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Comprehensive Guidelines for Geriatric EDs

Comprehensive Guidelines for Geriatric EDs

The geriatric population in the United States is growing at a faster rate than the total population, and there will be an increasing need for healthcare among this patient group. “The aging population represents an unprecedented and overwhelming challenge to the healthcare system as a whole and to EDs specifically,” says Mark S. Rosenberg, DO, MBA, FACEP. Studies show that geriatric patients have 20% longer ED lengths of stay and use 50% more laboratory and imaging services than younger patients. Geriatric ED patients are also significantly more likely to require social services. It has been suggested that contemporary emergency medicine management models may be inadequate to care for the geriatric patient population. Published studies show that ED physicians often feel that they lack the proper training to manage geriatrics. “It’s challenging for ED physicians to manage older adults because they often have other medical comorbidities, take multiple medications, and present with complex physiologic changes,” Dr. Rosenberg says. “Programs specifically designed to address these concerns may substantially improve care. As the initial site of care for many health events, EDs have the opportunity to set the stage for subsequent care.” Geriatric EDs To enhance geriatric patient care in the emergency medicine setting, institutions throughout the U.S. have developed geriatric EDs, which are EDs dedicated to caring for older adults. The first such institutions appeared in the U.S. in 2008, but geriatric EDs have become increasingly common since that time. In response to the proliferation of geriatric EDs, the American College of Emergency Physicians (ACEP), the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine issued...
HIV Screening in the ED

HIV Screening in the ED

The CDC and other agencies have emphasized that EDs should offer HIV screening because of their high patient volume and access to vulnerable populations, says Michael S. Lyons, MD, MPH. “The problem, however, is that EDs are already overburdened and many don’t have the dedicated resources they need to increase testing rates.” Efforts to increase ED HIV screening are growing, but controversy persists about who should be tested. HIV screening has been advocated to detect as many cases as possible, but this requires many tests and brings concerns about feasibility and effectiveness. The alternative—selectively targeting screening only to those at higher risk—may increase the chances that a test will be positive and require fewer tests, but studies show that this approach often misses cases. Prior failures in targeting may have been due to incomplete implementation or overly narrow selection criteria. Comparing Approaches Dr. Lyons and colleagues conducted a study, published in JAIDS, comparing the efficacy of universal and targeted screening in the context of an opt-in ED HIV screening program. In the attempt to overcome concerns about the inadequacy of targeted screening, the authors tested and implemented an exceedingly comprehensive approach to targeting—for example, any possible indication of increased risk could trigger a test offer—and implemented the strategy fully. The study assessed 9,572 visits during which patients were approached for either targeted or universal screening. For universal screening, 40.8% consented but just 0.3% were newly diagnosed with HIV. For targeted screening, 47.4% of patients who had HIV testing indications consented but just 0.2% were newly diagnosed with HIV. “Ultimately,” Dr. Lyons says, “using this targeted screening strategy was unlikely...
The New Bionics That Let Us Run, Climb, and Dance

The New Bionics That Let Us Run, Climb, and Dance

Hugh Herr is building the next generation of bionic limbs, robotic prosthetics inspired by nature’s own designs. Herr lost both legs in a climbing accident 30 years ago; now, as the head of the MIT Media Lab’s Biomechatronics group, he shows his incredible technology in a talk that’s both technical and deeply personal — with the help of ballroom dancer Adrianne Haslet-Davis, who lost her left leg in the 2013 Boston Marathon bombing, and performs again for the first time on the TED stage. Source:...
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