Emergencias
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Multicenter Study Observational Study
Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care.
To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. ⋯ Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.
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Review Meta Analysis
[Reliability and validity of the modified Allen test: a systematic review and metanalysis].
The objective was to evaluate the reliability and validity of the modified Allen test in screening for collateral circulation deficits in the palm and for predicting distal hand ischemia. We performed a systematic review of the literature indexed in 6 databases. We developed a search strategy to locate studies comparing the Allen test to Doppler ultrasound to detect circulation deficits in the hand, studies assessing the incidence of ischemic events on arterial puncture after an abnormal Allen test result, and studies of Allen test interobserver agreement. ⋯ Nor is it a good predictor of hand ischemia after arterial puncture. Moreover, its reliability is limited. There is insufficient evidence to support its systematic use before arterial puncture.
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The American College of Gastroenterology's 2016 clinical guidelines for treating lower gastrointestinal (GI) tract bleeding recommends evaluating of nasogastric tube aspiration and the ratio of blood urea nitrogen (BUN) to creatinine to differentiate upper from lower GI bleeds. However, the evidence base to support recommending these 2 diagnostic variables is low. This study aimed to evaluate the diagnostic utility of nasogastric tube aspiration and the BUN-to-creatinine ratio for distinguishing between upper and lower GI bleeding. ⋯ A negative result on either of the 2 diagnostic tests provides little useful information and does not firmly rule out an upper GI bleed. Nasogastric tube aspiration cannot be recommended for distinguishing between upper and lower GI bleeding. If the diagnosis is in doubt, endoscopic exploration of the upper GI tract is necessary.
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Randomized Controlled Trial Multicenter Study
Effect of combined individual-collective debriefing of participants in interprofessional simulation courses on crisis resource management: a randomized controlled multicenter trial.
Interprofessional simulation (IPS) training is an effective way to learn crisis resource management. The type of debriefing used in IPS training may affect participants' performance and their level of psychological safety. We aimed to assess and compare performance after standard collective debriefing versus a combination of individual and collective debriefing ("combined" approach). ⋯ During IPS courses on crisis resource management, debriefing improves participants' performance, but similar overall results can be obtained with both debriefing methods. Combined debriefing might be more effective for improving participants' leadership skills and psychological safety and also provide a better learning experience.
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Randomized Controlled Trial Comparative Study Clinical Trial
Differences in lung function after the use of 2 extrication systems: a randomized crossover trial.
The main purpose of this study in healthy volunteers was to compare the lung function effects of 2 extrication devices that use spinal vests: the Kendrick Extrication Device (KED) and the Ferno KED-XT board. ⋯ The use of spinal vests leads to decreases in lung function variables. The KED vest causes a greater decrease in FVC than the new KED-XT board, possibly because the crossed straps on the board compress the abdomen less.