Articles: hospital-emergency-service.
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Randomized Controlled Trial Comparative Study
Using a computer kiosk to promote child safety: results of a randomized, controlled trial in an urban pediatric emergency department.
The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. ⋯ These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.
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Randomized Controlled Trial Comparative Study
A randomised controlled trial to test the analgesic efficacy of topical morphine on minor superficial and partial thickness burns in accident and emergency departments.
To test the analgesic efficacy of topical morphine on superficial burns within the emergency department by comparing pain scores, comfort ratings and analgesia taken by participants. ⋯ Topical morphine sulphate does not seem to be as effective when used for the pain associated with superficial burns as when used for the pain associated with chronic inflammatory wounds. (The European Clinical Trials Database number for this study is 2005-003285-42.).
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Randomized Controlled Trial Comparative Study
A randomized clinical trial to assess the impact on an emergency response system on anxiety and health care use among older emergency patients after a fall.
Personal emergency response systems (PERSs) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department (ED) to home. This study measured the impact of a PERS on anxiety, fear of falling, and subsequent health care use among older ED patients. ⋯ In contrast to previous studies, there was no evidence that a PERS reduced anxiety, fear of falling, or return to the ED among older persons discharged from the ED.
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Randomized Controlled Trial
The effect of the assignment of a pre-sedation target level on procedural sedation using propofol.
The goal of this study was to determine if there is a difference in the achieved depth of sedation, the rate of respiratory depression, procedural difficulty, or patient perceived pain or recall between patients randomized to a pre-procedural target sedation level of moderate or deep procedural sedation using propofol during the reduction of fractures and dislocations in the Emergency Department (ED). This was a randomized, prospective study of adults undergoing procedural sedation (PS) with propofol for fracture or dislocation reduction in the ED between July 2003 and March 2004. Patients were randomized to a target sedation level of moderate or deep, using American Society of Anesthesiologists' definitions. ⋯ The mean physician VAS for procedural difficulty was 34.0 (95% CI 23.7-44.3) for the moderate PS group and 28.8 (95% CI 18.4-39.2) for the deep PS group (p = 0.46). In this study, the assignment of a pre-procedural target sedation level of moderate or deep PS did not influence the level of sedation achieved, the rate of respiratory depression, the occurrence of complications, the time to return of baseline mental status, or the success of the procedure. It does not seem that the assignment of a pre-procedural target sedation level is an effective means of changing the outcome of ED PS.
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Randomized Controlled Trial Multicenter Study
Physiologic variables and functional status independently predict COPD hospitalizations and emergency department visits in patients with severe COPD.
Using clinical and claims records from the National Emphysema Treatment Trial, we sought to identify factors that accurately predicted COPD exacerbations. This prospective cohort study consisted of subjects with severe emphysema randomized to medical therapy. Exacerbations were defined as a hospitalization or emergency department visit for COPD. ⋯ In 610 participants, 26.6% had a COPD exacerbation over 1-year follow-up. In a model incorporating spirometry, PaO2, dyspnea, prior exacerbations and co-morbidity, a 5-point decrement in percent predicted FEV1 (OR 1.16, 95% CI 1.00-1.34) and a 5-point worsening in SOBQ (OR 1.08, 1.02-1.14) independently predicted exacerbations (AUC for full model 0.68). Combining physiologic variables, dyspnea, prior exacerbations and co-morbidity may be useful in identifying patients at high risk for COPD exacerbations.