Articles: emergency-services.
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Our aim is to develop a risk-stratification model for use by emergency department (ED) clinical staff in the assessment of patients attending with self-harm. ⋯ Application of this simple, highly sensitive rule may facilitate assessment in the ED and help to focus psychiatric resources on patients at higher risk.
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Multicenter Study
A study of depression and anxiety among doctors working in emergency units in Denizli, Turkey.
Major work has been carried out on the psychological well-being of emergency room doctors in the US, Canada and in other developed countries, but little has been published regarding the same in the countries in economic transition. ⋯ The considerable amount of depression and anxiety found among doctors in this study should trigger further work. Studies using more powerful designs would help to illuminate the factors leading to depression and anxiety, which result in attrition among doctors from emergency units.
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Multicenter Study
Unspecified falls among youth: predictors of coding specificity in the emergency department.
Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as "unspecified". Non-specific coding compromises the utility of injury surveillance data. ⋯ Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives.
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Multicenter Study
Lessons learned from clinical anthrax drills: evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments.
Emergency department (ED) physicians and nurses are considered critical sentinels of a bioterrorist attack. We designed a special hospital drill to test EDs' response to inhalational anthrax and assess the level of preparedness for anthrax bioterrorism. We hypothesized that the occurrence of such a drill in an ED would improve the knowledge of its physicians, even those who had not actually participated in the drill. ⋯ A national framework of drills on bioterrorism can help estimate and potentially augment national preparedness for bioterrorist threats. It is not, on its own, an effective educational tool. More emphasis should be given to formal accredited continuing medical education programs on bioterrorism, especially for emergency physicians and ED nurses, who will be in the front line of a bioterrorist attack.
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Multicenter Study
The prevalence of nontherapeutic and dangerous international normalized ratios among patients receiving warfarin in the emergency department.
We determine the prevalence of nontherapeutic and coagulopathic international normalized ratios (INRs) among patients receiving warfarin and presenting to an emergency department (ED). As a secondary goal, we aim to determine whether a simple decision aid composed of physical examination and historical features could be predictive of INR greater than 5. ⋯ The prevalence of undesirable INR in the ED is higher than in warfarin populations previously studied, and a significant number of nontherapeutic levels were associated with thromboembolism, stroke, or hemorrhage. Given the prevalence and established danger of subtherapeutic and supratherapeutic levels, a low threshold should be maintained for testing and addressing INR levels in patients receiving warfarin in the ED.