Medicine
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Observational Study
Impact of a New Medical Record System for Emergency Departments Designed to Accelerate Clinical Documentation: A Crossover Study.
Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction. ⋯ The new EMR system significantly reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 ± 13.6 minutes vs 184.3 ± 13.6 minutes for standard system; P = 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings. The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction.
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Systemic activation of hemostasis and thrombosis has been implicated in tumor progression and metastasis. D-dimer has been used as an indicator for the thrombosis. Here, we investigated the role of the activation of coagulation in patients with metastatic gastric cancer by measuring D-dimer level. ⋯ In addition, the OS of patients with D-dimer levels <1.0 μg/mL at the first response evaluation was significantly longer than that of patients with D-dimer levels ≥1.0 μg/mL (22.0 vs 7.0 months, P = 0.009). The lower D-dimer levels (<1.0 μg/mL) at the first response evaluation after CTx was independent predictive factor for better survival in multivariate analysis (P = 0.037). This study suggests that D-dimer levels may serve as a biomarker for response to CTx and OS in patients with metastatic gastric cancer.
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The purpose of this study is to determine the features of second primary malignancies (SPMs) among patients with prior colorectal cancer (CRC) using a nationwide population-based dataset. Patients with CRC newly diagnosed between 1996 and 2011, and >1 year of follow-up were recruited from the Taiwan National Health Insurance database. Standardized incidence ratios (SIRs) of SPMs in patients with CRC were calculated. ⋯ The pattern of SPMs was distinct between patients with colon and rectal cancer. Age, men, COPD, cirrhosis, and dyslipidemia were independent risk factors for SPMs. Surveillance and education should be provided for survivors with respect to risk for SPMs.
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Refractory ventricular arrhythmia is a serious problem in acute myocardial infarction (AMI), with an extremely high mortality rate and limited effective treatment. Extracorporeal membrane oxygenation (ECMO) is useful to rescue patients with cardiopulmonary collapse. However, little is known about whether ECMO is a potential rescue technique for patients with refractory ventricular arrhythmia in AMI. ⋯ In multivariate Cox regression analysis, both the presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant predictive factors for both primary and secondary endpoints. ECMO is a feasible rescue therapy and bridge to revascularization in patients with refractory ventricular arrhythmia in acute myocardial infarction. The presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant prognostic factors.
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Out-of-hospital cardiac arrest (OHCA) is a crucial public health problem. To improve outcomes of patients after cardiac arrest, the American Heart Association promotes the concept of the chain of survival. We report a case of a 19-year-old man with no markedly past medical history who suffered from OHCA, and he was resuscitated with cardiopulmonary resuscitation, without interruption, during the rescue process for 120 minutes until return of spontaneous circulation (ROSC). ⋯ Therefore, the patient was diagnosed with Brugada syndrome. Postcardiac arrest care was performed after ROSC, including mild therapeutic hypothermia, hemodynamic monitoring and management, and ICD implantation, and then the patient completely recovered without any noticeable neurological or intellectual deficits in the follow-up examinations. Our case demonstrates that even after an OHCA with prolonged time (120 minutes) until ROSC, survival with a favorable neurological outcome is possible, provided implementation of an extremely effective rescue chain.