Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Rapid two-stage emergency department intervention for seniors: impact on continuity of care.
A two-stage intervention comprising screening and a brief standardized nursing assessment and referral, for emergency department (ED) patients aged 65 years and over, reduced the rate of functional decline four months after the visit, without increasing societal costs. In this study, the authors investigated the effects of the intervention on the process of care at, and during the month after, the ED visit. ⋯ The beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician.
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial of intravenous aminophylline for atropine-resistant out-of-hospital asystolic cardiac arrest.
Myocardial ischemia, during cardiopulmonary arrest, can lead to atropine-resistant bradyasystole from interstitial accumulation of endogenous adenosine. Aminophylline is a nonspecific adenosine receptor antagonist capable of reversing ischemia-induced bradyasystole in a variety of settings. The hypothesis of this study was that aminophylline improves the rate of return of spontaneous circulation (ROSC) in atropine-resistant asystolic out-of-hospital cardiac arrest when used early in the resuscitation effort. ⋯ Addition of aminophylline appears to be a promising new intervention in the ACLS treatment of atropine-resistant asystolic out-of-hospital cardiac arrest.
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Multicenter Study
Patient satisfaction data as a quality indicator: a tale of two emergency departments.
Patient satisfaction is a commonly measured indicator of quality emergency care. However, the existing empirical literature on emergency department (ED) patient satisfaction provides little guidance on how to analyze, interpret, and use data obtained in the clinical setting. Using two EDs as examples, the authors describe practical strategies designed to identify priority areas for potential improvement. ⋯ A combination of applying explicit acceptability criteria to descriptive statistics and using correlation coefficients with overall satisfaction can help to maximize the usefulness of patient satisfaction data by uncovering priority areas. These priority areas were broken down into maintenance and remediation indicators and were found to vary considerably depending on the hospital in question. Such strategies can help to refine performance improvement efforts by targeting those domains with the greatest impact on overall satisfaction.
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Multicenter Study
Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department.
Plasma B-type natriuretic peptide (BNP) can reliably identify acute congestive heart failure (CHF) in patients presenting to the emergency department (ED) with acute dyspnea. Heart failure, asthma, and chronic obstructive pulmonary disease (COPD) are syndromes where dyspnea and wheezing are overlapping signs, and hence, these syndromes are often difficult to differentiate. ⋯ The yield of adding routine BNP testing in patients with a history of asthma or COPD in picking up newly diagnosed CHF is approximately 20%. This group of patients presents a substantial therapeutic opportunity for the initiation and chronic administration of ACEI and BB therapy, as well as other CHF management strategies.
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Emergency physicians commonly perform death notifications. Physician training in death notification has been limited. Resident physicians are rarely evaluated in their performance of death notifications. ⋯ Death notification is a skill that can be evaluated like other EM skills. Trained EM residents performed well in actual death notifications when directly observed and evaluated. Senior residents and female residents were more likely to be rated excellent.