Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of an adult-learning, self-directed model compared with traditional lecture-based teaching methods in out-of-hospital training.
Until recently, the U.S. Army Combat Medic School used a traditional teaching model with heavy emphasis on large group lectures. Skills were taught separately with minimal links to didactics. ⋯ In this study setting, an adult-learning model offers only a modest improvement in cognitive evaluation scores over traditional teaching when measured at the end of the course. Additionally, students in the traditional teaching model assess themselves as proficient more frequently than instructors, whereas instructor and student perception of proficiency more closely matched in the adult-learning model.
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Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. ⋯ However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.
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No single universal definition of emergency department (ED) overcrowding exists. The authors hypothesize that a previously developed site-sampling form for academic ED overcrowding is a valid model to quantify overcrowding in academic institutions and can be used to develop a validated short form that correlates with overcrowding. ⋯ Overcrowding varied widely between academic centers during the study period. Results of a five-question reduced model are valid and accurate in predicting the degree of overcrowding in academic centers.
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No widely used triage instrument accurately assesses patient acuity. The Emergency Severity Index (ESI) promises to facilitate reliable acuity assessment and possibly predict patient disposition. However, reliability and validity of ESI scores have not been established in emergency departments (EDs) outside the original research sites, and version 3 (v.3) of the ESI has not been evaluated. The study hypothesis was that scores on the ESI v.3 show good interrater reliability and predict hospital admission, admission site, and death. ⋯ Scores on the ESI assigned by nurses have excellent interrater reliability and predict hospital admission and location of admission.