Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Observational Study
Intravenous Ondansetron and the QT Interval in Adult Emergency Department Patients: An Observational Study.
Ondansetron is known to cause QT interval prolongation, but this effect and clinical significance has not been prospectively studied in adult emergency department (ED) patients. The primary objective was to determine the mean maximal corrected QT interval (QTc) prolongation after intravenous (IV) administration of 4 mg of ondansetron. The secondary objective was to report any serious adverse cardiac electrical events. ⋯ While QTc prolongation does occur in adult ED patients receiving IV ondansetron, the clinical impact is questionable.
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The objective of this study was to evaluate operational policies that may improve the proportion of eligible stroke patients within a population who would receive intravenous recombinant tissue plasminogen activator (rt-PA) and minimize time to treatment in eligible patients. ⋯ Given the potential societal benefits, continued efforts to deploy telemedicine appear warranted. Aligning the incentives between those who would have to fund the up-front technology investments and those who will benefit over time from reduced ongoing health care expenses will be necessary to fully realize the benefits of telemedicine for stroke care.
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Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998. ⋯ While satisfaction with fellowship preparation for professional activities in PEM is improving, gaps remain in training in nonclinical skills. Symptoms of burnout are prevalent, and there is likely to be substantial attrition of PEM providers in the near future.
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Traditionally, in both pediatric and adult trauma patients, management of hemorrhage and shock has included early rapid intravenous fluid (IVF) replacement at the scene or during transport to a definitive care facility. Because prehospital resuscitation can be considered as a lifesaving intervention, severely injured patients are more likely to receive IVF. Observational studies not adequately adjusting for this confounding by indication (indication bias) while evaluating the impact of prehospital IVF on mortality in clinically heterogeneous patient populations are likely to find an increased mortality associated with the use of prehospital IVF, an association that may be spurious even after traditional multivariable risk adjustment. Propensity scores can be used to mitigate the impact of this selection bias on the estimated effect. The authors hypothesized that the effect of IVF on mortality will differ based on whether propensity scores (based on a set of prehospital indications for IVF) are adjusted for in a multivariable outcome model. ⋯ Propensity-adjusted survival analysis suggests that the observed increased risk in mortality associated with use of prehospital IVF replacement may be a spurious association resulting from inadequate control of confounding by indication inherent in observational studies. In the absence of patient subgroup-specific results from well-controlled studies, IVF resuscitation should not be a reason to delay patient transport to a definitive care facility. Randomized trials evaluating the effect of prehospital fluids are warranted in the pediatric trauma population, as such studies have shown clinical significance in the adult trauma population.
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Research findings are not consistently adopted in the clinical setting and there is a gap between best evidence and clinical practice across a range of conditions and settings. A number of factors may contribute to this discrepancy, including the direction of the research findings (i.e., whether positive or negative for an intervention). The objectives of this study were to measure the translation of results from randomized controlled trials (RCTs) into clinical care and to determine whether the direction of the trial findings influence the uptake of research reports into clinical practice. ⋯ In the ED setting, results of RCTs published in high-impact journals are more likely to be translated into clinical care when they demonstrate the benefits of an intervention. Our findings indicate that direction of research evidence is an important factor when evaluating knowledge uptake into clinical practice.