Background:Although the Canadian Triage and Acuity Scale (CTAS) have been developed since two decades ago, the reliability of the CTAS has not been questioned comparing to moderating variable.Aims:The study was to provide a meta-analytic review of the reliability of the CTAS in order to reveal to what extent the CTAS is reliable.Materials and Methods:Electronic databases were searched to March 2014. Only studies were included that had reported samples size, reliability coefficients, adequate description of the CTAS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models and meta-regression was done based on method of moments estimator.Results:Fourteen studies were included. Pooled coefficient for the CTAS was substantial 0.672 (CI 95%: 0.599-0.735). Mistriage is less than 50%. Agreement upon the adult version, among nurse-physician and near countries is higher than pediatrics version, other raters and farther countries, respectively.Conclusion:The CTAS showed acceptable level of overall reliability in the emergency department but need more development to reach almost perfect agreement.

IntrOductIOnHospital triage in the emergency department (ED) is defined as allocating priority for the provision of care and cure for the patients in the emergency department [1]. In response to overcrowding in emergency departments and in order to ensure critically-ill patients receive services in a timely manner, so hospital triage is developed by using reliable and valid guidelines in order to improve effectiveness [2]. Since the triage decision making process has been introduced as a context-dependent process which is affected by significant internal and external factors [3][4][5][6][7][8], so the complexity of triage decision making has resulted in special attention to the validity and reliability while using triage scales in the emergency departments [6][7][8][9][10][11].The reliability of the Emergency severity index (ESI) triage has been assessed using inter-rater agreement mainly and test-retest among nurses and physicians [2,[12][13][14][15]. The validity of triage has been assessed by key indicators such as emergency department admission [13][14][15][16][17][18][19][20][21] or ICU admission [13,14,19], length of ED [16,19] or hospital stay [13,22], mortality [17,19,20], Hospital discharge [13,14] or left without being seen [16][17][18][19] and resource utilization [13,20,22].Being simple and objective has made the ESI triage system reasonable to be accepted worldwide. The reliability and validity of the ESI has been approved in U.S. [23][24][25] but in the other countries need more investigation and verification. Kyranou in Greece [16] demonstrated that the establishment of the ESI in the ED had good reliability and validity but improvement of nurses` experience and long-term follow-up are necessary to succeed. Grossmann in Switzerland [13] revealed that using the ESI in the ED of an urban tertiary care center is valid, reliable and culturally adapted. Chi in Taiwan [19] found that the ESI produces more accurate discrimination on the basis of patient acuity than the Taiwan triage system. Elshove-Bolk in Norway [21] showed that the ESI triage reliably predicts patient acuity in a population of self-referred patients. Selman [26] revealed that the ESI triage system assists the practitioner in identifying the priorities of care and has the potential for significantly improve patient outcomes. But there are serious concerns about using the ESI in emergency departments of other countries because there are significant differences in the structure of their health care system and culture of care comparing to U.S. Therefore, it is essential to consider the compliance of the triage process in emergency departments with the ESI The ESI has been shown to have good reliability and validity in EDs of many developed countries [12,13,16,19,21]. The importance of applying valid and reliable scales in EDs has been recommended [27,28] however, little information on the ESI reliability and validity in emergency departments of Iran is available [29]. In early 2011, there were only a few emergency departments which used...

BACKGROUND: Although the Australasian Triage Scale (ATS) has been developed two decades ago, its reliability has not been defi ned; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator. RESULTS:Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428 (95%CI 0.340-0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version. CONCLUSION:The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.

The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement.

Objective. The aim of this study was to present a comprehensive review of the literatures describing barriers and facilitators of patient education (PE) perceived by Iranian nurses in order to explain clinical applicability of patient education. Methods. Review of the literature was undertaken using the international databases including PubMed/Medline, Scopus, ScienceDirect, as well as Google Scholar. Also, Persian electronic databases such as Magiran, SID and IranMedex were searched. Electronic databases were searched up from conception to September 2014 using search terms: "patient education", " patients education", "patient teaching", "patient training", "nurse", " nurses", " nursing", " and "Iran". Only studies were included that were related to barriers and facilitators of PE among Iranian nurses. Results. Twenty-seven studies were included. The main influential barriers were categorized into three major areas: 1) Nurserelated factors: nursing shortage 2) Administrationrelated factors: unsupportive organizational culture, and 3) Patient-related factors: low compliance. The most perceived facilitators were recognized as "increasing, selecting and training special nurses for providing PE" and "providing PE courses for nurses and appropriate facilities for PE". Conclusion. Iranian nurses encounter barriers in PE, and the most frequently encountered barriers were related to administration factors. These findings have implications for administrators and managers in health settings. In order to promote PE among nurses, administrators should create a supportive environment and use effective strategies to smooth the progress of PE by nurses in their practice in order to ensure optimal outcomes for patients. "educación del paciente", "educación de pacientes", "enseñanza del paciente", "entrenamiento del paciente", "enfermera", "enfermeras", e "Irán". Solo se analizaron los estudios relacionados con las barreras y facilitadores de EP entre enfermeras iraníes.Resultados. Se incluyeron 27 estudios. Las principales barreras se clasificaron en tres grandes áreas: 1) Factores relacionados con la enfermería: escasez de este recurso humano, 2) Factores relacionados con la administración: inapropiada cultura organizacional y 3) Factores relacionados el paciente: bajo cumplimiento. Los facilitadores más percibidos se reconocieron como "el aumento, la selección y formación especial de las enfermeras para proporcionar EP" y "disponibilidad de cursos de EP para las enfermeras y la disponibilidad de instalaciones adecuadas para brindar el EP". Conclusión. Las enfermeras iraníes encuentran barreras en la EP, siendo las más frecuentes las relacionadas con factores de la gestión de los recursos. Estos resultados tienen implicaciones para los administradores y directivos de las instituciones de salud, pues para promover que las enfermeras en su práctica brinden la EP, se debe crear un ambiente de apoyo y utilizar estrategias eficaces con el fin de garantizar resultados óptimos en los pacientes.Palabras clave: educación del paciente c...