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NAUSEA, PAIN, PREVENTIVE medicine, ACUPUNCTURE, CHI-squared test, EMERGENCY medical services, HOSPITAL emergency services, PATIENT satisfaction, PATIENT safety, RESEARCH funding, T-test (Statistics), U-statistics, PILOT projects, PATIENT refusal of treatment, VISUAL analog scale, DATA analysis software, DESCRIPTIVE statistics, and PREVENTION

Objective: To evaluate the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea. Methods: A feasibility study (with historical controls) undertaken at the Northern Hospital ED in Melbourne, Australia, involving people presenting to ED triage with pain (VAS 0–10) and/or nausea (Morrow Index 1–6) between January and August 2010 (n=400). The acupuncture group comprised 200 patients who received usual medical care and acupuncture; the usual care group comprised 200 patients with retrospective data closely matched from ED electronic health records. Results: Refusal rate was 31%, with ‘symptoms under control owing to medical treatment before acupuncture’ the most prevalent reason for refusal (n=36); 52.5% of participants responded ‘definitely yes’ for their willingness to repeat acupuncture, and a further 31.8% responded ‘probably yes’. Over half (57%) reported a satisfaction score of 10 for acupuncture treatment. Musculoskeletal conditions were the most common conditions treated n=117 (58.5%), followed by abdominal or flank pain n=49 (24.5%). Adverse events were rare (2%) and mild. Pain and nausea scores reduced from a mean±SD of 7.01±2.02 before acupuncture to 4.72±2.62 after acupuncture and from 2.6±2.19 to 1.42±1.86, respectively. Conclusions: Acupuncture in the ED appears safe and acceptable for patients with pain and/or nausea. Results suggest combined care may provide effective pain and nausea relief in ED patients. Further high-quality, sufficiently powered randomised studies evaluating the cost-effectiveness and efficacy of the add-on effect of acupuncture are recommended. [ABSTRACT FROM AUTHOR]

LITTER (Trash), WASTE management, BEHAVIOR, SOCIAL norms, ENVIRONMENTAL responsibility, ENVIRONMENTALISM, ENVIRONMENTAL sociology, SURVEYS, and PSYCHOLOGY

Two studies tested littering norm activation by trash can design. The first was a scenario study using a 4 (norm type: social injunctive vs. social descriptive vs. personal vs. control) × 2 (activation type: explicit vs. implicit activation) between-group design, with judgments of a litterer as the dependent variable. Explicit norm activation was more effective than implicit activation. A field study subsequently tested the effect of personal norm activation on actual littering behavior, following a 2 (explicit activation: no vs. yes) × 2 (Implicit activation: no vs. yes) between-group design. Here, both explicit activation through a verbal prompt and implicit activation through design had significant effects, reducing the amount of litter by 50%. A post hoc survey revealed significant effects of age and gender on the personal norm against littering. These findings helped explain the absence of norm activation effects in the youngest age group as found in the field study. [ABSTRACT FROM AUTHOR]

We developed a continous quality improvement (CQI) program for anesthesia services based on self- reporting of critical incidents and negative outcomes through a dichotomous (yes/no) response on the anes thesia record. Immediate case investigation provides data for systematic peer review of anesthesia man agement. Trend analysis of the database of critical incidents and negative outcomes identifies opportu nities for improvement. The CQI program resulted in the reporting of nearly twice as many problems re lated to anesthesia management (5% of all anes thetics) as did the checklist it replaced (2.7%). Esca lation of patient care (3.2%) and operational ineffi ciencies (2.2%) were more common than patient injury (1.5% of all anesthetics). Among the 537 cases with anesthesia management problems were 119 hu man errors and equipment problems (22%). Regional nerve blocks and airway management represented the most common problem areas. Improvement in anesthesia services was made through prompt imple mentation of strategies for problem prevention de vised by the practitioners themselves through peer review, literature review, and clinical investigations. [ABSTRACT FROM PUBLISHER]