PubMed Health⌕ Search

Biomedical subjects

Sharon E Mace

Publications and source records attributed to Sharon E Mace.

12 recordsLinked to original sources
PubMed2006

Pediatric mental health emergencies in the emergency medical services system. American College of Emergency Physicians.

Emergency departments (EDs) are vital in the management of pediatric patients with mental health emergencies (MHE). Pediatric MHE are an increasing part of emergency medical practice because EDs have become the safety net for a fragmented mental health infrastructure which is experiencing critical shortages in services in all sectors. EDs must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses including those with mental retardation, autistic spectrum disorders, attention deficit hyperactivity disorder (ADHD), and those experiencing a behavioral crisis. EDs also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, post traumatic stress disorder, maltreatment, and those exposed to violence and unexpected deaths. EDs must address not only the physical but also the mental health needs of patients during and after mass casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support the following actions: advocacy for increased mental health resources, including improved pediatric mental health tools for the ED, increased mental health insurance coverage, adequate reimbursement at all levels; acknowledgment of the importance of the child's medical home, and promotion of education and research for mental health emergencies.

Adolescent↗
PubMed2006

Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department.

Patient- and family-centered care (PFCC) is an approach to health care that recognizes the role of the family in providing medical care, encourages collaboration between the patient, family, and health care professionals; and honors individual and family strengths, cultures, traditions, and expertise. Although there are many opportunities for providing PFCC in the emergency department, there are also challenges to doing so. The American Academy of Pediatrics and American College of Emergency Physicians support the following: promoting patient dignity, comfort, and autonomy; recognizing the patient and family as key decision makers in the patient's medical care; recognizing the patient's experience and perspective in a culturally sensitive manner; acknowledging the interdependence of child and parent as well as the pediatric patient's evolving independence; encouraging family member presence; providing information to the family during interventions; encouraging collaboration with other health care professionals; acknowledging the importance of the patient's medical home; and encouraging institutional policies for PFCC.

Child↗
PubMed2006

Pediatric mental health emergencies in the emergency medical services system.

Emergency departments are vital in the management of pediatric patients with mental health emergencies. Pediatric mental health emergencies are an increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. Emergency departments must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses, including those with mental retardation, autistic spectrum disorders, and attention-deficit/hyperactivity disorder and those experiencing a behavioral crisis. Emergency departments also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, posttraumatic stress disorder, and maltreatment and those exposed to violence and unexpected deaths. Emergency departments must address not only the physical but also the mental health needs of patients during and after mass-casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support advocacy for increased mental health resources, including improved pediatric mental health tools for the emergency department, increased mental health insurance coverage, and adequate reimbursement at all levels; acknowledgment of the importance of the child's medical home; and promotion of education and research for mental health emergencies.

Child↗
PubMed2005

Pediatric surgeons and pediatric emergency physicians' attitudes towards analgesia and sedation for incarcerated inguinal hernia reduction.

UNLABELLED: Inguinal hernias become incarcerated in 10% to -15% of children and reduction of the hernia is an urgent painful procedure. No recommendations exist for analgesia during this procedure. We surveyed pediatric emergency physicians (PEP) and pediatric surgeons (PS) for their analgesia and sedation use during the reduction. The survey was mailed to 19 centers in North America. A total of 56% (185/331) surveys were completed by PEP and 56% (68/122) from PS. A total of 96.7% (245/253) of responders reported giving analgesia or sedation during reduction. PS were more likely to use intravenous drugs, try for a longer time, wait longer between trials, and conduct more trials compared to the PEP. Clinically related variables were more important for PEPs than PS for analgesia and sedation. System-related variables were more important by PS for admission. PERSPECTIVE: This survey shows significant variability between specialties in the drugs, route, and number of attempts during reduction of a painful incarcerated hernia in children. Development of a sedation and analgesia protocol may be useful in order to unify management of pain and discomfort during hernia reduction.

Adult↗
PubMed2003

A national survey of observation units in the United States.

The objective of this study was to survey the use of observation units (OUs) in the United States. A written survey was mailed to every third hospital (sequential by zip code) in the United States. There was a 32.9% response to the survey (522 of 1588 hospitals). A total of 18.8% of hospitals had an OU with another 11.6% planning to open an OU. Those hospitals that had OUs had a higher overall ED census, higher rate of diversion of ambulances, and were more likely to be in metropolitan areas (P <.05), but there was no relationship to payor mix or to ED hospital admission rate. The OUs were characterized by a mean 4.8 years in existence, 57.3% ED administratively responsible, 59.4% ED clinically responsible, a mean of 1330 patients per year, an average length of stay of 15.3 hours, a 4.2 nurse-to-patient ratio, and 22.3% hospital admission rate.

Emergency Service, Hospital↗
PubMed2003

The death of a child in the emergency department.

The death of a child in the emergency department (ED) is often overwhelming to the child's community, including the health care providers involved in that child's care. Sudden death, especially of a child, induces a strong emotional response in health care providers and in the families involved. Advanced preparation by emergency staff is vital to appropriately care for the patient, the grieving family, and the ED staff. The American College of Emergency Physicians and the American Academy of Pediatrics have jointly adopted a policy statement entitled "Death of a Child in the Emergency Department Joint Statement by the American Academy of Pediatrics and the American College of Emergency Physicians." The purpose of this article is to provide the emergency physician with information related to the management of children and their families who die in the ED. The following important issues will be discussed: a family and team-centered approach when a child dies, support for families and communities, communication within the child's medical home, identification of resources for use when a child dies, and critical incident stress management.

Bereavement↗
PubMed2002

Observation medicine in emergency medicine residency programs.

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.

Education, Medical, Graduate↗
PubMedDate not supplied

An analysis of Disaster Medical Assistance Team (DMAT) deployments in the United States.

OBJECTIVE: To determine the prevalence and types of disasters on which Disaster Medical Assistance Teams (DMAT) teams have been deployed. METHODS: This descriptive study used the websites of the 42 DMAT teams in the United States with information confirmed by NDMS websites for a historical analysis of DMAT team deployment. All 42 DMAT teams were included in the analysis from 1985 through 2002. One DMAT team did not have a website, so they were contacted by phone. RESULTS: From 1985 through 2002 DMAT teams were deployed for 50 disasters: 41 natural (41/50=82%), and 9 man-made disasters (9/50=18%). Of the 41 natural disasters, there were 17 hurricanes/tropical storms (17/41=41.6%), 10 floods (10/41=24.3%), 7 earthquakes (7/41=17.0%), 4 fires (4/41=9.8%), 2 blizzards/ice storms (2/41=4.9%), and 1 tornado (1/41=2.4%). Of the 9 man-made disasters, there were 3 terrorist attacks (3/9=33.3%), 2 epidemics (2/9=22.2%), 2 plane crashes (2/9=22.2%), 1 fire (1/9=11.1%) and 1 relief mission (1/9=11.1%). Of the 8 disasters outside of the United States, there were 4 earthquakes (4/8=50%), 2 tropical storms (2/8=25%), 1 wildfire (1/8=12.5%) and 1 relief mission (1/8=12.5%). There were also numerous "stand-by" deployments. CONCLUSION: The majority (over 80%) of DMAT team deployments from 1985 through 2002 were for natural disasters, although there has been an increase in "man-made" disasters in recent years with terrorist attacks being the most frequent man-made disaster. DMAT teams have also been deployed on missions outside the United States, most often responding to earthquakes and secondly for hurricanes/tropical storms. There has been a prevalence of "water-related" natural disasters including hurricanes/tropical storms and floods, which accounted for three fourths of all natural disasters (25/34=73.5%) and about two thirds of all (natural and man-made) disasters (25/43=59.5%) in the United States over an 18 year period. Recent events including hurricane Katrina suggest that our finding of a prevalence of "water-related" natural disasters is a reliable trend. In the future, DMAT teams need to be prepared to function in a variety of disasters, both natural and man-made, although resources and planning must include "water-related" disasters because they comprise the majority of disasters in the United States.

Disasters↗
PubMedDate not supplied

Continuous quality improvement for the clinical decision unit.

Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

Benchmarking↗