Internal and emergency medicine
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Network meta-analysis is a technique for comparing multiple treatments simultaneously in a single analysis by combining direct and indirect evidence within a network of randomized controlled trials. Network meta-analysis may assist assessing the comparative effectiveness of different treatments regularly used in clinical practice and, therefore, has become attractive among clinicians. ⋯ The aim of this paper is to illustrate the process of network meta-analysis with the aid of a working example on first-line medical treatment for primary open-angle glaucoma. We discuss the key assumption of network meta-analysis, as well as the unique considerations for developing appropriate research questions, conducting the literature search, abstracting data, performing qualitative and quantitative synthesis, presenting results, drawing conclusions, and reporting the findings in a network meta-analysis.
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Observational Study
Variation in opioid prescribing patterns between ED providers.
Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. ⋯ There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.
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The Residency Review Committee in Emergency Medicine requires residency programs to deliver at least 5 hours of weekly didactics. Achieving at least a 70 % average attendance rate per resident is required for residency program accreditation, and is used as a benchmark for residency graduation in our program. We developed a web-based, asynchronous curriculum to replace 1 hour of synchronous didactics, and hypothesized that the curriculum would be feasible to implement, well received by learners, and improve conference participation. ⋯ Our curriculum is feasible to develop and implement. Despite technical difficulties, residents report high satisfaction with this new curriculum. Among PGY-1 residents there is improved conference participation compared to the prior year.