Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The objective was to examine the effectiveness of triage liaison physicians (TLPs) on mitigating the effects of emergency department (ED) overcrowding. ⋯ While the evidence summarized here suggests that to have a TLP is an effective intervention to mitigate the effects of ED overcrowding, due to the weak research methods identified, more research is required before its widespread implementation.
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For the first time in history, four generations are working together-traditionalists, baby boomers, generation Xers (Gen Xers), and millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. ⋯ Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another.
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A standard value for the minimum clinically significant difference (MCSD) in pain in nonelderly ED patients has been identified and has facilitated research in this age group. It is not clear that this value is similar in older patients. The standard method for calculating the MCSD in pain is to average scores on a numerical rating scale (NRS) over contiguous time periods. This method is based on the assumption that the MCSD remains constant over time. In an earlier hypothesis-generating study of elderly patients, this assumption was not met for the arithmetic MCSD, making it difficult to identify a single benchmark for measuring efficacy in analgesia trials in elders. The proportional MCSD was more stable, suggesting that it might constitute a better measure of analgesic efficacy in elderly patients. The objective of the study was to test the hypotheses that: 1) the arithmetic MCSD in adults 65 years and older declines over time and that 2) the proportional MCSD remains constant. ⋯ Both the arithmetic and the proportional MCSD in elderly patients in acute pain declined over time. Because both measures were numerically unstable, there does not appear to be a single value for the MCSD that can be used to identify the MCSD in pain for use in analgesic efficacy trials in elderly patients. A different metric may be needed to study pain and assess comparative analgesic efficacy in elderly patients.
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Obesity constitutes an independent predictor for a nondiagnostic screening ultrasound (US) in suspected appendicitis. Furthermore, the imaging route consisting of the screening US with a second US if necessary has a significantly lower diagnostic accuracy in the obese children (83%) than their lean counterparts (93%). However, the effect of this association on clinical outcomes in the obese population is unknown. ⋯ Previously healthy obese children undergoing screening US for suspected appendicitis experienced comparable clinical outcomes to their normal-weight counterparts. However, they were three times more likely to receive a CT scan during their investigation. These results argue for continuing current practice of using the screening US in this population, followed by a CT if clinically warranted upon reexamination.