Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Inclusion of a measure of comorbidity in trauma scoring has been suggested due to the potential for preexisting conditions to impact on patient outcomes, but studies have reported varied results. The Charlson Comorbidity Index (CCI) includes 19 diseases weighted on the basis of their association with mortality, and can be extrapolated from International Classification of Diseases, Ninth Revision (ICD-9) codes for administrative databases. ⋯ While the CCI can be extrapolated from ICD codes and provides a measure of comorbid condition severity and was associated with mortality, addition of the CCI to prediction models did not result in a substantial improvement in performance.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: a double-blind, randomized, controlled trial.
Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of acute pain. However, to the best of the authors' knowledge, no previous reports have compared the efficacies of these commonly prescribed agents. ⋯ Treatment with acetaminophen and either oxycodone, 5 mg po, or hydrocodone, 5 mg po, resulted in pain relief among ED patients with acute fractures, and there was no difference between the two agents at 30 and 60 minutes. Adverse effect profiles were similar, with the exception of a higher incidence of subsequent constipation with the use of hydrocodone. These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures.
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Despite numerous advances in medicine, sepsis remains an unconquered challenge. Although outcomes have improved slightly over decades, the unacceptably high mortality rate of 30%-50% for severe sepsis and septic shock continues. However, after years of unsuccessful clinical trials, several investigations over the last few years have reported survival benefit in the treatment of sepsis. ⋯ Clinicians must change the approach to this disease, as well as the way the septic patient is viewed. Although complex and challenging, these therapies must be brought to the patient's bedside. We propose and describe the Multiple Urgent Sepsis Therapies (MUST) protocol as a practical way to implement a comprehensive treatment plan using available evidence-based therapies.
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During the 2003 severe acute respiratory syndrome (SARS) outbreak, health care workers (HCWs) experienced unusual stressors. The study hospital introduced psychosocial interventions to help HCWs. This study aimed to examine the coping strategies adopted by the emergency department (ED) HCWs who cared for the SARS patients. ⋯ With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.
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There are numerous resources available to help educators of medical students improve their methods of instruction. For example, several Internet sites exist that describe specific ways to teach and reinforce concepts basic to emergency medicine. ⋯ Educators may wish to take advantage of distance learning programs that offer instruction in areas such as adult learning, curriculum and teaching methods, and medical education evaluation and research. Finally, educators may wish to participate in professional development opportunities such as fellowships and online modules that have been designed to offer instruction on teaching skills, provide an arena for exchange of effective techniques, and acclimate faculty to academic medicine.