Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Bedside teaching is a valuable instructional method that facilitates the development of history and physical examination skills, the modeling of professional behaviors, and the direct observation of learners. The emergency department (ED) is an ideal environment for the practice of bedside teaching, because its high patient volume, increased acuity of illness, and variety of pathology provide plentiful patient-centered teaching opportunities. ⋯ The authors propose several practical strategies to increase bedside teaching by academic emergency physicians (EPs). These techniques emphasize careful preparation and a focused teaching approach to overcome the inherent challenges of a typically busy ED shift.
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Comparative Study
Clinical and economic factors associated with ambulance use to the emergency department.
Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. ⋯ Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means.
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Randomized Controlled Trial Comparative Study
Asthma coaching in the pediatric emergency department.
Coaching and monetary incentives have been used to modify medical behavior of individuals with several chronic diseases, including asthma. The authors performed a randomized, controlled trial of an intervention combining asthma coaching during an emergency department (ED) visit for asthma, and monetary incentive to improve follow-up with primary care providers (PCP). ⋯ An intervention combining asthma coaching during acute ED visits and a monetary incentive to return for a PCP visit does not appear to increase follow-up with the PCP.
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Randomized Controlled Trial Multicenter Study
A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology.
Therapeutic hypothermia has been shown to be of benefit in improving neurological outcome in cardiac arrest. It now is being investigated in acute stroke and myocardial infarction. The majority of the literature describes its use in intubated, pharmacologically paralyzed patients, using surface cooling techniques that are susceptible to patient shivering, imprecise temperature control, time lag to target-temperature acquisition, and rebound hyperthermia. ⋯ This is a method by which a rapid and precise therapeutic decrease in core temperature can be achieved without the necessity for intubation or neuromuscular blockade and with minimal patient discomfort or shivering.
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Randomized Controlled Trial Comparative Study
The verbal numeric pain scale: effects of patient education on self-reports of pain.
Emergency department (ED) patients are frequently asked to provide a self-report of the level of pain experienced using a verbal numeric rating scale. ⋯ Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self-reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.