Objective: To test the null hypothesis that for nurses working in emergency department, there is no difference between self-instruction and traditional method of training cast application technique, with respect to cost-effectiveness. Method: This was a prospective, single-blind, randomised, controlled trial carried out at the Accident & Emergency Department of North District Hospital from 11 November 1998 to 16 May 2000. Thirty-three full-time emergency department nurses (9 nursing officers, 20 registered nurses and 4 enrolled nurses) were randomly assigned into two groups. Sixteen were given the self-instruction training program (intervention group) and 17 were instructed by traditional training program (control group). The primary outcome measure was cost-effectiveness analysis. The predetermined relative cost ratio was compared with the relative success ratio of the two methods. The secondary outcome measures were individual skill performance, knowledge scores and attitude ranks. Results: There was no statistically significant difference between self-instruction and traditional method of training. The relative cost ratio of self-instruction to traditional method was 0.80. The relative success ratio of self-instruction to traditional method was 0.82. All nurses showed improvement in their knowledge (mean knowledge score, 38 versus 89). Trainees in the traditional method had more confidence performing cast application. Subgroup analysis showed that trainee characteristics and attitude did not predict the outcome. Conclusion: Self-instruction method and traditional method may be equally cost-effective for training cast application technique. Both methods resulted in significant improvement in knowledge of cast application. Nurses trained with the traditional method had more confidence than those trained with self-instruction method. (Hong Kong j.emerg.med. 2001;8:9-15)

Chung Chin Hung, Charles, MBB S(HK), FRCS (Glas g), FH KAM (Eme rgency Medic ine) We describe a case of acute on chronic theophylline intoxication with severe headache as the chief complaint in a Chronic Obstructive Pulmonary Disease (COPD) patient. Headache is a non-specific symptom. The intensity of headache is unusually severe in our patient, and is much worse than the headache commonly encountered by an experienced emergency physician. (Hong Kong j.emerg.med.