Janeiro.</p><p> </p>