Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

Apparent life-threatening event or child abuse?

Abstract: Children with apparent life-threatening events (ALTEs) often pose a diagnostic and management dilemma in a pediatric emergency department. Although the term ALTE is nonspecific and symptoms are vague, it may have alarming connotations and may signal serious life threatening conditions. It may be a subtle presentation of child abuse. We report an infant who was presented with an ALTE and subsequently determined to have subdural hematoma caused by nonaccidental injury.

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

Abstract: Background Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. Objective To develop a novel real-world dollar model to assess the direct and indirect cost–benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). Method A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. Results This cost–benefit model found a cost–benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. Conclusions If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients).

Do workshops in evidence-based practice equip participants to identify and answer questions requiring consideration of clinical research? A diagnostic skill assessment.

Abstract: Evidence-based practice (EBP) requires practitioners to identify and formulate questions in response to patient encounters, and to seek, select, and appraise applicable clinical research A standardized workshop format serves as the model for training of medical educators in these skills We developed an evaluation exercise to assess the ability to identify and solve a problem requiring the use of targeted skills and administered it to 47 North American junior faculty and residents in various specialties at the close of two short workshops in EBP Prior to the workshop, subjects reported prior training in EBP and completed a previously validated knowledge test Our post-workshop exercise differed from the baseline measures and required participants to spontaneously identify a suitable question in response to a simulated clinical encounter, followed by a description of a stepwise approach to answering it They then responded to successively more explicitly prompted queries relevant to their question We analyzed responses to identify areas of skill deficiency and potential reasons for these deficiencies Twelve respondents (26%) initially failed to identify a suitable question in response to the clinical scenario Ability to choose a suitable question correlated with the ability to connect an original question to an appropriate study design Prior EBP training correlated with the pretest score but not with performance on our exercise Overall performance correlated with ability to correctly classify their questions as pertaining to therapy, diagnosis, prognosis, or harm We conclude that faculty and residents completing standard workshops in EBP may still lack the ability to initiate and investigate original clinical inquiries using EBP skills