Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients. Methods: Blood glucose levels were synchronously analysed using a bedside blood glucometer on capillary and venous derived samples from consenting ED patients aged .12 years. The venous sample was sent for comparative testing using a laboratory based multichannel analyser. Mean difference and correlation coefficients were determined. Results: A total of 20 subjects (aged 13-88 years) were enrolled, with 100% data capture. The mean laboratory glucose was 7.075 mmol/l. The mean capillary blood glucose was 7.66 mmol/l (mean difference compared with mean laboratory glucose 0.58 mmol/l; 95% confidence interval 0.3 to 0.9). The mean venous derived blood glucometer glucose was 7.99 mmol/l (mean difference compared with mean laboratory glucose 0.91 mmol/l; 95% CI 0.6 to 1.2). The correlation coefficient for the laboratory blood glucose versus the capillary blood glucometer glucose was 0.97 mmol/l (p,0.001). The correlation coefficient for the laboratory blood glucose and the venous blood glucometer glucose was 0.96 (p,0.001). Variation occurred between the glucometer and the laboratory blood glucose results. Conclusions: There is a small but significant difference in the blood glucose results analysed on a bedside glucometer when the samples are taken from capillary or venous sources. Although good correlation is the norm between venous and capillary derived samples, caution must be exercised in accepting the results as equivalent or using either as substitutes for a laboratory blood glucose result.

The study suggests that the use of instructional DVD for clinical skills teaching results in improved learning outcomes compared with the traditional face-to-face didactic teaching method.

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Objectives: To ascertain if the use of a structured pain assessment tool and nurse initiated oral analgesia protocols improve uptake and time to analgesia for children presenting to the emergency department with minor or moderate musculoskeletal injuries. Methods: Three groups of children with peripheral limb injuries were examined to identify the rates of analgesia provision and time from attendance to analgesia provision. These groups corresponded to an initial group with no pain scoring and physician initiated analgesia, a second group with pain scoring at triage then physician initiated analgesia, and a third group with pain scoring and nurse initiated analgesia. Results: The mean time to analgesia in the initial group was 138 minutes. After initiation of triage pain assessment the mean time to analgesia was 93 minutes, there was no statistical difference between these two groups. After the introduction of nurse initiated analgesia, the time to analgesia fell to a mean of 46 minutes. The rate of analgesia provision was initially 20.5% while after the initiation of triage pain assessment the provision rate was 23%. After the initiation of nurse initiated analgesia the analgesia provision rate significantly rose to 34% of attendances. Conclusions: The use of a nurse initiated, oral analgesia protocol for treatment of children with mild to moderate injury can significantly increase analgesia provision rates and decrease time to provision of analgesia.T he assessment of pain in children has proved problematical particularly in the acute setting.1 There is now clear evidence to show that children and indeed neonates have well established and effective neural pathways to conduct pain.2 A mounting body of evidence has shown that children are frequently underprovided for in terms of analgesia assessment and provision of pain relief.3-5 Indeed the use of analgesia in children is known to be consistently inferior to that in adults. 6 The reasons behind this oligoanalgesia for acute pain in children is unclear but almost certainly includes staff inexperience in paediatric pain prescription, fear of causing drug side effects or dependence, 7 and lack of proper pain assessment methods.1 Adult work suggests that analgesic dependence is not a significant issue 8 and that children are able to cope with even the most potent opioids in a similar fashion to adults.9 Validated pain tools for use in children are also now available and in use in many acute situations. 10 We carried out a study to ascertain if changes in current traditional working practices, namely, triage pain assessment and nurse initiated analgesia can have an impact on the rates of analgesia provision and times to analgesia provision for children in the emergency department. METHODSThis prospective interventional study was conducted in an urban Australasian emergency department with an annual attendance of 43 thousand patients per annum of which 14 000 are aged under 16 years. The study was conduct over a total of three, two month periods from February to Aug...

The repeatability of energy-expenditure measurements were studied in five children and four adults without disabilities using the Cosmed K4 (high technology). The ability to detect change in measurements was compared between this instrument and the Physiological Cost Index (PCI; low technology). The results of repeatability (95% range) for oxygen cost were 13.1% in children and 13% in adults. In contrast, the SD of PCI was 6 to 72% of the mean in adults and wider in children (91%; 95% range). The validity of PCI as an outcome measure was questioned. In addition, 177 children with motor disability were prospectively studied using the Cosmed K4. Previous experience with the Cosmed K2 (intermediate technology) helped to develop a practical and repeatable protocol for testing children with disability using the Cosmed K4. The protocol commenced with 5 minutes of rest to achieve baseline values of heart rate and oxygen consumption, followed by 10 minutes of continuous walking at a self-selected speed on a 10