J Emerg Med
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To determine whether receipt of smoking cessation counseling affects satisfaction scores in adult emergency department (ED) smokers. ⋯ ED patients who report having received a tobacco control intervention are more likely to be satisfied with their care. There is a dose-response relationship between the number of patient-reported tobacco interventions received and the global satisfaction score. Of all providers, only physicians' performance of tobacco control was associated with improved satisfaction scores. Routine screening, intervention, and referral of ED patients for smoking will not harm, and may improve, satisfaction scores. The mechanism underlying this effect is unknown.
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Multicenter Study
Standardization of severe sepsis management: a survey of methodologies in academic and community settings.
Evidence-based therapies for severe sepsis include early antibiotics, early goal-directed therapy, corticosteroids, recombinant human activated protein C, glucose control, and lung protective strategies. ⋯ Implementation of a sepsis management protocol incorporating evidence-based therapies can be accomplished in both academic and community hospitals, with minimal additional staffing. The presence of a protocol champion and education program is crucial to success, and may result in improved patient outcome.
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Multicenter Study
Multicenter survey of emergency physician management and referral for hyperglycemia.
The Emergency Department (ED), with its high-risk and often disenfranchised patient population, presents a novel opportunity to identify patients as having undiagnosed or uncontrolled diabetes. ⋯ Emergency Physicians support improved recognition of and referral for hyperglycemia, based on glucose values collected during usual ED care. We plan to develop tools to interpret random ED glucose values in the context of undiagnosed and uncontrolled diabetes.
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Multicenter Study
Motor vehicle crashes: the association of alcohol consumption with the type and severity of injuries and outcomes.
The effect of alcohol ingestion on short-term outcomes for trauma patients is indeterminate. Experimental and clinical reports often conflict. The objective of this study was to investigate the prevalence of positive alcohol screens, the effect of alcohol ingestion on injury patterns, severity, and outcomes in patients who were involved in motor vehicle crashes (MVC). ⋯ However, in this group of severely injured, the high ETOH group had a significantly better survival rate than patients in the no ETOH group (adjusted odds ratio 0.41, 95% confidence interval 0.16-0.94, p = 0.05). Severely injured MVC victims with a high BAL have a higher incidence of severe head trauma and septic complications than no ETOH patients. However, the high ETOH group had superior adjusted survival rates.