Articles: adult.
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To assess the performance of the newly implemented Canadian Emergency Department Triage and Acuity Scale (CTAS) triage system in a redesigned 200-bed community hospital emergency department (ED) and to evaluate the predictive validity of CTAS in this setting. ⋯ The CTAS is adaptable to countries beyond Canada and its operating objectives are achievable. Time to triage and fractile response rates can be considered indicators of triage quality and ED performance. CTAS is a valid instrument for predicting admission rates, hospital LOS and diagnostic utilization.
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Emergency physicians (EPs) are uniquely positioned to act as health advocates for individual patients, emergency department (ED) patient populations and the Canadian public. However, most ED practice environments do not encourage health advocacy, and staff EPs often do not feel adequately prepared to address many health-determinant issues. ⋯ At the University of Toronto, we have developed a new curriculum using evidence-based ED initiatives, examples of Canadian EP advocacy, and a description of organizations involved in advocacy, and we have incorporated several principles of adult learning to increase learner investment, maximize relevancy for EPs and optimize retention into practice. Residents believe the curriculum is highly relevant, allowing them to recognize advocacy opportunities in their own practices.
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Rev Bras Anestesiol · Jun 2003
[Processed electroencephalogram in children anesthetized with sevoflurane. Is it feasible?].
EEG-derived bispectral index (BIS), has been indicated as a major substrate for measuring hypnotic effects of anesthetic drugs. However, there are only limited data on the use of EEG in anesthetized children. This study aimed at evaluating changes in BIS, SEF95%, relative delta band frequency amplitude (d%) and suppression rate (SR) in children, correlating these changes with sevoflurane pharmacodynamic variables (EC and EC/MAC) as compared to adults. ⋯ Unlike d%, the variations of which seem brain maturation-related, BIS and SEF95% may be used to monitor sevofluranes anesthetic depth in children aged 0 to 12 years, observing the parameters suggested for adults.
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To examine age-related differences in pain, catastrophizing, and affective distress (depression and anxiety) after athletic injury and knee surgery. DESIGN AND SETTING: Participants were assessed with measures of pain intensity, pain-related catastrophizing, depression, and anxiety symptoms at 24 hours after anterior cruciate ligament (ACL) surgery. SUBJECTS: Twenty patients (10 adolescents, 10 adults) with an acute complete tear of the ACL. MEASUREMENTS: Pain was assessed by Visual Analog Scale (VAS), catastrophizing with the Pain Catastrophizing Scale (PCS), depressive symptoms with the Beck Depression Inventory (BDI), and anxiety with the state form of the State-Trait Anxiety Inventory (STAI-S). ⋯ After ACL surgery, athletic adolescents and adults differed significantly in pain, catastrophizing, and anxiety. Catastrophizing seemed to be a particularly strong factor in postoperative pain differences between adolescents and adults, with clinical-management implications. These data indicate the need for continued research into specific pain- and age-related factors during the acute postoperative period for athletes undergoing ACL surgery.
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Interact Cardiovasc Thorac Surg · Jun 2003
Repair of adult Scimitar syndrome with an intra-atrial conduit.
The management of Scimitar syndrome in adulthood is controversial, with no guidelines for surgical correction. We present the case of a 66-year-old woman who presented late in life with Scimitar syndrome and a significant left-to-right shunt. We describe repair using an intra-atrial conduit from the anomalous vein to the foramen ovale, with a successful outcome.