OBJECTIVE: The purpose of this study was to report utilization of chiropractic care during The World Games 2017 in Wroclaw, Poland.
METHODS: A retrospective analysis was performed on treatment records. Thirty-five chiropractors trained in sports injuries provided care for athletes and non-athletes (support personnel) who voluntarily sought chiropractic care. Data included demographics (age, sex, role, country, and sport), category of anatomical regions treated, treatment modality (manipulation, myotherapy, mobilization, taping, and other), and participants\' self-reported pain ratings.
RESULTS: A total of 1902 completed treatment forms representing 1902 encounters were included for athletes (n = 1238, 65%) and non-athletes (n = 664, 35%). There were 9385 individuals (athlete or non-athlete). Five hundred ninety of 3666 (16%) athletes and 422 of 5719 (7%) non-athletes received chiropractic treatment. Athletes represented 28 of 31 (90%) sports and 79 of 108 (73%) countries present. The thoracic spine was the most frequently treated spinal region (n = 846, 44%), followed by lumbar spine (n = 831, 44%) and cervical spine (n = 725, 38%). Frequency of treatment modalities was manipulation (n = 1610, 82%), myotherapy (n = 1522, 80%), mobilization (n = 607, 32%), and taping (n = 380, 20%). Acute injuries were more prevalent for athletes (61%) than non-athletes (35%), and athletes sought follow-up care (54%) more than non-athletes (36%). Overall, 89% of participants reported pain reduction immediately after treatment.
CONCLUSIONS: This article describes chiropractic care utilization at a multisport event as part of a health care team. The range of treatments included manipulation myotherapy, mobilization, and taping. Although a minority of athletes and non-athletes received chiropractic treatment, many participants reported pain reduction immediately after treatment.

Nurses who provide the majority of hands-on care for hospitalized patients are disproportionately affected by the current state of electronic health records (EHRs), and little is known about their lived perception of EHR use. Using a mixed-methods research design, we conducted an in-depth analysis and synthesis of data from EHR usage log files, interviews, and surveys and assessed factors contributing to the nurse documentation burden in acute and critical at a large academic medical center. There remain substantial spaces where we can develop viable solutions for enhancing the usability of multi-component EHR systems.

BACKGROUND: Service use among employees with mental health problems and the associated costs for the health and social system have not yet been systematically analysed in studies or have only been recorded indirectly. The aim of this article is to report the service use in this target group, to estimate the costs for the health and social system and to identify possible influencing factors on the cost variance.
METHODS: As part of a multicentre study, use and costs of health and social services were examined for a sample of 550 employees with mental health problems. Service use was recorded using the German version of the Client Sociodemographic Service Receipt Inventory (CSSRI). Costs were calculated for six months. A generalized linear regression model was used to examine influencing cost factors.
RESULTS: At the start of the study, the average total costs for the past six months in the sample were € 5227.12 per person (standard deviation € 7704.21). The regression model indicates significant associations between increasing costs with increasing age and for people with depression, behavioural syndromes with physiological symptoms, and other diagnoses.
CONCLUSIONS: The calculated costs were similar in comparison to clinical samples. It should be further examined in longitudinal studies whether this result changes through specific interventions.
UNASSIGNED: EINLEITUNG: Die Inanspruchnahme von Leistungen durch Arbeitnehmer:innen mit psychischen Belastungen sowie die damit verbundenen Kosten im Gesundheits- und Sozialsystem wurden bisher nicht systematisch in Studien erhoben bzw. nur indirekt erfasst. Diese Publikation hat zum Ziel, die Inanspruchnahme in dieser Zielgruppe zu dokumentieren, die Kosten im Gesundheits- und Sozialsystem erstmalig abzuschätzen und mögliche Einflussfaktoren der Kostenvarianz zu untersuchen.
METHODS: Als Teil einer Multicenter-Studie wurden Häufigkeiten der Inanspruchnahme sowie Kosten im Gesundheits- und Sozialsystem von 550 Arbeitnehmer:innen mit psychischen Belastungen erhoben. Die Inanspruchnahme von Leistungen wurde mit der deutschen Version des Client Sociodemographic Service Receipt Inventory (CSSRI) erhoben. Kosten wurden für 6 Monate berechnet. Mithilfe eines Regressionsmodells wurden Einflussfaktoren auf die Kosten überprüft.
UNASSIGNED: Zu Studienbeginn betrugen die durchschnittlichen Gesamtkosten der vergangenen 6 Monate in der Stichprobe € 5227,12 (Standardabweichung € 7704,21). Das Regressionsmodell weist auf einen signifikanten Anstieg der Kosten mit zunehmendem Alter sowie bei Personen mit Depressionen, Verhaltensauffälligkeiten mit körperlichen Symptomen und anderen Diagnosen hin.
CONCLUSIONS: Die berechneten Kosten sind im Vergleich zu klinischen Stichproben ähnlich hoch. Des Weiteren sollte zukünftig untersucht werden, ob sich dieses Ergebnis durch die Analyse der Längsschnittdaten verändert und ob die Intervention einen Kosteneinfluss aufweist.

OBJECTIVE: To identify the perceived factors contributing to imaging overuse in the emergency department, according to radiologists and emergency physicians.
METHODS: A survey study on imaging overuse in the emergency department was conducted among 66 radiologists and 425 emergency physicians. Five-point Likert scales (not a problem at all/strongly disagree [score 1] to very serious problem/strongly agree [score 5]) were used to score the various aspects of overimaging.
RESULTS: Both radiologists and emergency physicians gave a median score of 4 to the question if imaging overuse is a problem in their emergency department. CT accounts for the vast majority of imaging overuse, according to both radiologists (84.8%) and emergency physicians (75.3%). Defensive medicine/fear of malpractice, the presence of less experienced staff, and easy access to imaging all were given a median score of 4 as factors that influence imaging overuse, by both physician groups. Median ratings regarding the influence of pressure from patients and a lack of time to examine patients on imaging overuse varied between 3 and 4 for radiologists and emergency physicians. Pressure from consultants to perform imaging, the use of imaging to decrease turnaround time in the emergency department, a lack of space in the emergency department, a lack of proper medical education, and inability to access outside imaging studies, were also indicated to give rise to imaging overuse.
CONCLUSIONS: Imaging overuse in the emergency department (particularly CT overuse) is a problem according to most radiologists and emergency physicians, and is driven by several factors.

OBJECTIVE: To investigate psychiatric service use depending on distances (travel times) to inpatient and outpatient service sites.
METHODS: Retrospective cohort analysis of all patients aged 18-64 years who had been treated in a Swiss psychiatric services system in 2022.
RESULTS: Outpatient service utilization rates decreased statistically significantly with increasing distance (travel time by public transportation) between the place of residence and the responsible outpatient clinic. For inpatient utilization, the distance decay effects were much less strong and did not always reach a statistically significant level.
CONCLUSIONS: In an easily accessible and economically reasonable psychiatric services system, inpatient and specialized services should be organized centrally, while general outpatient psychiatric services should be planned decentralized and close to the communities where people live.
UNASSIGNED: Untersuchung der psychiatrischen Inanspruchnahme in Abhängigkeit von der Anreisezeit zu den Behandlungsangeboten.
METHODS: Retrospektive Analyse der Inanspruchnahmekohorte 2022 (18–64 Jahre alt) in einem psychiatrischen Dienst in der Schweiz.
UNASSIGNED: Die bevölkerungsbezogenen ambulanten Inanspruchnahmeraten nahmen mit zunehmender Distanz (Reisezeit im öffentlichen Verkehr) zwischen den Wohngemeinden und den zuständigen Ambulatorien deutlich und statistisch signifikant ab. Für die stationäre Inanspruchnahme fanden sich deutlich geringere Distanzeffekte.
UNASSIGNED: In einem gut zugänglichen und ökonomisch vernünftigen psychiatrischen Versorgungssystem sollten stationäre und spezialisierte Angebote zentral organisiert werden, während ambulante, allgemeinpsychiatrische Angebote eher dezentral und wohnortsnah zu planen sind.

暂无摘要。

OBJECTIVE: To investigate variations in intended utilization in cases of an acute psychotic episode, an alcohol related or depressive disorder depending on different case characteristics.
METHODS: A telephone survey with case vignettes was conducted (N=1,200). Vignettes varied in terms of urgency of symptoms, daytime, sex of the afflicted person and age/mental disorder. The respondents were asked to indicate whom they would contact first in the described case.
RESULTS: Outpatient physicians were named most frequently as the first point of contact (61.1%) while only 6.5% of the respondents named emergency medicine including the medical on call service (8.1% in high urgency cases, i. e. emergencies that did not tolerate any delay). Intended utilization varied by urgency and age/mental illness.
CONCLUSIONS: More Information about the need to seek medical help immediately in cases of mental illnesses with high urgency should be provided.
UNASSIGNED: Die Untersuchung von Variationen intendierter Inanspruchnahme in Fällen einer psychotischen Episode, einer alkoholbezogenen oder depressiven Störung in Abhängigkeit unterschiedlicher Falleigenschaften.
METHODS: Eine telefonische Befragung mit Fallvignetten wurde durchgeführt (N=1.200). Die Vignetten variierten hinsichtlich Dringlichkeit, Tageszeit, Geschlecht und Alter/ Erkrankung. Die Befragten sollten angeben, an wen sie sich in den beschriebenen Fällen als erstes wenden würden.
UNASSIGNED: Niedergelassene Ärzt*innen wurden am häufigsten als erste Anlaufstelle genannt (61,1%), wohingegen nur 6,5% der Befragten notfallmedizinische Angebote nannten (8,1% bei hoher Dringlichkeit, d. h. Notfälle, die keinen Aufschub duldeten). Die intendierte Inanspruchnahme variierte in Abhängigkeit von der Dringlichkeit und dem Alter bzw. der Erkrankung.
UNASSIGNED: Es sollte verstärkt darüber aufgeklärt werden, dass es bei dringlichen psychischen Beschwerden notwendig ist, umgehend medizinische Hilfe aufzusuchen.

BACKGROUND: We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient\'s hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs.
METHODS: We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients\' inpatient designation prior to discharge and change the patient\'s designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019.
RESULTS: A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review.
CONCLUSIONS: This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.

暂无摘要。

BACKGROUND: The aim of this study was to obtain a differentiated view of interventions delivered by community paramedics (Gemeindenotfallsanitäter, G‑NFS) in older people in need of care living in nursing homes and at home.
METHODS: A retrospective analysis of G‑NFS documentation from 2021 with a focus on patients aged ≥65 years was performed. Data were grouped into callouts to nursing homes or private homes. Interventions, urgency, transport, and further recommendations were analyzed descriptively.
RESULTS: Of 5,900 G-NFS protocols, 43.0% (n = 2,410) were related to elderly people (mean age 80.8 years, 49.7% female). A total of 20.6% of these callouts involved nursing home residents, 38.4% (n = 926) were homecare patients, and 41% (n = 988) of callouts were to persons who did not rely on care. No specific interventions except advice were given to 48.4% of nursing home residents, and to even 82.1% of those in homecare and 83.7% of those without care needs. About 60% of the G‑NFS interventions were classified as non-urgent. Transport was waived for 63.1% of nursing home residents, for 58.1% in homecare, and for 60.6% of persons without care needs. A visit to the emergency department was recommended to 29.4% of nursing home residents, 37.6% of homecare patients, and 33.6% of persons without need of care. Measures related to urine catheters were documented much more often in nursing homes (38.5%) than in patients in homecare (15.1%) or without need of care (9.3%).
CONCLUSIONS: Community paramedics perform primary care tasks and can contribute to a reduction in unnecessary transport. It should be discussed whether the emergency medical service is responsible for such interventions and how older people in need of care can be cared for according to their needs in the future.
UNASSIGNED: HINTERGRUND: Ziel der Arbeit war eine differenzierte Betrachtung der Rettungsdiensteinsätze von Gemeindenotfallsanitätern (G-NFS) bei älteren Pflegebedürftigen im Pflegeheim und in der Häuslichkeit.
METHODS: Retrospektive Auswertung aller G‑NFS-Einsatzprotokolle aus dem Jahr 2021 von älteren Patienten (≥65 Jahre), unterteilt nach den Einsatzorten Pflegeheim, häusliche Pflege und nichtpflegebedürftig. Es wurden Maßnahmen, Dringlichkeit, Transport und Empfehlung deskriptiv analysiert.
UNASSIGNED: Von 5900 G‑NFS-Protokollen entfielen 43,0 % (n = 2410) auf ältere Patienten (Durchschnittsalter 80,8 Jahre, 49,7 % weiblich). Die Einsätze erfolgten mit 20,6 % (n = 496) bei Pflegeheimbewohnern, 38,4 % (n = 926) bei Pflegebedürftigen in häuslicher Versorgung und 41 % (n = 988) bei Nichtpflegebedürftigen. Eine Beratung erhielten 48,4 % der Pflegeheimbewohner, 82,1 % der Pflegebedürftigen in häuslicher Versorgung und 83,7 % der Nichtpflegebedürftigen. Etwa 60 % der Einsätze wurden bei allen Einsatzorten als nichtdringlich eingestuft. Auf Transporte wurde bei 63,1 % der Pflegeheimbewohner, 58,1 % der Pflegebedürftigen in häuslicher Versorgung und 60,6 % der Nichtpflegebedürftigen verzichtet. Ein Besuch der Notaufnahme wurde 29,4 % der Pflegeheimbewohner, 37,6 % der Pflegebedürftigen in häuslicher Versorgung und 33,6 % der Nichtpflegebedürftigen empfohlen. Dauerkatheter wurden häufiger im Pflegeheim (38,5 %) versorgt als in häuslicher Versorgung (15,1 %) und bei Nichtpflegebedürftigen (9,3 %).
UNASSIGNED: G‑NFS übernehmen primärversorgende Aufgaben und können zu einer Reduzierung unnötiger Transporte beitragen. Es muss jedoch diskutiert werden, inwieweit der Rettungsdienst für solche Einsätze zuständig ist und wie ältere Pflegebedürftige zukünftig bedarfsgerecht versorgt werden können.