Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial
A mobile phone text message program to measure oral antibiotic use and provide feedback on adherence to patients discharged from the emergency department.
Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions. ⋯ Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge.
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The association between emergency department (ED) characteristics, ED director's perceptions of preventive services, and the availability of human immunodeficiency virus (HIV) screening are unknown. The authors hypothesized that, after adjusting for ED operational and demographic characteristics, teaching hospital status would be associated with increased availability, and ED crowding and ED director agreement with barriers to screening would be associated with decreased availability. ⋯ After adjusting for other ED operational and demographic characteristics, ED crowding and teaching hospital affiliation were not independently associated with the availability of HIV screening. EDs whose directors were concerned about the cost of preventive services were less likely to provide routine HIV screening. Addressing ED director's concerns about the added costs of ED preventive services, increasing social work availability, and implementing testing laws consistent with Centers for Disease Control and Prevention (CDC) recommendations may facilitate increased adoption of ED HIV screening.
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Comparative Study
Disagreement between emergency physician and inpatient physician diagnosis of infection in older adults admitted from the emergency department.
Older adults with infection are at increased risk of misdiagnosis while they are patients in the emergency department (ED) due to the common presence of nonspecific signs and symptoms. The primary objective was to determine the proportion of admitted older adult patients thought by the emergency physician (EP) to be infected, as compared with the diagnostic impression of inpatient physicians. The secondary objective was to determine the agreement between EP and inpatient physician diagnosis of specific infection types. ⋯ In older patients admitted from the ED, the provisional ED diagnosis and the inpatient diagnosis of an acute infection often disagree. In this sample, 18% of older ED patients diagnosed with infection during an ED stay were not diagnosed as infected by the inpatient physician. Regarding infection types, EPs were poor at diagnosing bacteremia and overdiagnosed pulmonary infections. EP diagnosis of skin and soft tissue infection generally agreed with the inpatient physician. There was also disagreement regarding presence of UTI, but the true nature of this difference is unclear from the data obtained in this study.
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The objective was to assess the performance of a clinical practice guideline for evaluation of possible appendicitis in children. The guideline incorporated risk stratification, staged imaging, and early surgical involvement in high-risk cases. ⋯ The clinical practice guideline performed well in a general teaching hospital. Rates of negative appendectomy and missed appendicitis were low and 58% of patients were managed without a CT scan.
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Comparative Study
A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations.
The objective was to evaluate the cost-effectiveness of dexamethasone versus prednisone for the treatment of pediatric asthma exacerbations in the emergency department (ED). ⋯ This decision analysis model illustrates that use of 2 days of dexamethasone instead of 5 days of prednisone at the time of ED visit for asthma leads to a decreased number of ED visits and hospital admissions within 7 to 10 days of the sentinel ED visit and provides cost savings.