Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Patients suffering from chronic painful conditions frequently present to the emergency department (ED) for pain control. In an effort to better manage these patients we implemented and measured the effect of enrollment in a chronic pain protocol in a single ED. ⋯ Through instituting a chronic pain protocol, we found significant reductions in the number of return visits to a single ED and the number of controlled substance medications prescribed by all providers. Additional studies using similar protocols could help establish their impact on the care of patients suffering from chronic pain and the potential to reduce healthcare costs, ED overcrowding, and prescription drug abuse.
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The Patient-Centered Outcomes Research Institute (PCORI) was established by Congress in 2010 to promote the conduct of research that could better inform patients in making decisions that reflect their desired health outcomes. PCORI has established five national priorities for research around which specific funding opportunities are issued: 1) assessment of prevention, diagnosis, and treatment options; 2) improving healthcare systems; 3) communication and dissemination research; 4) addressing disparities; and 5) improving methods for conducting patient-centered outcomes research. ⋯ We suggest that these same factors that have been seen as challenges to performing patient-centered research within the emergency setting are also potential strengths to be leveraged to conduct PCORI research. This paper explores factors unique to patient-centered emergency care research and highlights specific areas of potential alignment within each PCORI priority.
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Randomized Controlled Trial
Safety of a 4-Factor Prothrombin Complex Concentrate versus Plasma for Vitamin K Antagonist Reversal: an Integrated Analysis of two Phase IIIb Clinical Trials.
Clinicians often need to rapidly reverse vitamin K antagonists (VKAs) in the setting of major hemorrhage or urgent need for surgery. Little is known about the safety profile of the traditional reversal agent, plasma, or the newly approved agent, four-factor prothrombin complex concentrate (4F-PCC), in a randomized setting. This is an integrated analysis of safety data from two clinical trials that evaluated 4F-PCC versus plasma for the treatment of patients requiring rapid VKA reversal for acute major bleeding or prior to an urgent surgical/invasive procedure. ⋯ These safety data represent the largest controlled assessment of a 4F-PCC to date. For patients requiring urgent VKA reversal, 4F-PCC had a safety profile similar to that of plasma (AEs, SAEs, thromboembolic events, and deaths), but was associated with fewer fluid overload events.
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The study of preventable deaths is essential to trauma research for measuring service quality and highlighting avenues for improving care and as a performance indicator. However, variations in the terminology and methodology of studies on preventable prehospital trauma death limit the comparability and wider application of data. The objective of this study was to describe the heterogeneity in terminology and methodology. ⋯ The heterogeneity in methodology, terminology, and definitions of "preventable" between studies render data incomparable. To facilitate common understanding, comparability, and analysis, a commonly agreed ontology by the prehospital research community is required.
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Randomized Controlled Trial Clinical Trial
A Comparison of the Effect of Interposed Abdominal Compression-Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation Methods on End Tidal CO2 and the Return of Spontaneous Circulation following Cardiac Arrest: A Clinical Trial.
Sudden cardiac arrest is a major cause of death in the adult population of developed countries, with only 10%-15% of cardiopulmonary resuscitations (CPRs) being successful. We aimed to compare the effects of interposed abdominal compression CPR (IAC-CPR) with standard CPR (STD-CPR) methods on end-tidal CO2 (ETCO2 ) and the return of spontaneous circulation (ROSC) following cardiac arrest in a hospital setting. ⋯ The increase in the ETCO2 during IAC-CPR is an indicator of the increase in cardiac output following the use of this method of CPR.