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Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine

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https://www.readbyqxmd.com/read/28646590/randomized-controlled-double-blind-trial-comparing-haloperidol-combined-with-conventional-therapy-to-conventional-therapy-alone-in-patients-with-symptomatic-gastroparesis
#1
Carlos J Roldan, Kimberly A Chambers, Linda Paniagua, Sonali Patel, Marylou Cardenas-Turanzas, Yashwant Chathampally
OBJECTIVE: Gastroparesis is a debilitating condition that causes nausea, vomiting, and abdominal pain. Management includes analgesics and antiemetics, but symptoms are often refractory. Haloperidol has been utilized in the palliative care setting for similar symptoms. The study objective was to determine whether haloperidol as an adjunct to conventional therapy would improve symptoms in gastroparesis patients presenting to the emergency department. METHODS AND TRIAL DESIGN: This was a randomized, double-blind, placebo-controlled trial of adult emergency department patients with acute exacerbation of previously diagnosed gastroparesis...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646584/prehospital-advanced-cardiac-life-support-for-out-of-hospital-cardiac-arrest-a-cohort-study
#2
Alexis Cournoyer, Eric Notebaert, Massimiliano Iseppon, Sylvie Cossette, Luc Londei-Leduc, Yoan Lamarche, Judy Morris, Éric Piette, Raoul Daoust, Jean-Marc Chauny, Catalina Sokoloff, Yiorgos Alexandros Cavayas, Jean Paquet, André Denault
OBJECTIVES: Out-of-hospital advanced cardiac life support (ACLS) has not consistently shown a positive impact on survival. Extracorporeal cardiopulmonary resuscitation (E-CPR) could render prolonged on-site resuscitation (ACLS or basic cardiac life support [BCLS]) undesirable in selected cases. The objectives of this study were to evaluate, in patients suffering from out-of-hospital cardiac arrest (OHCA) and in a subgroup of potential E-CPR candidates, the association between the addition of prehospital ACLS to BCLS and survival to hospital discharge, prehospital return of spontaneous circulation (ROSC) and delay from call to hospital arrival...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646558/neurology-concepts-young-women-and-ischemic-stroke-evaluation-and-management-in-the-emergency-department
#3
Bernard P Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen
OBJECTIVE: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g. premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28646519/the-association-of-health-literacy-with-preventable-ed-visits-a-cross-sectional-study
#4
Meenakshi P Balakrishnan, Jill Boylston Herndon, Jingnan Zhang, Thomas Payton, Jonathan Shuster, Donna L Carden
BACKGROUND: Policy-makers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. OBJECTIVE: To determine the association of health literacy and preventable ED visits...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28628260/society-for-academic-emergency-medicine-statement-on-plagiarism
#5
Shellie L Asher, Kenneth V Iserson, Lisa H Merck
The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications...
June 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28621810/adherence-to-standards-for-reporting-diagnostic-accuracy-in-emergency-medicine-research
#6
Lucas Gallo, Nadia Hua, Mathew Mercuri, Angela Silveira, Andrew Worster
BACKGROUND: Diagnostic tests are used frequently in the emergency department (ED) to guide clinical decision-making and, hence, influence clinical outcomes. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria was developed to ensure diagnostic test studies are performed and reported to best inform clinical decision making in the ED. OBJECTIVE: To determine the extent to which diagnostic studies published in emergency medicine journals adhered to STARD 2003 criteria...
June 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28608494/comparing-the-no-objective-testing-rule-to-the-heart-pathway
#7
Jaimi Greenslade, Louise Cullen
We read with great interest the article by Stopyra and colleagues(1) comparing the no objective testing (NOT) rule and the HEART pathway using a cohort of 141 patients. The two rules, developed to risk stratify patients presenting to the emergency department (ED) with acute chest pain, were 100% sensitive for identifying major adverse cardiac events (MACE) at 30 days. The HEART pathway identified a more sizeable portion of low-risk patients who could be discharged without additional cardiac testing. This article is protected by copyright...
June 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28608431/response-to-the-letter-to-the-editor
#8
Jason P Stopyra, Chadwick D Miller, Simon A Mahler
We appreciate the insights and concerns raised in the above letter to the editor. The authors have thoughtfully highlighted some important distinctions between the original derivation of NOTR and our validation study.(1,2) Specifically, the original NOTR derivation included cardiac death, acute myocardial infarction (MI), unstable angina (UA), and "urgent and emergent" revascularization in a composite safety endpoint (and did not include "elective" coronary revascularizations). Our study included death, MI, and any coronary revascularization events, but did not include UA...
June 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28590591/hot-off-the-press-point-of-care-ultrasound-for-non-angulated-distal-forearm-fractures-in-children
#9
Justin Morgenstern, Corey Heitz, William K Milne
This prospective, cross-sectional diagnostic study examined the performance of point of care ultrasound (POCUS) in the diagnosis of suspected non-angulated forearm fractures in pediatric patients aged 4-17 years, using x-rays as the gold standard. The test characteristics reported are a sensitivity of 94.7% (95% CI 89.7-99.8%), a specificity of 93.5% (95% CI 88.6-98.5%), a positive likelihood ratio of 14.6, and a negative likelihood ratio of 0.6. This article is protected by copyright. All rights reserved.
June 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28585355/improving-care-of-transgender-patients
#10
LETTER
Nancy Lutwak
The recent publication, Is It Okay To Ask: Transgender Patient Perspectives on Sexual Orientation and Gender Identity Collection in Healthcare, is significant in its discussion of circumstances affecting willingness of transgender patients to disclose gender identity and sexual orientation as well as the participants' focus on the need for improved LGBT education for medical staff. The authors also emphasize the importance of safe environments in primary care settings and emergency departments where providers may pose questions regarding intimate issues(1) ...
June 5, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28580586/the-plight-of-veterans
#11
Nancy Lutwak
As I listen to the sounds of the VA emergency department I realize the plight of many veterans is tragic and some have lived through hard times not commonly recognized. There are so many headlines about veteran suicides, homelessness, post-traumatic stress disorder and injuries from explosive devices. This article is protected by copyright. All rights reserved.
June 5, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28574631/starry-aims-to-overcome-knowledge-translation-inertia-the-standards-for-reporting-implementation-studies-stari-guidelines
#12
Christopher R Carpenter, Hilary Pinnock
In 2007, Academic Emergency Medicine hosted a Consensus Conference on "Knowledge Translation in Emergency Medicine" with the objective of identifying high-yield research priorities for the concept of moving from evidence to action.(1) Patients often fail to receive care that aligns with quality indicators, and the Institute of Medicine has estimated that on average 17 years pass before just 14% of effective interventions reach the bedside.(2-4) Equally important is the concept that de-implementing wasteful, inefficient, or outdated clinical approaches frequently require more time and effort than is available, so the trajectory of bedside decision-making often yields to the status quo...
June 2, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28548220/bedside-ultrasound-in-acute-appendicitis-in-the-emergency-department-methodological-and-statistical-issues-on-diagnostic-value
#13
Fatemeh Koohi, Siamak Sabour
We were interested to read the recent paper by Gungor F and colleagues published in May issue of the Acad Emerg Med 2017.(1) The aim of the authors was to evaluate diagnostic value of point-of-care US (POCUS) in clinical decision making of emergency physicians (EPs) for acute appendicitis (AA) in the emergency department (ED).(1) A total of 264 patients were included into a prospective observational clinical study and based on their results 169 (64%) had a diagnosis of AA. This article is protected by copyright...
May 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28544288/impact-of-hospital-best-practice-mandates-on-prescription-opioid-dispensing-after-an-emergency-department-visit
#14
Benjamin C Sun, Nicoleta Lupulescu-Mann, Christina J Charlesworth, Hyunjee Kim, Daniel M Hartung, Richard A Deyo, K John McConnell
OBJECTIVE: Washington State mandated seven hospital "best practices" in July 2012, several of which may affect ED opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. METHODS: We performed a retrospective, observational analysis of ED visits by Medicaid fee-for service beneficiaries in Washington State, between July 1, 2011 to June 30, 2013...
May 23, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28544100/undetectable-concentrations-of-an-fda-approved-high-sensitivity-cardiac-troponin-t-assay-to-rule-out-acute-myocardial-infarction-at-emergency-department-arrival
#15
Andrew D McRae, Grant Innes, Michelle Graham, Eddy Lang, James E Andruchow, Yunqi Ji, Shabnam Vatanpour, Tasnima Abedin, Hong Yang, Danielle A Southern, Dongmei Wang, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
BACKGROUND: The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. METHODS: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs were, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function...
May 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28503848/in-response-ultrasound-assisted-lumbar-puncture-on-infants-in-the-pediatric-emergency-department
#16
Samuel H F Lam
I read with interest the recently published article on ultrasound assisted pediatric lumbar puncture (UALP) by Gorn and colleagues(1) . As an advocate of point-of-care ultrasound in the pediatric emergency department setting, I am greatly encouraged by the study results. However, I would suggest clarification on several details of the study, some of which could potentially lead to biased outcomes. This article is protected by copyright. All rights reserved.
May 15, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28500785/don-t-label-me-a-qualitative-study-of-patients-perceptions-and-experiences-of-sedation-during-behavioral-emergency-in-the-emergency-department
#17
Celene Y L Yap, Jonathan C Knott, David C M Kong, Marie Gerdtz, Kay Stewart, David McD Taylor
OBJECTIVES: Behavioral emergencies are commonly seen in emergency departments. Acutely agitated patients can be difficult to manage and sedation may be required to decrease dangerous behavior and to ensure the safety of both the patient and staff. While the experience of staff caring for this population has been reported, patients' experiences with their overall management remains unknown. We aimed to describe the perceptions and experiences of patients regarding the use of sedation during acute behavioral emergencies...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#18
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28493646/validation-of-the-no-objective-testing-rule-and-comparison-to-the-heart-pathway
#19
Jason P Stopyra, Chadwick D Miller, Brian C Hiestand, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Robert F Riley, Gregory B Russell, James W Hoekstra, Simon A Mahler
BACKGROUND: The No Objective Testing Rule (NOTR) is a decision aid designed to safely identify Emergency Department (ED) patients with chest pain who do not require objective testing for coronary artery disease. OBJECTIVES: To validate the NOTR in a cohort of US ED patients with acute chest pain and compare its performance to the HEART Pathway. METHODS: A secondary analysis of 282 participants enrolled in the HEART Pathway Randomized Controlled Trial was conducted...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28493642/adverse-events-with-ketamine-versus-ketofol-for-procedural-sedation-on-adults-a-double-blinded-randomized-controlled-trial
#20
Fabien Lemoel, Julie Contenti, Didier Giolito, Mathieu Boiffier, Jocelyn Rapp, Jacques Istria, Marc Fournier, François-Xavier Ageron, Jacques Levraut
OBJECTIVES: The goal of our study was to compare the frequency and severity of recovery reactions between ketamine and ketamine-propofol 1:1 admixture ("ketofol"). METHODS: We performed a multicentric, randomized, double-blinded trial in which adult patients received emergency procedural sedations with ketamine or ketofol. Our primary outcome was the proportion of unpleasant recovery reactions. Other outcomes were frequency of interventions required by these recovery reactions, rates of respiratory or hemodynamic events, emesis, and satisfaction of patients as well as providers...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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