Articles: emergency-medicine.
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Multicenter Study
Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study.
Limited information relative to the management of atrial fibrillation in the emergency department (ED) daily practice is available. This study evaluates current management of atrial fibrillation in this setting to identify areas for practice improvement. ⋯ In our ED population, rate-control effectiveness is poor and rhythm control is not attempted in most recent-onset episodes. Methods to improve rate-control effectiveness, the selection of patients for rhythm control, and the use of electrocardioversion appear warranted.
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Multicenter Study Comparative Study
Artificial neural network models for prediction of acute coronary syndromes using clinical data from the time of presentation.
Clinical and ECG data from presentation are highly discriminatory for diagnosis of acute coronary syndromes, whereas definitive diagnosis from serial ECG and cardiac marker protein measurements is usually not available for several hours. Artificial neural networks are computer programs adept at pattern recognition tasks and have been used to analyze data from chest pain patients with a view to developing diagnostic algorithms that might improve triage practices in the emergency department. The aim of this study is to develop and optimize artificial neural network models for diagnosis of acute coronary syndrome, to test these models on data collected prospectively from different centers, and to establish whether the performance of these models was superior to that of models derived using a standard statistical technique, logistic regression. ⋯ This study confirms that artificial neural networks can offer a useful approach for developing diagnostic algorithms for chest pain patients; however, the exceptional performance and simplicity of the logistic model militates in favor of logistic regression for the present task. Our artificial neural network models were well calibrated and performed well on unseen data from different centers. These issues have not been addressed in previous studies. However, and unlike in previous studies, we did not find the performance of artificial neural network models to be significantly different from that of suitably optimized logistic regression models.
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Multicenter Study
Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts.
We determine success rates of endotracheal intubation performed in emergency departments (EDs) by North American emergency medicine residents. ⋯ Success of initial intubation attempts increased over the first 3 years of residency. This large multicenter study demonstrates the success of airway management by emergency medicine residents in North America. Using rapid-sequence intubation predominantly, emergency medicine residents achieved high levels of success.
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Multicenter Study
What do emergency medicine learners want from their teachers? A multicenter focus group analysis.
To the best of the authors' knowledge, there are no reports describing what learners believe are good emergency medicine (EM) teaching practices. EM faculty developers are compromised by this lack of knowledge about what EM learners appreciate in their teachers. ⋯ Learners are sensitive to the constraints of the ED teaching environment, and have consistent views about good ED teaching practices. Among 14 general principles identified, "takes time to teach," "gives feedback," "tailors teaching to the learner," "uses teachable moments," and "has a good teacher attitude" were the most commonly reported.
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Multicenter Study
A review of emergency equipment carried and procedures performed by UK front line paramedics on paediatric patients.
In 1997 a review of paramedic practice upon adult patients in the UK found many inconsistencies and deficiencies in basic care. A follow up review in 2002 identified widespread improvement in provision of equipment and skills to provide basic and advanced life support.Paediatric care was not assessed in either review. The authors conducted this study to identify current standards of care in paediatric paramedic practice and areas of potential improvement. ⋯ Ambulance Trusts not meeting standards set out in the JRCALC guidelines must address their areas of deficiency. Failure to do so endangers children's lives and leaves Trusts open to criticism.