Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection.

RATIONALE: Nearly 60% of U.S. children live in counties with particulate matter less than or equal to 2.5 µm in aerodynamic diameter (PM2.5) concentrations above air quality standards. Understanding the relationship between ambient air pollution exposure and health outcomes informs actions to reduce exposure and disease risk. OBJECTIVES: To evaluate the association between ambient PM2.5 levels and healthcare encounters for acute lower respiratory infection (ALRI). METHODS: Using an observational case-crossover design, subjects (n = 146,397) were studied if they had an ALRI diagnosis and resided on Utah's Wasatch Front. PM2.5 air pollution concentrations were measured using community-based air quality monitors between 1999 and 2016. Odds ratios for ALRI healthcare encounters were calculated after stratification by ages 0-2, 3-17, and 18 or more years. MEASUREMENTS AND MAIN RESULTS: Approximately 77% (n = 112,467) of subjects were 0-2 years of age. The odds of ALRI encounter for these young children increased within 1 week of elevated PM2.5 and peaked after 3 weeks with a cumulative 28-day odds ratio of 1.15 per +10 µg/m3 (95% confidence interval, 1.12-1.19). ALRI encounters with diagnosed and laboratory-confirmed respiratory syncytial virus and influenza increased following elevated ambient PM2.5 levels. Similar elevated odds for ALRI were also observed for older children, although the number of events and precision of estimates were much lower. CONCLUSIONS: In this large sample of urban/suburban patients, short-term exposure to elevated PM2.5 air pollution was associated with greater healthcare use for ALRI in young children, older children, and adults. Further exploration is needed of causal interactions between PM2.5 and ALRI.

Assessing American Red Cross First Aid mobile app user trends: Implications for resilience.

OBJECTIVE: Disasters have devastated communities, impacted the economy, and resulted in a significant increase in injuries. As the use of mobile technology increasingly becomes a common aspect of everyday life, it is important to understand how it can be used as a resource. The authors examined the use of American Red Cross mobile apps and aimed to characterize user trends to better understand how mobile apps can help bolster individual and community preparedness, resilience, and response efforts. DESIGN/MAIN OUTCOME MEASURES: Tornado data were obtained from the National Oceanic and Atmospheric Administration and the National Weather Service. Data for the mobile apps were provided by the American Red Cross. All data were reviewed for 2013, 2014, and three specific tornado events. Data were organized in Microsoft Excel spreadsheets and then graphed or mapped using ArcMap 10.2(™). RESULTS: Between 2013 and 2014, 1,068 tornado watches and 3,682 tornado warnings were issued. Additionally, 37,957,560 Tornado app users and 1,289,676 First Aid app users were active from 2013 to 2014. Overall, there was an increase in the use of American Red Cross mobile apps during tornado occurrences. Yet the increase does not show a consistent correlation with the number of watches and warnings issued. CONCLUSIONS: Mobile apps can be a resourceful tool. This study shows that mobile app use increases during a disaster. The findings indicate that there is potential to use mobile apps for building resilience as the apps provide information to support individuals and communities in helping before, during, and after disasters.

Follow-up consultation billing and documentation.

Frequently, bills are not submitted for follow-up visits for patients who have been evaluated psychiatrically on medical-surgical services. There often is confusion regarding which procedure codes are most appropriate to use in billing. To help the consultant understand the documentation requirements for various procedure codes, information from several sources was synthesized and distilled. This paper should help minimize documentation errors and maximize reimbursement for clinical services. The authors have reviewed available billing choices, and clarified the documentation requirements for different procedure codes according to Medicare regulations.

Contact between psychotherapists and psychiatric residents who provide medication backup.

OBJECTIVE: Psychiatric residents frequently prescribe medication for patients who are in psychotherapy with another clinician. This study examined the extent and characteristics of communication between psychiatric residents and psychotherapists who treated patients in a university outpatient clinic. METHODS: Thirteen psychiatric residents who prescribed medications for 83 patients seen by other clinicians for therapy were surveyed about whether and how often during a five-month period they had contact with the therapist, who initiated the contact, and whether it took place with the patient's consent. Patients' charts were reviewed to determine if contacts were documented. RESULTS: The psychiatric residents indicated they had contact with the therapist in 44 of 83 cases (53 percent). Contact was initiated by the prescribing psychiatrist in 47.7 percent of the cases and by the therapist in 43.2 percent of the cases. The charts of only seven patients (8.4 percent) included written documentation of contact. CONCLUSIONS: Several steps are necessary to optimize communication between treating clinicians and documentation of such communication. They include initial contact to discuss the treatment contract and clarify each clinician's responsibilities, formal written consent from the patient, regular contacts between clinicians to discuss the patient's progress, and collaboration between clinicians on the patient's treatment plan.

Subclinical status epilepticus following ECT.

Subclinical status epilepticus is a rare complication of electroconvulsive therapy (ECT). We describe the case of a 70-year-old man with psychotic depression who developed prolonged subclinical status epilepticus following an initial ECT treatment; he subsequently received a course of ECT without complications. It is important to consider status epilepticus in the differential diagnosis of patients who do not regain consciousness following ECT, even in the absence of overt motor seizure activity. The development of this complication does not preclude the future use of ECT; in fact, ECT has been repeated successfully in individuals who developed this complication, including this case. Identification of potential risk factors, appropriate preventive measures, and early intervention are important in the management of this complication. The literature is reviewed and appropriate preventive and treatment measures are discussed.