Wireless E911 Emergency Communications Fund Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense independent auditor's reports, basic financial statements and supplementary information, June 30, 2008.

Audit report on the Wireless E911 Emergency Communication Fund of the Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense for the year ended June 30, 2008

Agreed upon procedures of the Iowa Department of Human Services, IowaCare Project for the year ended June 30, 2008

Agreed upon procedures of the Iowa Department of Human Services, IowaCare Project for the year ended June 30, 2008

Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score.

ABSTRACT: BACKGROUND: Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care. METHODS: Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group. RESULTS: The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774) revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81) with a sensitivity of 85.6% and a specificity of 47.2%. CONCLUSIONS: This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

Iowa Secretary of State 2008 Report, 2008

This report highlights the landmark election legislation adopted in the past two years and statistical information on absentee ballots, provisional ballots, and Election Day Registration. In addition, the report outlines the responsibilities of our Business Services Division which handles hundreds of thousands of corporate filings annually. The Secretary of State’s proposals to the 83rd General Assembly for 2009 legislation are mostly technical in nature and are also set forth in this report. The presidential election on November 4, 2008, brought more voters to the polls in Iowa than ever before. Despite fears of election day problems due to new voting equipment, Election Day Registration, and challenged voter procedures, the election went very smoothly in Iowa. The Elections and Voter Registration Division of my office worked diligently to provide training materials for election administrators and fielded thousands of calls and emails from voters. The result was an efficiently-run election statewide. Though the Secretary of State’s Office, like all other state agencies, is operating under strict budgetary constraints, I assure you that my staff and I will continue to provide excellent service and develop innovative solutions to get through these rough economic times.

Emergency Department use by patients aged 85 years and over, between 2005 and 2010 in a Swiss university hospital

Introduction: Population ageing challenges Emergency Departments (ED) with a population shift toward higher age groups. People over 65 years are heterogenous with respect to polymorbidity and functional capacity. Complex situations become more prevalent among patients aged 85+, the fastest growing segment of the elderly population (+72% between 2010 and 2030). Objectives: To identify the trend of ED admission rates for patients aged 85+ and to compare the characteristics of their ED visits with the one of patients aged 65-84. Method: Retrospective analysis of 56162 ED admissions of patients aged 65+ at the University of Lausanne Medical Center (CHUV), from 2005 to 2010. All visits of patients aged 65+ at the time of admission were considered. Analyses focus on demographic characteristics, living arrangement, hospital admission, and median Length of Stay (LOS) in the ED. Data from 2010 were examined for the degree of emergency (DE), the main reason for visiting the ED (Swiss triage scale) and readmission at 30 days. Results: Between 2005 and 2010, ED visits of patients aged 65 years and over increased from 8228 to 10390/year (with a slight decrease of women from 56% to 54%). This is an increment of +26% i.e. 5.9 patients/day more. Patients aged 85+ increased by +46% vs +20% for the 65-84. ED visits of people aged 18-64 years raised by +20%. Among patients over 65 years, the proportion of patients aged 85 and more increased from 23% in 2005 to 27% in 2010. In 2010, 85+ patients were more likely than 65-84 patients to come from a NH setting (13% vs 4%), to be hospitalised (70% vs 59%) and to stay longer in the ED (median LOS 9 hours vs 7 hours). Readmission to ED within 30 days after discharge did not differ (85+: 14% vs 65-84: 12%) (similar proportions in 2005). In 2010, the first reason for patients 85+ to visit ED was fall/injury (27% vs 18% by 65-84), whereas the main cause for patients aged 65-84 years was a cardiovascular disorder (18% vs 16% by 85+). The part of high emergency cases was similar for patients 85+ and 65-84 (42%). Conclusion: Among aged patients those aged 85 and over are the fastest growing group admitted to ED. Compared to their younger counterparts, their reason to visit ED and their pattern of health services utilization differ due to specific epidemiological conditions. ED addressing specific needs of geriatric patients would improve their care and lead to a better use of available resources.

Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system

Objectifs - Identifier les facteurs de vulnérabilité sociaux et médicaux associés au recours multiple aux consultations des urgences. - Déterminer si les patients à recours multiple sont plus à même de combiner ces facteurs dans un système d'assurance universelle. Méthode Il s'agit d'une étude cas-contrôle rétrospective basée sur l'étude de dossiers médico-administratifs comparant des échantillons randomisés de patients à recours multiple à des patients n'appartenant pas à cette catégorie, au sein des urgences du Centre Hospitalier Universitaire Vaudois et de la Policlinique Médicale Universitaire de Lausanne. Les auteurs ont défini les patients à recours multiple comme comptabilisant au moins quatre consultations aux urgences durant les douze mois précédents. Les patients adultes (>18 ans) ayant consulté les urgences entre avril 2008 et mars 2009 (période d'étude) étaient inclus ; ceux quittant les urgences sans décharge médicale étaient exclus. Pour chaque patient, le premier dossier d'urgence informatisé inclus dans la période d'étude était sélectionné pour l'extraction des données. Outre les variables démographiques de base, les variables d'intérêt comprennent des caractéristiques sociales (emploi, type de résidence) et médicales (diagnostic principal aux urgences). Les facteurs sociaux et médicaux significatifs ont été utilisés dans la construction d'un modèle de régression logistique, afin de déterminer les facteurs associés avec le recours multiple aux urgences. De plus, la combinaison des facteurs sociaux et médicaux a été étudiée. Résultats Au total, 359/Γ591 patients à recours multiple et 360/34'263 contrôles ont été sélectionnés. Les patients à recours multiple représentaient moins d'un vingtième de tous les patients des urgences (4.4%), mais engendraient 12.1% de toutes les consultations (5'813/48'117), avec un record de 73 consultations. Aucune différence en termes d'âge ou de genre n'est apparue, mais davantage de patients à recours multiples étaient d'une nationalité autre que suisse ou européenne (n=117 [32.6%] vs n=83 [23.1%], p=0.003). L'analyse multivariée a montré que les facteurs de vulnérabilité sociaux et médicaux les plus fortement associés au recours multiple aux urgences étaient : être sous tutelle (Odds ratio [OR] ajusté = 15.8; intervalle de confiance [IC] à 95% = 1.7 à 147.3), habiter plus proche des urgences (OR ajusté = 4.6; IC95% = 2.8 à 7.6), être non assuré (OR ajusté = 2.5; IC95% = 1.1 à 5.8), être sans emploi ou dépendant de l'aide sociale (OR ajusté = 2.1; IC95% = 1.3 à 3.4), le nombre d'hospitalisations psychiatriques (OR ajusté = 4.6; IC95% = 1.5 à 14.1), ainsi que le recours à au moins cinq départements cliniques différents durant une période de douze mois (OR ajusté = 4.5; IC95% = 2.5 à 8.1). Le fait de comptabiliser deux sur quatre facteurs sociaux augmente la vraisemblance du recours multiple aux urgences (OR ajusté = 5.4; IC95% = 2.9 à 9.9) ; des résultats similaires ont été trouvés pour les facteurs médicaux (OR ajusté = 7.9; IC95% = 4.6 à 13.4). La combinaison de facteurs sociaux et médicaux est fortement associée au recours multiple aux urgences, puisque les patients à recours multiple étaient dix fois plus à même d'en comptabiliser trois d'entre eux (sur un total de huit facteurs, IC95% = 5.1 à 19.6). Conclusion Les patients à recours multiple aux urgences représentent une proportion modérée des consultations aux urgences du Centre Hospitalier Universitaire Vaudois et de la Policlinique Médicale Universitaire de Lausanne. Les facteurs de vulnérabilité sociaux et médicaux sont associés au recours multiple aux urgences. En outre, les patients à recours multiple sont plus à même de combiner les vulnérabilités sociale et médicale que les autres. Des stratégies basées sur le case management pourraient améliorer la prise en charge des patients à recours multiple avec leurs vulnérabilités afin de prévenir les inégalités dans le système de soins ainsi que les coûts relatifs.

Intoxications alcooliques massives aux urgences: combien, qui, quoi et comment [Massive alcoholic poisoning in the emergency department: how many, who, what and how?].

Alcohol abuse causes numerous medical and social problems. In spite of the decrease of the global consumption of alcohol per capita in Switzerland during the last years, the cases of massive alcoholic poisoning seem increasing in emergency departments. Very few data is available at the moment on this phenomenon. The present article focuses on this problem within the framework of the emergency department of the CHUV. It aims at bringing to light on the sociodemographic and medical characteristics, as well as on the characteristics of the stay of these patients who are admitted with such a problem, to have a global vision of this phenomenon.

Médecine d'urgence [Emergency medicine: update 2008]

The emergency medicine appears more and more as a transversal discipline, leaning on specific competences regularly updated with evidence-based medicine concepts. This selection of recent articles presents an update on frequent conditions, including the place of neuroimaging for patients with seizures or minor head injuries, the management of acute cocaine intoxications, the diagnosis of aortic dissections, or the management of cardiopulmonary arrest. The primary care physician will find elements of diagnostic or therapeutic strategies. This selection reflects the dynamism of emergency medicine.

ROBETH: un logiciel pour les procédés statistiques robustes [ROBETH: a library for robust statistical procedures].

In the past 20 years the theory of robust estimation has become an important topic of mathematical statistics. We discuss here some basic concepts of this theory with the help of simple examples. Furthermore we describe a subroutine library for the application of robust statistical procedures, which was developed with the support of the Swiss National Science Foundation.

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2009

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2009

Fingerprint Card and Final Disposition Report Procedures, January 10, 2008

This is a manual produced by the Iowa Department of Public Safety on how to process a fingerprint card for an arrested person.

Wireless E911 Emergency Communications Fund Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense independent auditor's reports, basic financial statements and supplementary information, June 30, 2009.

Audit report on the Wireless E911 Emergency Communication Fund of the Iowa Homeland Security and Emergency Management Division of the Iowa Department of Public Defense for the year ended June 30, 2009