Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study
An evaluation of two screening tools for cognitive impairment in older emergency department patients.
Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. ⋯ The SIS, using a cutoff of
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Randomized Controlled Trial
Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport.
Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. ⋯ TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.
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This article uses a case report and discussion to demonstrate the concept of active and latent failures, and the "systems approach" to the reduction of adverse events in medicine. The case involves an inadvertently misplaced and retained guidewire during femoral vein catheterization using the Seldinger technique, and the subsequent failure to identify the guidewire in the chest despite several chest radiographs and a computed tomography (CT) scan read by radiologists, emergency physicians, and intensivists. This event reveals active failures in the performance of the Seldinger technique, latent failures in the design of the catheter kit, and problems with the current system of interpretation of radiographs. The authors conclude that the design of the catheter kit and the Seldinger technique should be critically examined from a human factors standpoint and that radiographic interpretation is still heavily subject to human error.
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As an initial step in disseminating an emergency department (ED)-based quality improvement program (QIP) to improve antibiotic prescribing for patients with acute respiratory infections, the authors conducted a nationwide survey to assess the value and feasibility of the QIP. ⋯ Many EDs identify barriers to implementing an antibiotic QIP. Perceived and real barriers are important factors to consider in translating successful QIPs into routine clinical practice.
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Randomized Controlled Trial Comparative Study
Intensive intervention improves primary care follow-up for uninsured emergency department patients.
To test an intervention designed to improve primary care use and decrease emergency department (ED) utilization for uninsured patients using the ED. ⋯ This project has demonstrated that it is possible to improve primary care follow-up for uninsured ED patients.