Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Medical students are taught some procedural skills during medical school, but there is no uniform set of procedures that all students learn before residency. ⋯ In the cohort studied, new PGY1 EM residents had not attained competence in performing LPs from training in medical school. Most new PGY1 residents probably require training, practice, and close, direct supervision of this procedure by attending physicians until the residents demonstrate competent performance.
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Randomized Controlled Trial
Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport.
Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. ⋯ TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.
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Randomized Controlled Trial Comparative Study
An evaluation of two screening tools for cognitive impairment in older emergency department patients.
Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. ⋯ The SIS, using a cutoff of
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Controlled Clinical Trial
The effect of financial incentives on adherence with outpatient human immunodeficiency virus testing referrals from the emergency department.
Undiagnosed human immunodeficiency virus (HIV) infection is not uncommon among patients who seek care in urban inner-city emergency departments (EDs). The optimal method for providing appropriate HIV counseling, testing, and referral in this setting is unclear. A previous evaluation of an outpatient referral system for HIV testing among patients seen in the ED demonstrated that only 11% returned to be tested; of those tested, 7% were seropositive. The purpose of this study was to evaluate the effect of a financial incentive on the proportion of referred ED patients who completed outpatient HIV counseling and testing. ⋯ The use of a modest financial incentive increased the proportion of patients who completed HIV counseling and testing after being referred from the ED. It is unclear whether the use of a financial incentive increases the identification of HIV-infected patients unaware of their status or if it is cost-effective.
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As an initial step in disseminating an emergency department (ED)-based quality improvement program (QIP) to improve antibiotic prescribing for patients with acute respiratory infections, the authors conducted a nationwide survey to assess the value and feasibility of the QIP. ⋯ Many EDs identify barriers to implementing an antibiotic QIP. Perceived and real barriers are important factors to consider in translating successful QIPs into routine clinical practice.