Search

2019 MAY 2 (NewsRx) -- By a News Reporter-Staff News Editor at Women's Health Weekly -- Investigators discuss new findings in Oncology - Breast Cancer. According to news reporting from [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.03.043 Byline: Frank Xavier Scheuermeyer (a), Jim Christenson (a), Grant Innes (b), Barb Boychuk (a), Eugenia Yu (a), Eric Grafstein (a) Abstract: Emergency department (ED) crowding has been associated with a variety of adverse outcomes. Current guidelines suggest that patients with potentially ischemic chest pain should undergo rapid assessment and treatment in a monitored setting to optimize the diagnosis of acute coronary syndrome. These patients may be at high risk of incorrect diagnosis and adverse events when their evaluation is delayed because of crowding. To mitigate crowding-related delays, we developed processes that enabled emergency physicians to evaluate potentially sick patients in the waiting room when all nurse-staffed stretchers are occupied. The objective of this study was to investigate the safety of waiting room chest pain evaluation. Author Affiliation: (a) Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada (b) Division of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada Article History: Received 26 November 2009; Revised 6 March 2010; Accepted 30 March 2010 Article Note: (footnote) Supervising editor: David L. Schriger, MD, MPH, Author contributions: FXS and JC conceived the study and designed the trial. JC, GI, BB, and EG supervised the conduct of the trial and data collection. BB and EY managed the database. FXS provided statistical analysis and drafted the article. All authors contributed substantially to its revision. FXS takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication date: Available online May 23, 2010., Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com., See page 456 for the Editor's Capsule Summary of this article., Provide feedback on this article at the journal's Web site, www.annemergmed.com.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.03.043 Byline: Frank Xavier Scheuermeyer (a), Jim Christenson (a), Grant Innes (b), Barb Boychuk (a), Eugenia Yu (a), Eric Grafstein (a) Abstract: Emergency department (ED) crowding has been associated with a variety of adverse outcomes. Current guidelines suggest that patients with potentially ischemic chest pain should undergo rapid assessment and treatment in a monitored setting to optimize the diagnosis of acute coronary syndrome. These patients may be at high risk of incorrect diagnosis and adverse events when their evaluation is delayed because of crowding. To mitigate crowding-related delays, we developed processes that enabled emergency physicians to evaluate potentially sick patients in the waiting room when all nurse-staffed stretchers are occupied. The objective of this study was to investigate the safety of waiting room chest pain evaluation. Author Affiliation: (a) Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada (b) Division of Emergency Medicine, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada Article History: Received 26 November 2009; Revised 6 March 2010; Accepted 30 March 2010 Article Note: (footnote) Supervising editor: David L. Schriger, MD, MPH, Author contributions: FXS and JC conceived the study and designed the trial. JC, GI, BB, and EG supervised the conduct of the trial and data collection. BB and EY managed the database. FXS provided statistical analysis and drafted the article. All authors contributed substantially to its revision. FXS takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication date: Available online May 23, 2010., Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com., See page 456 for the Editor's Capsule Summary of this article., Provide feedback on this article at the journal's Web site, www.annemergmed.com.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.02103.x Keywords: hospital at home; hospital care; functional status; activities of daily living; instrumental activities of daily living Abstract: OBJECTIVES: To compare differences in the functional outcomes experienced by patients cared for in Hospital at Home (HaH) and traditional acute hospital care. DESIGN: Survey questionnaire of participants in a prospective nonrandomized clinical trial. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbations of chronic heart failure or chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in HaH and 130 in an acute care hospital. INTERVENTION: Treatment in a HaH care model that substitutes for care provided in the traditional acute care hospital. MEASUREMENTS: Change in activity of daily living (ADL) and instrumental activity of daily living (IADL) scores from 1 month before admission to 2 weeks post admission to HaH or acute hospital and the proportion of groups that experienced improvement, no change, or decline in ADL and IADL scores. RESULTS: Patients treated in HaH experienced modest improvements in performance scores, whereas those treated in the acute care hospital declined (ADL, 0.39 vs -0.60, P=.10, range -12.0 to 7.0; IADL 0.74 vs -0.70, P=.007, range -5.0 to 10.0); a greater proportion of HaH patients improved in function and smaller proportions declined or had no change in ADLs (44% vs 25%, P=.10) or IADLs (46% vs 17%, P=.04). CONCLUSION: HaH care is associated with modestly better improvements in IADL status and trends toward more improvement in ADL status than traditional acute hospital care. Author Affiliation: (*)Division of Geriatric Medicine, School of Medicine and ([dagger])Department of Health Policy and Management, School of Public Health, The Johns Hopkins University, Baltimore, Maryland ([double dagger])Portland Veterans Administration Medical Center, Portland, Oregon (s.)Division of General Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon ([parallel])Division of Geriatrics, Department of Medicine, State University of New York, Buffalo, New York (#)Independent Health, Buffalo, New York (**)Univera Health, Buffalo, New York; and ([dagger][dagger])Division of Geriatrics, Fallon Community Health Plan and Fallon Clinic, Worcester, Massachusetts. Article note: Address correspondence to Bruce Leff, Johns Hopkins University School of Medicine, Johns Hopkins Care Center, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: bleff@jhmi.edu

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2006.10.008 Byline: Manesh R. Patel (a), Anita Y. Chen (a), Matthew T. Roe (a), E. Magnus Ohman (a), L. Kristin Newby (a), Robert A. Harrington (a), Sydney C. Smith (b), W. Brian Gibler (c), James E. Calvin (d), Eric D. Peterson (a) Keywords: Acute coronary syndromes; Patient care; Quality improvement Abstract: Although adherence to guidelines recommendations is assumed to be more difficult for nonacademic community hospitals, patterns of adherence have not been evaluated by hospital type. We sought to identify hospital characteristics associated with high levels of adherence in order to gain insight into successful processes of care. Author Affiliation: (a) Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (b) University of North Carolina at Chapel Hill, Chapel Hill (c) University of Cincinnati School of Medicine, Cincinnati, Ohio (d) Rush University Medical Center, Chicago, Ill. Article Note: (footnote) CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by the Schering-Plough Corporation. The Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides additional funding support. Millennium Pharmaceuticals, Inc. also funded this research.

Byline: Adam J Singer (*), Peter B Richman (a ), Agnes Kowalska (*), Henry C Thode (*) Abstract: Study objective: To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures. Methods: This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of ED patients. Research assistants recorded the procedure performed and historical and demographic information on standardized data collection instruments. After each procedure, both the patient and practitioner independently recorded assessments of patient pain on a 100-mm visual analog scale (VAS). Use of preprocedure anesthetics and patient preferences regarding their use were also identified. Categorical variables were analyzed by I[degrees].sup.2 tests. Patient and practitioner VAS scores were compared using a paired t test; [alpha] was preset at .05. Correlation coefficients were calculated to assess correlation between patient and practitioner pain scores. Results: A total of 1, 171 procedures were evaluated for the 15 most common procedures performed. The mean patient age was 42.8[+ or -]18.7 years and 46.1% were male. Overall, the mean patient VAS was 20.8 mm[+ or -]25.1 mm; the mean practitioner VAS was 23.5 mm[+ or -]20.3 mm. The mean difference between groups was 3.0 mm (95% confidence interval [Cl], 1.3 to 4.1). Correlation between patient and practitioner pain scores for individual procedures was poor to fair (r=26 to .68). The most painful procedures according to patients in descending order were nasogastric intubation, abscess drainage, fracture reduction, and urethral catheterization. Local anesthetics were administered in 12.8% of procedures yet would be requested before similar future procedures by 17.1% of patients. Patients who would choose local anesthetics in the future gave higher pain scores than those who would not (43.3 mm versus 16.3 mm; mean difference=27.0 mm, 95% Cl, 22.2 to 31.8 mm). Conclusion: The most painful procedures for ED patients were nasogastric intubation, incision and drainage of abscesses, fracture reduction, and urethral catheterization. Although practitioners also identified these procedures as most painful, the correlation between patient and practitioner pain assessments in individual patients was highly variable. Overall use of anesthetics before these procedures was low. Practitioners should be attentive to their patients' individual anesthetic needs before performing painful procedures. Author Affiliation: (*) Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, Stony Brook, NY, USA (a ) Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, NJ. USA Article History: Received 28 September 1998; Revised 28 December 1998; Accepted 18 February 1999 Article Note: (footnote) * Presented in part at the annual meeting for the Society of Academic Emergency Medicine, Washington DC, May 1997.

Byline: Mark A Brandenburg, Daniel J Dire Abstract: Study objective: To determine whether venous blood gas values can replace arterial gas values in the initial emergency department evaluation of patients with suspected diabetic ketoacidosis. Methods: This prospective comparison was performed in an adult university teaching hospital ED. Samples for arterial and venous blood gas analysis were obtained during initial ED evaluations. The venous gas samples were collected with samples for other blood tests at the time of intravenous line insertion. Both arterial and venous samples were obtained before the initiation of treatment. Result: Data from 44 episodes of diabetic ketoacidosis in 38 patients were analyzed. Laboratory findings of those patients with diabetic ketoacidosis were as follows (mean[+ or -]SD): arterial pH, 7.20[+ or -].14; venous pH, 7.17[+ or -].13; serum glucose, 33.8[+ or -]16 mmol/L (609[+ or -]288 mg/dL); arterial HCO.sub.3.sup.-, 11.0[+ or -]6.0 mmol; venous HCO.sub.3.sup.-, 12.8[+ or -]5.5 mmol/L; serum CO.sub.2, 11.8[+ or -]5.0 mmol/L; and anion gap, 26.7[+ or -]7.6 mmol/L. The mean difference between arterial and venous pH values was 0.03 (range 0.0 to 0.11). Arterial and venous pH results (r=.9689) and arterial and venous HCO.sub.3.sup.- results (r=.9543) were highly correlated and showed a high measure of agreement. Conclusion: Venous blood gas measurements accurately demonstrate the degree of acidosis of adult ED patients presenting with diabetic ketoacidosis. [Brandenburg MA, Dire DH: Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic ketoacidosis. Ann Emerg Med April 1998; 31:459-465.] Article History: Received 26 September 1996; Revised 20 May 1997; Revised 22 October 1997; Accepted 29 October 1997 Article Note: (footnote) [star] From the Section of Emergency Medicine & Trauma, University of Oklahoma Health Sciences Center, Oklahoma City, OK., [star][star] Address for reprints: Daniel J Dire, MD, Section of Emergency Medicine & Trauma, PO Box 26307, Room EB319, Oklahoma City, OK 73126-0307, 405-271-5135, a 47/1/88630

Byline: Andrew B Cole, Francis L Counselman Abstract: Study objective: To compare transcribed and handwritten emergency department charts for completeness of documentation. Design: Convenience sample, retrospective chart review. Setting: Level I tertiary-care referral center and primary training site for a fully accredited postgraduate year 2 through postgraduate year 4 emergency medicine residency program. Participants: Two hundred two patients admitted to telemetry or CCU/ICU with a final diagnosis of myocardial infarction, unstable angina, rule out myocardial infarction, or evaluation of chest pain from July 15, 1990, through June 30, 1991. Interventions: Each chart, unknown to the faculty and residents, was reviewed for documentation of the presence or absence of 28 critical items. Equal weight was given to each item. Two-tailed testing for independent proportions was used to determine the presence of a statistically significant difference between the transcribed and handwritten charts. In addition, the mean and SD for the number of critical items documented were determined for both the transcribed and handwritten charts. A two-tailed Student t test was used to determine the presence of a statistically significant difference. Significance was set at a P value of less than .05. Results: Ninety-four transcribed and 108 handwritten charts were reviewed. Transcribed charts contained a greater proportion of the 28 critical items than did the handwritten charts (P Article History: Received 6 June 1994; Revised 10 August 1994; Accepted 6 September 1994 Article Note: (footnote) [star] From the Department of Emergency Medicine Eastern Virginia Medical Schol, and Emergency Physicians of Tidewater, Norfolk, Virginia., [star][star] No reprints available from the authors. , a Reprint no. 47/1/62559

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2008.03.008 Byline: Tyler W. Barrett (a), David L. Schriger (b) Abstract: Nesiritide was widely advocated as a useful therapy for heart failure patients until safety concerns were raised. Author Affiliation: (a) Vanderbilt University Medical Center, Nashville, TN (b) University of California, Los Angeles, Los Angeles, CA Article Note: (footnote) SEE RELATED ARTICLE, P. 571. , Editor's Note: You are reading the third installment of Annals of Emergency Medicine Journal Club. This bimonthly feature seeks to improve the critical appraisal skills of emergency physicians and other interested readers through a guided critique of actual Annals of Emergency Medicine articles. Each Journal Club will pose questions that encourage readers, be they clinicians, academics, residents, or medical students, to critically appraise the literature. Answers to this Journal Club will be published in the October issue. During a 2- to 3-year cycle, we plan to ask questions that cover the main topics in research methodology and critical appraisal of the literature. To do this we will select articles that use a variety of study designs and analytic techniques. These may or may not be the most clinically important articles in a specific issue, but they are articles that serve the mission of covering the clinical epidemiology curriculum. Journal Club entries will be published in 2 phases. In the first phase, a list of questions about the article will be published in the issue in which the article appears. Questions are rated 'novice,' (a*) 'intermediate,' (a*) and 'advanced' (a*) so that individuals planning a journal club can assign the right question to the right student. The 'novice' rating does not imply that a novice should be able to spontaneously answer the question. 'Novice' means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. The second phase of each journal club consists of the publication of suggested answers. This will be done 5 months after the publication of the questions. However, residency directors can have immediate access to the answers for the purpose of guiding the journal club. US residency directors can access the answers through the Council of Emergency Medicine Residency Directors Share Point Web site. International residency directors can gain access to the answers by going to http://www.emergencymedicine.ucla.edu/annalsjc/ and following the directions. Thus, if an actual journal club is conducted within 5 months of the publication of the questions, no one will have access to the published answers except the residency director. The purpose of delaying the publication of the answers is to promote discussion and critical review of the literature by both residents and medical students and discourage regurgitation of the published answers. It is our hope that the Journal Club will broaden Annals of Emergency Medicine's appeal to residents and medical students. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments. This is the first journal club in our series that considers a randomized controlled trial (RCT). For that reason, we include some basic questions about this fundamental study design. We will cover other topics about RCTs in future installments. Those planning a journal club should note that although 1a is a novice question, it requires a substantial amount of work to answer. This task could be divided among several participants.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.04.019 Byline: Elke Platz (a)(b), Katja Goldflam (a), Maria Mennicke (a), Emilio Parisini (b), Michael Christ (c), Christian Hohenstein (d) Abstract: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method. Author Affiliation: (a) Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA (b) Harvard School of Public Health, Boston, MA (c) Department of Emergency Medicine, Klinikum Nurnberg, Nurnberg, Germany (d) Department of Anesthesiology, Klinikum Kempten Oberallgau, Kempten, Germany Article History: Received 27 September 2009; Revised 4 January 2010; Revised 13 March 2010; Revised 10 April 2010; Accepted 22 April 2010 Article Note: (footnote) Provide feedback on this article at the journal's Web site, www.annemergmed.com., Supervising editor: Peter C. Wyer, MD, Author contributions: E. Platz and KG conceived the study, designed the trial, and supervised the conduct of the trial and data collection. E. Platz obtained research funding. MC and CH undertook recruitment of participating centers and subjects. MM managed the data, including quality control. E. Parisini provided statistical advice on study design and analyzed the data. E. Platz drafted the article, and all authors contributed substantially to its revision. E. Platz takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Esther B. Kahn Fund from the Department of Emergency Medicine, Brigham and Women's Hospital, Boston., Publication dates: Available online June 11, 2010., Please see page 661 for the Editor's Capsule Summary of this article., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2010.04.019 Byline: Elke Platz (a)(b), Katja Goldflam (a), Maria Mennicke (a), Emilio Parisini (b), Michael Christ (c), Christian Hohenstein (d) Abstract: Training physicians in new skills through classroom-based teaching has inherent cost and time constraints. We seek to evaluate whether Web-based didactics result in similar knowledge improvement and retention of basic ultrasonographic principles and the Extended Focused Assessment with Sonography for Trauma (EFAST) compared with the traditional method. Author Affiliation: (a) Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA (b) Harvard School of Public Health, Boston, MA (c) Department of Emergency Medicine, Klinikum Nurnberg, Nurnberg, Germany (d) Department of Anesthesiology, Klinikum Kempten Oberallgau, Kempten, Germany Article History: Received 27 September 2009; Revised 4 January 2010; Revised 13 March 2010; Revised 10 April 2010; Accepted 22 April 2010 Article Note: (footnote) Provide feedback on this article at the journal's Web site, www.annemergmed.com., Supervising editor: Peter C. Wyer, MD, Author contributions: E. Platz and KG conceived the study, designed the trial, and supervised the conduct of the trial and data collection. E. Platz obtained research funding. MC and CH undertook recruitment of participating centers and subjects. MM managed the data, including quality control. E. Parisini provided statistical advice on study design and analyzed the data. E. Platz drafted the article, and all authors contributed substantially to its revision. E. Platz takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the Esther B. Kahn Fund from the Department of Emergency Medicine, Brigham and Women's Hospital, Boston., Publication dates: Available online June 11, 2010., Please see page 661 for the Editor's Capsule Summary of this article., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2007.10.026 Byline: Amy H. Kaji (a)(b)(c)(d), Vinette Langford (e), Roger J. Lewis (a)(b)(c) Abstract: There is currently no validated method for assessing hospital disaster preparedness. We determine the degree of correlation between the results of 3 methods for assessing hospital disaster preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and video analysis of team performance in the hospital incident command center. Author Affiliation: (a) Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA (b) David Geffen School of Medicine at UCLA, Torrance, CA (c) Los Angeles Biomedical Research Institute, Torrance, CA (d) The South Bay Disaster Resource Center at Harbor-UCLA Medical Center, Los Angeles, CA (e) MedTeams and Healthcare Programs Training Development and Implementation, Dynamics Research Corporation, Andover, MA Article History: Received 11 August 2007; Revised 4 October 2007; Accepted 29 October 2007 Article Note: (footnote) Supervising editor: Jonathan L. Burstein, MD, Author contributions: AHK and RJL conceived and designed the study and obtained research funding. AHK and RJL supervised the conduct of the data collection. AHK undertook recruitment of participating centers and managed the data. AHK and RJL analyzed the data from the on-site survey and the disaster drill. VL analyzed the data for teamwork behaviors from the video. AHK drafted the article, and all 3 authors contributed substantially to its revision. All authors had full access to the data and take full responsibility for the integrity of the data and the accuracy of the data analysis. AHK takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication date: Available online January 11, 2008., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2007.04.021 Byline: Benoit Bailey (a)(b)(c), Sylvie Bergeron (a)(c), Jocelyn Gravel (a)(c), Raoul Daoust (d) Abstract: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED). Author Affiliation: (a) Division of Emergency Medicine, HA[acute accent]pital du Sacre-Coeur, Montreal, Quebec, Canada (b) Division of Clinical Pharmacology and Toxicology, HA[acute accent]pital du Sacre-Coeur, Montreal, Quebec, Canada (c) Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, HA[acute accent]pital du Sacre-Coeur, Montreal, Quebec, Canada (d) Department of Emergency Medicine, HA[acute accent]pital du Sacre-Coeur, Montreal, Quebec, Canada. Article History: Received 1 March 2007; Revised 15 April 2007; Accepted 19 April 2007 Article Note: (footnote) Supervising editor: Steven M. Green, MD Author contributions: BB, SB, and JG conceived the study and designed the trial. SB obtained research funding. BB, SB, and JG supervised the conduct of the trial and data collection and undertook recruitment of patients. BB managed the data. BB, JG, and RD provided statistical advice on study design. BB analyzed the data. BB drafted the article, and all authors contributed substantially to its revision. BB takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by a grant from Fonds d'Operation pour les Projets de Recherche Clinique Epidemiologique et Evaluative du Centre de Recherche de l'HA[acute accent]pital Ste-Justine. Publication dates: Available online June 22, 2007. Reprints not available from the authors.

Congress asked the Government Accountability Office to study the differences between payments in the hospital outpatient department and the ASC setting. The GAO found that the outpatient payments accurately reflected [...]

Introduction: Adverse drug-related events (ADREs) cause approximately 12% of ED visits. Our objective was to determine how emergency physicians (EPs) and clinical pharmacists (CPs) compare in attributing drug-related ED visits (DRVs) to medication-related problems. Methods: This prospective study enrolled adults presenting to a tertiary care ED over 12 weeks. DRVs were defined as visits caused by ADREs. CPs evaluated patients for DRV using validated assessment algorithms in the ED. EPs, blinded to CP assessment, evaluated patients in their standard manner and indicated whether they believed the visit was medication-related at the end of their shift by face to face interview. CPs followed up patients in whom they were uncertain until after ED or hospital discharge, and made final assessments after completion of follow-up. An independent committee reviewed and adjudicated all cases in which the EPs' and the final CPs' assessments were discordant. The primary outcomes were the proportion of DRVs attributed to a medication-related problem by CPs and EPs at the point of care. Results: EPs and CPs simultaneously evaluated 725 patients for DRV, of whom 96 were diagnosed with a DRV (13.2%, 95% CI 11.0%-15.9%). At the end of the ED visit CPs correctly attributed 67.7% (65/96, 95% CI 57.8%-76.2%) of DRVs to a medication-related problem, remained uncertain in 19.8% (19/96, 95% CI 13.0-28.9) and missed 12.5% (12/96, 95% CI 7.3-20.6). EPs correctly attributed 63.5% (61/96 95% CI 53.5%-72.5%) of DRVs to a medication-related problem, remained uncertain in 14.6% (14/96, 95% CI 8.9-23.0), and missed 21.9% (21/96, 95% CI 14.8-31.1). Thirteen DRVs were only identified by CPs, and 7 only by EPs. Conclusion: CPs and EPs attribute a similar proportion of DRVs to medication-related problems at the point of care. Both groups signal events as DRVs that are not attributed by the other rater. Further research to optimize the identification and care of patients with medication-related problems is warranted. Keywords: drug-related visits, emergency physician recognition, pharmacists

Hospitalizations at children's hospitals account for only one-third of pediatric inpatients. Examining data from the 2000 Healthcare Cost and Utilization Project Kids' Inpatient Database, Richard Wasserman, M.D., and a team [...]