Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Review Case Reports
Profiles in patient safety: authority gradients in medical error.
The term "authority gradient" was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority. A number of unintentional aviation, aerospace, and industrial incidents have been attributed, in part, to authority gradients. ⋯ The concept that authority gradients might contribute to medical error is largely unrecognized. This article presents one case and a series of examples to detail how authority gradients can contribute to medical error, and describes methods used in other disciplines to avoid their potentially negative impact.
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In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections. ⋯ In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of valdecoxib and an oxycodone-acetaminophen combination for acute musculoskeletal pain in the emergency department: a randomized controlled trial.
Oral opioids are potent analgesics that are used to treat acute pain in the emergency department (ED). However, they are associated with adverse events such as sedation that may delay safe patient discharge. ⋯ Valdecoxib is as effective as an oxycodone-acetaminophen combination in treating ED patients with acute musculoskeletal pain at 30 minutes and less likely to cause sedation or the need for rescue analgesia over the next day.
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Comparative Study
Analysis of costs, length of stay, and utilization of emergency department services by frequent users: implications for health policy.
In efforts to decrease emergency department (ED) crowding and health care costs, frequent users of ED services have been targeted for interventions to decrease their utilization. Previous studies have had different definitions for "frequent users" and have considered all frequent users as a homogeneous group. To the authors' knowledge, no study has examined visit characteristics and resource utilization of different levels of frequent use. ⋯ Frequent ED users are a heterogeneous group. Many patients previously thought to overutilize the ED for socioeconomic or insignificant medical problems are as sick as less-frequent ED users. There is a small subgroup with more than 20 visits who are less ill or injured but also incurred lower-than-average costs per visit.
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Evidence-based medicine (EBM) is the rubric for an approach to learning and practicing medicine that applies skills from clinical epidemiology, library science, and information management to clinical practice. Teaching EBM effectively requires a longitudinal approach throughout medical education. This presents many opportunities for academic emergency physicians, especially in the setting of an emergency medicine clerkship. ⋯ Bedside teaching of EBM also requires ready access to modern information resources. Other venues for teaching EBM include morning report, teaching conferences, and journal clubs. Many tools can be used to aid the process, including Web-based sources such as UpToDate, textbooks, and Web-based tutorials, educational prescriptions, and critically appraised topics.