Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Emergency medicine in the United States is facing tremendous challenges due to recent public health emergencies, continuing threats of bioterrorism, and an increasing and unprecedented demand for emergency department services. These challenges include overcrowding; long waiting times; "boarding" of patients; ambulance diversion; a need for better, more reliable tools for triaging patients; and medical errors and other patient safety concerns. These challenges and concerns were brought to the forefront several years ago by the Institute of Medicine in several landmark reports that call for closing the research-to-practice gap in emergency medicine. ⋯ The agency's Healthcare Cost and Utilization Project is gathering data that will allow researchers to examine a broad range of issues affecting the use, quality, and cost of emergency services. Although progress has been made over the past few years in closing the research-to-practice gap in emergency medicine, many challenges remain. The Agency for Healthcare Research and Quality has supported and will continue to support a broad portfolio of research to address the many challenges confronting emergency medicine, including ways to improve emergency care through the application of research findings.
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Randomized Controlled Trial
Adding long-acting beta-agonists to inhaled corticosteroids after discharge from the emergency department for acute asthma: a randomized controlled trial.
Relapses of asthma following emergency department discharge can be reduced with oral and inhaled corticosteroids (ICSs), but the benefits of long-acting beta-agonists (LABAs) are unclear. ⋯ Outpatient treatment with a short course of systemic corticosteroids combined with ICSs is adequate for most patients with asthma discharged from the emergency department; those already receiving ICS agents may benefit from ICS/LABA combination therapy to improve quality of life. Larger studies are needed to confirm the role of inhaled LABAs in acute asthma.
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Comparative Study
Reliability of a computerized version of the Pediatric Canadian Triage and Acuity Scale.
The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability. ⋯ A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.