Pediatric EM Morsels

JULY 28, 2023

Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! The Pediatric Emergency Medicine Collaborative Research Commitee. Authors: Drs. Then we’ve likely got DKA. PMID: 12461495.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Sensible Medicine

JULY 30, 2024

In this context, the Canary Prostate Active Surveillance Study ( PASS ) sought to understand the long-term outcomes of active surveillance. Question What are the long-term outcomes for patients with favorable risk prostate cancer managed with protocol-directed active surveillance?

Outcomes 89

Outcomes Research 89

Don't Forget the Bubbles

OCTOBER 30, 2023

Except there’s one problem… I never had anyone actually teach me how to read a research paper… Do I read it like a book? Most traditional research papers have these key sections. The problem is that most research studies are imperfect and have biases. Pay attention to what primary and secondary outcomes were specified.

Research 144

Research Outcomes 144

Emergency Medicine Journal

JULY 22, 2024

Research focusing on the unique needs of children and their families has improved patient outcomes in the ED, outpatient and inpatient settings. However, little research has been done on optimising patient outcomes after ED discharge.

Outcomes 52

Outcomes Research 52

Sensible Medicine

OCTOBER 19, 2023

To the editor: Subpart D of 45 Code of Federal Regulations Section §46.404 states that research involving children should not entail greater than minimal risk, meaning that harm or discomfort should be no greater than those encountered in everyday life. Yet the journal refuses to print it.

Documentation/Coding 130

Documentation/Coding Pediatrics Research Outcomes 130

The Skeptics' Guide to EM

DECEMBER 21, 2024

Day 3: Three Missing Values Missing data is the Grinch of research. Outcomes: Clearly defined primary and secondary endpoints. Ignoring it or using improper methods to handle it can bias your results in unpredictable directions. We often forget that missing data extends beyond interventional studies.

Outcomes 95

Outcomes Research Ultrasounds 95

RebelEM

JUNE 22, 2023

Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Outcomes: Primary: The development of long-COVID up to 300 days after enrollment. This secondary outcome became the primary outcome (see discussion for more detail). More research is necessary in this area.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

Emergency Medicine Journal

AUGUST 21, 2024

Feasibility outcomes were recruitment, retention and adherence. Clinical end points (pulmonary complications, pain and frailty-specific outcomes) and patient questionnaires were collected to determine feasibility of data collection and inform health economic scoping. Pain and some frailty-specific outcomes were not feasible to collect.

Fractures 97

Fractures Research Outcomes Hospitals 97

First 10 EM

NOVEMBER 11, 2024

The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.

Research 126

Research Outcomes EMS 126

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. The aim of TTM is to control the body and brain’s temperature, thus reducing secondary brain injury and improving the neurological outcome.

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

Emergency Medicine Journal

DECEMBER 30, 2024

We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs). Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes. Results 39 doctors were matched with 384 patients.

52

52

ACEP Now

MARCH 6, 2024

Every year, the volume of published research continues to outpace capacity to consume. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. Gotta catch ‘em all!” How Best to Stop the Bleeding in Trauma? percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Sensible Medicine

MARCH 19, 2024

EBM model, individual clinical decisions should be based on three components – “patient’s clinical state and circumstances”, “patient’s preferences and actions” and “research evidence” – and clinical expertise plays a central role in integrating these components (Figure 1).

Research 139

Research Outcomes 139

EM Literature of Note

DECEMBER 4, 2024

But, the net effect becomes – the ED is a focus for patient safety research. In modern parlance, “diagnostic errors” become “missed opportunities for diagnosis” (MODs), and well-meaning researchers are devising further methods to shine bright lights upon our inadequacies.

Emergency Department 92

Emergency Department Stroke Patient Safety Research 92

Mind The Bleep

JANUARY 18, 2024

Introduction Starting my research journey as a medical student has been an incredible and transformative experience. In this article, I wholeheartedly share my personal journey, and the invaluable lessons I’ve learned along the way, and offer friendly tips to fellow medical students who aspire to delve into the world of research.

Research 52

Research Administration Hospitals Outcomes 52

RebelEM

JUNE 1, 2023

Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. The first is from an international research group that searched the usual databases and initially found 921 records. It is from a group of researchers from our big Boston trauma centers and the Netherlands.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

Sensible Medicine

SEPTEMBER 16, 2024

The New York Times’ piece included this line: Now, a large-scale study from the Feinstein Institutes for Medical Research in Manhasset, N.Y., The primary outcome was death in the hospital. Other outcomes included respiratory complications (pneumonia), intubation and hospital length of stay (LOS).

Outcomes 119

Outcomes Hospitals Research 119

RebelEM

SEPTEMBER 7, 2023

More research is needed to inform preventive treatment strategies for seizures in patients with spontaneous intracerebral hemorrhage (ICH). OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. The primary outcome was patient-oriented.

Seizures 133

Seizures Stroke Outcomes Research 133

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? What should you focus on?

Research 83

Research Outcomes Fractures Pediatrics 83

RebelEM

MAY 27, 2024

It is the first research paper to explore the synergistic effects of combining MVM and IV Adenosine in treating PSVT. The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 137

Outcomes Research Hospitals Operations 137

ACEP Now

SEPTEMBER 6, 2024

In this case, because outcomes are so dismal already from large-vessel occlusions, there is some benefit to treatment with tenecteplase, 33 percent versus 24 percent advantage for good or excellent functional outcomes. More troubling, however, were the poor patient-oriented outcomes observed in the trial. N Engl J Med.

Research 49

Research Stroke Outcomes Sepsis 49

The Skeptics' Guide to EM

NOVEMBER 30, 2024

With a survival rate to discharge often below 10% globally, rapid, effective interventions are needed to improve patient outcomes. Multiple studies have demonstrated how the administration of epinephrine can improve short-term outcomes, such as return of spontaneous circulation (ROSC).

Administration 85

Administration CPR Airway Management Outcomes 85

The Skeptics' Guide to EM

DECEMBER 16, 2023

Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) Microaggressions are discriminatory behaviors that may be subtle or unintentional but may disempower affected individuals leading to differential care and worse healthcare outcomes.(7-10)

Emergency Department 116

Emergency Department Research Outcomes 116

The Skeptics' Guide to EM

OCTOBER 5, 2024

She is the co-founder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and a research methodology editor for the Annals of Emergency Medicine. Secondary Outcome: The device's diagnostic accuracy in detecting LVO stroke.

Stroke 103

Stroke EMS Outcomes Research 103

RebelEM

NOVEMBER 30, 2023

What They Did: Researchers performed a systematic review and meta-analysis. Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. The study was conducted according to PRISMA guidelines. 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

Intensive Blog

MARCH 13, 2024

Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing.

CPR 130

CPR Resuscitation Outcomes Hospitals 130

RebelEM

OCTOBER 30, 2023

This could dilute any beneficial effects seen Lack of blinding may bias results (Although mortality is a solid objective primary outcome, bias may still creep in terms of management) Discussion: Authors were looking for an absolute mortality difference of 7% from baseline mortality of 26% with a 90% power. Cryoprecipitate Group: 25.3%

Administration 128

Administration Blood Transfusions Outcomes Hospitals 128

RebelEM

MAY 29, 2023

Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. MB decreases nitric oxide levels by inhibiting inducible nitric oxide synthase (iNOS) and soluble guanylate cyclase (sGC). Through these mechanisms it restores vasoregulation. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Sensible Medicine

JULY 29, 2024

The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats. Importantly, however, there were no differences in health outcome measures, such as BP, BMI, HbA1c or cholesterol level. More than 70% were first-language Spanish speaking.

Outcomes 119

Outcomes Research Sepsis Emergency Department 119

The Trauma Pro

SEPTEMBER 12, 2023

The authors are given very little print space to fully describe their research idea, their methods, and their results’ significance. Even then, it needs to be taken in context with past, similar research before trickling down to patient care. But mercifully, this does not happen often. The first abstract is fascinating.

Fractures 113

Fractures Head Injuries Research Outcomes 113

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 125

CDC Radiology Radiology Outcomes 125

The Trauma Pro

MAY 3, 2024

Various hospital outcomes were tabulated, including hospital charges, mortality, and discharge location. AE and PPP have equivalent outcomes. You can feel comfortable that outcomes will be the same as AE. There is still room for research in this space. Bottom line: This is the largest comparison of AE and PPP to date.

Fractures 113

Fractures Documentation/Coding Radiology Radiology 113

PulmCCM

OCTOBER 16, 2024

In other words, five hundred Chinese people apparently agreed to have their arms painfully constricted and released on and off for a period of 30 minutes, just to participate in a research trial for an unproven therapy. RIPC has not been shown to improve cardiovascular outcomes more generally after cardiac surgery.

Outcomes 52

Outcomes Operations Research Hospitals 52

Sensible Medicine

MARCH 25, 2024

In this study , the research team used an NHANES database. They took adults who self-reported their time windows of eating and then linked them to another database to learn future outcomes. Readers of Sensible Medicine, however, would hardly be surprised about the weak methods because we highlight this game plan so often.

Research 142

Research Outcomes 142

Sensible Medicine

AUGUST 3, 2024

What was the outcome? The outcome was not illness. ” To reiterate, the outcome was clicking the right boxes in an online survey. This study's surrogate treatment and outcome are so many steps away from the causal chain we cared about. The control group was explicitly instructed not to wear masks. What did we learn?

Documentation/Coding 132

Documentation/Coding Outcomes Research 132