Annals of emergency medicine
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Multicenter Study Comparative Study Clinical Trial
A multicenter study to improve emergency medicine residents' recognition of intracranial emergencies on computed tomography.
Cranial computed tomography (CT) has assumed a critical role in the practice of emergency medicine for the evaluation of intracranial emergencies. Several recent studies have documented a deficiency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of emergency medicine residents to interpret cranial CTs, and to test a novel method of cranial CT interpretation designed for the emergency physician in training. ⋯ Emergency medicine residents are deficient in their ability to interpret cranial CT scans. A novel educational course was demonstrated to significantly improve this ability.
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The emergence of vancomycin-resistant organisms is a major problem at many hospitals. Vancomycin use is associated with development of resistance. The objective of this study was to determine the appropriateness of vancomycin use in the emergency department. In addition, we sought to determine whether appropriateness of vancomycin use increased after the publication of the Centers for Disease Control and Prevention guidelines for prudent vancomycin use. ⋯ Overall vancomycin use rose each year despite an increase in the proportion with appropriate use. However, inappropriate use remained common. Emergency physicians and consultants should become familiar with national and local guidelines for prudent vancomycin use.
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This study was designed to identify patients who frequently use the emergency department, compare them with the general ED population, and determine why they choose the ED over other sources of medical care. ⋯ Frequent users of emergency care have access to other sources of primary care, but use the ED for complaints they believe are serious and need immediate attention. These patients often have chronic complaints and are more likely to be admitted to the hospital. Efforts to cut medical costs should not limit access to the ED, which often becomes an important source of medical care for such patients.
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To identify diagnostic predictors of return emergency department visits, and to compare actual and perceived associations between initial ED diagnosis and revisits to help identify target diagnoses for prevention strategies. ⋯ Initial ED diagnosis may be a useful predictor of early ED return and admission. Patients with an initial diagnosis of dehydration are at particularly high risk for early return and admission, yet providers underestimate the risk in this very common group. Screening a return ED population for high-frequency diagnoses may reveal underrecognized target groups for specific prevention strategies.
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Thirty years ago, the National Academy of Science paper, Accidental Death and Disability: The Neglected Disease of Modern Society, created EMS as we know it today. The document has served us well, but recent shifts in health care require new insights, goals, skills, and resources for continued success in EMS. The 1996 document EMS: Agenda for the Future merges the many facets of EMS into a common vision and lays out 3 areas for change-building bridges, creating infrastructure, and developing new tools and resources. Emergency physicians' leadership is essential to steer the EMS community toward a productive future that will strengthen the nation's emergency medical safety net for the next 30 years.