Articles: hospital-emergency-service.
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J Hand Surg Eur Vol · Oct 2003
Randomized Controlled Trial Clinical TrialThe use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial.
Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. ⋯ There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Rapid two-stage emergency department intervention for seniors: impact on continuity of care.
A two-stage intervention comprising screening and a brief standardized nursing assessment and referral, for emergency department (ED) patients aged 65 years and over, reduced the rate of functional decline four months after the visit, without increasing societal costs. In this study, the authors investigated the effects of the intervention on the process of care at, and during the month after, the ED visit. ⋯ The beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician.
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Randomized Controlled Trial Comparative Study Clinical Trial
Scheduled follow-up after a pediatric emergency department visit for asthma: a randomized trial.
Follow-up with a primary care provider (PCP) is recommended after an emergency department (ED) visit for asthma to assess clinical status and develop a management plan to improve future care. However, previous ED-based studies of urban children with asthma have reported low follow-up rates. The objective of this study was to determine whether scheduling an appointment at the time of an ED visit improves PCP follow-up for urban children. A secondary goal was to assess the effect of this intervention on short-term health outcomes and the use of recommended preventive controller medications. ⋯ Scheduling an appointment after an ED visit increased the likelihood that urban children with asthma would follow up with a PCP. An appointment could not be obtained during the ED visit for most children. Other interventions are needed to improve linkage between ED and primary care for asthma and to improve the use of controller medications.
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Randomized Controlled Trial Clinical Trial
Continuous 12-lead electrocardiographic monitoring in an emergency department chest pain unit: an assessment of potential clinical effect.
Continuous 12-lead serial ECG monitoring has been proposed to assist in the evaluation of patients with acute coronary syndrome and nondiagnostic ECG in an emergency department chest pain unit. However, the ability of serial ECG to detect acute coronary syndrome and its benefit in addition to a standard protocol has not been established. We evaluate the ability of continuous 12-lead ECG to detect acute coronary syndrome, assess the incremental benefit of the serial ECG in association with a set protocol in an ED chest pain unit, and evaluate whether serial ECG changes could be considered as prognostic factors. ⋯ Serial ECG is of limited value in the diagnostic evaluation of intermediate-risk patients managed in the chest pain unit with a standard protocol. However, when ST-segment changes are present, they indicate an increased likelihood for an adverse cardiac event.
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Randomized Controlled Trial Clinical Trial
Interobserver agreement in emergency department triage.
We measure the interobserver reliability of the triage process, examine the effect of vital signs on the triage process, and provide a context for the prior observation of poor interobserver agreement between in-person and telephonic interviews. ⋯ There was poor interobserver agreement between certified triage nurses using a 5-item triage scale designed for telephonic triage. These findings suggest that only a small portion of the poor interobserver agreement observed in a prior study of telephonic versus in-person triage can be attributed to the use of the telephone.