Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Clinical Trial
Frequent users of the emergency department: can we intervene?
To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utilization by frequent ED users. ⋯ The use of individualized care plans and case management did not significantly decrease ED utilization by frequent ED users. However, the impact of individualized care plans and case management on other quality-of-care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary care visits, and health care costs) remains to be determined.
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To determine which characteristics of older patients who use a hospital ED are associated with repeat visits during the 90 days following the index visit. ⋯ Self-reported risk factors can help to identify a group of elders likely to make repeated ED visits; the development of a screening instrument incorporating questions on these problems and implementation of appropriate interventions might improve these patients' quality of life and reduce the demand for further ED care in this age group.
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To identify characteristics associated with provision of bystander CPR in witnessed out-of-hospital cardiac arrest cases. ⋯ Patients who have had witnessed cardiac arrests outside the home are nearly 4 times more likely to receive bystander CPR, and are twice as likely to survive. This observation emphasizes the need for CPR training of family members in the authors' locale. This phenomenon may also represent a significant confounder in studies of out-of-hospital cardiac arrest and resuscitation.
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Case Reports
Bioimpedance cardiac output measurements in patients with presumed congestive heart failure.
To describe preliminary ED experience with thoracic electrical bioimpedance (TEB) for evaluation of patients with complaints suggestive of congestive heart failure (CHF). ⋯ Significant differences in TEB variables exist between patients who appear similar on initial examination in the ED. Changes noted on TEB may help to further elucidate physiologic differences. The clinical use of TEB-based hemodynamic measurements to guide presumed CHF patient management remains speculative.
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To determine the accuracy of a syringe esophageal detector device (EDD) for detecting esophageal intubations in an out-of-hospital setting. ⋯ In this paramedic field study, the EDD demonstrated poor sensitivity for esophageal intubations. Further EMS studies of the EDD are needed to clarify the value of the device in out-of-hospital emergent clinical intubations.