Background Inhaled short-acting anticholinergics (SAAC) and short-acting beta-agonists (SABA) are e ective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more e ective in reducing hospitalisations compared to treatment with SABA alone. Objectives To conduct an up-to-date systematic search and meta-analysis on the e ectiveness of combined inhaled therapy (SAAC + SABA agents) vs. SABA alone to reduce hospitalisations in adult patients presenting to the ED with an exacerbation of asthma. Search methods We searched MEDLINE, Embase, CINAHL, SCOPUS, LILACS, ProQuest Dissertations & Theses Global and evidence-based medicine (EBM) databases using controlled vocabulary, natural language terms, and a variety of specific and general terms for inhaled SAAC and SABA drugs. The search spanned from 1946 to July 2015. The Cochrane Airways Group provided search results from the Cochrane Airways Group Register of Trials which was most recently conducted in July 2016. An extensive search of the grey literature was completed to identify any other potentially relevant studies. Selection criteria Included studies were randomised or controlled clinical trials comparing the e ectiveness of combined inhaled therapy (SAAC and SABA) to SABA treatment alone to prevent hospitalisations in adults with acute asthma in the emergency department. Two independent review authors assessed studies for inclusion using predetermined criteria. Data collection and analysis For dichotomous outcomes, we calculated individual and pooled statistics as risk ratios (RR) or odds ratios (OR) with 95% confidence intervals (CI) using a random-e ects model and reporting heterogeneity (I). For continuous outcomes, we reported individual trial results using mean di erences (MD) and pooled results as weighted mean di erences (WMD) or standardised mean di erences (SMD) with 95% CIs using a random-e ects model. Main results We included 23 studies that involved a total of 2724 enrolled participants. Most studies were rated at unclear or high risk of bias. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma (Review)

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Technical adequacy and usability are important considerations in selecting early childhood social-emotional (SE) screening and assessment measures. As identification of difficulties can be tied to programming, intervention, accountability, and funding, it is imperative that practitioners and decision makers select appropriate and quality measures from the plethora of measures available. This study systematically reviewed and evaluated the technical adequacy and usability of 10 commonly used SE assessment and screening measures, using a framework for evaluating selected properties of measures (e.g., reliability, validity). Through this review, it was found that there are inadequacies in many commonly used SE measures, deserving the attention of both users and developers.

BackgroundScreening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care.Methods/DesignA nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient satisfaction with care; secondary outcome measures included alcohol and drug use, health care and addiction treatment use, uptake of SBIRT strategies, and physician attitudes about addiction.DiscussionEffective knowledge translation requires careful consideration of the intended knowledge recipient’s context and needs. Knowledge translation in disadvantaged settings may be optimized by using a community-based participatory approach to resource development that takes into account relevant patient engagement issues.Trial registrationNorthern Alberta Clinical Trials and Research Centre #30094

an adult and 3.0 mmol/L in child < age 2 ) was found in 1 case when BS was checked-overall 1/501 (0.2%); adults 1/388 (0.3%), paedatric 0/113 (0.0%). Case 1-age 70 yr, GCS 12, BS 3.8 mmol/L. Conclusion: Hypoglycemia was rarely found in patients who had a pre-hospital seizure. It did not require treatment. When it was found, hypoglycemia was unlikely to be the cause of the seizure. The results are similar to the findings from other recent, retrospective, reviews. The routine determination of blood sugars in all patients who have had a seizure prior to paramedic arrival should be reconsidered.