Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. These females should have imaging with either MRI or CT as well as abdominal or transvaginal ultrasound to assess for ovarian teratoma. Earlier diagnosis leads to better outcomes. It is best to assume the worst and cover for this possibility. 2019.12.016.

Seizures 265

Seizures Psychiatric Outcomes Pediatrics 265

Dr. Smith's ECG Blog

JULY 11, 2024

In support of this ECG representing acute proximal LAD OMI — is the clearly abnormal complex in lead aVL ( within the BLUE rectangle ) — which shows a surprisingly wide and deep Q wave ( given tiny size of the QRS in this lead ) — as well as slight-but-real ST elevation of coved morphology with terminal T wave inversion.

EKG/ECG 91

EKG/ECG Outcomes Hospitals Wellness 91

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. Now, again, we examine thrombolysis in “mild” stroke, in this case, NIHSS ≤3 – and fail.

Stroke 114

Stroke Outcomes Wellness 114

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Case: A 32-year-old woman with no previous medical history calls you while a passenger on a […] The post SGEM#284: Might as Well Jump, but We would Recommend a Parachute first appeared on The Skeptics Guide to Emergency Medicine. Secondary Outcomes: Health status and subgroup analysis based on type of aircraft or previous parachute use.

Wellness 52

Wellness Outcomes Emergency Department Research 52

American Medical Compliance

SEPTEMBER 9, 2024

Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status. Recognize and reward teamwork in addressing skin issues. Monitor and Measure Outcomes Regularly monitor the outcomes of skin care interventions.

Teamwork 101

Teamwork Best Practices Outcomes Wellness 101

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. A 2008 Cochrane review found adult depression screening does not improve outcomes. The last two trials convincingly demonstrate that when patients with postpartum depression have better access to mental health services, outcomes improve.

Outcomes 135

Outcomes Military Psychiatric Wellness 135

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 131

Sepsis Hospitals Administration Outcomes 131

Stop and Think

AUGUST 28, 2024

Trial after trial after trial finds that fixing stable coronary artery disease does not improve outcomes over basic medications and lifestyle changes. The trial found no difference in outcomes. of patients had a primary outcome (death or heart attack). of the patients had a primary outcome (death or heart attack).

Outcomes 121

Outcomes Shock Hospitals Wellness 121

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. What patients, doctors, hospitals and payers want to know is that does the $43 billion spent on screening lead to better outcomes in the average patient. My thinking aligns well with his.

Outcomes 117

Outcomes Research Wellness Hospitals 117

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

EM Literature of Note

SEPTEMBER 24, 2024

Among the ~150 patients in each arm, those randomized to “high-intensity” NIPPV improved their primary outcome of “need for endotracheal intubation” – 4.8% These observations were durable in both unadjusted and adjusted results, as well as across most pre-specified subgroups. in each group.

COPD 83

COPD Outcomes Emergency Department Wellness 83

Emergency Medicine Journal

SEPTEMBER 25, 2024

Being a trauma team leader, emergency physician in charge or clinical lead all look very different and require a range of skills, but are all certainly forms of leadership that have a significant impact on the running of an emergency department, patient outcomes and, as is increasingly being recognised, staff well-being.

Leadership 52

Leadership Emergency Department Outcomes Wellness 52

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly. The problem here is that it’s hard to compare a subjective outcome (like feeling better) when one group of patients get a procedure and the other group gets tablets.

Stroke 77

Stroke Outcomes Shock Research 77

EM Literature of Note

APRIL 11, 2024

Each of these disease states has well-defined pathways for “optimal” therapy and escalation. The most notable feature of this trial is the simple, negative topline result – rollout of this intervention had no reliably measurable effect on patient-oriented outcomes relating to disease progression or acute clinical deterioration.

Outcomes 92

Outcomes Administration Hospitals Wellness 92

The Trauma Pro

SEPTEMBER 20, 2023

The primary outcome was mortality, and secondary outcomes included the need for surgery, fluid and blood infusions, and the use of a massive transfusion protocol. These low numbers and the nature of this particular registry could inject significant bias as well. AAST 2023 Plenary paper #29.

Military 113

Military Blood Transfusions Administration Outcomes 113

Taming the SRU

SEPTEMBER 18, 2024

The form included information that, based on literature review and expert opinion, was thought to be either positively or negatively associated with one of the serious outcomes. Using logistic regression models, investigators identified 7 variables independently associated (either positively or negatively) with a serious outcome.

Stroke 84

Stroke Outcomes Emergency Department Radiology 84

RebelEM

FEBRUARY 1, 2024

Limitations : Open label study design Outcome assessments were done via telephone interview. mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% Unadjusted risk difference 2.1% [ 95% CI -2.6 mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% mg/kg followed by 0.81

Stroke 135

Stroke Blood Transfusions Outcomes EMS 135

Sensible Medicine

NOVEMBER 20, 2023

The primary outcome was stroke or systemic embolism. Lessons and Questions: This surprise illustrates exactly why we need properly powered Phase 3 trials, which measure hard clinical outcomes. But, ultimately, a new medical intervention has to improve an important outcome as well as or better than standard care.

Stroke 101

Stroke Outcomes Wellness 101

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

Sensible Medicine

NOVEMBER 13, 2023

of patients experienced a first primary outcome event in the semaglutide arm vs 8.0% The Kaplan-Meier curves for outcomes began separating early and continued over 3-4 years. There were other positive results as well. Each component of the primary outcome was lower. Patients in the trial were in their low sixties.

Outcomes 101

Outcomes Stroke Wellness Research 101

The Skeptics' Guide to EM

JUNE 8, 2024

It has been shown in previous research that TGD individuals have both high ED avoidance due to discrimination, as well as a high need for emergency services due to the impacts of minority stress on this population [3,4]. Yes The outcomes were clinically relevant. of the overall population, and up to 4.1%

Best Practices 123

Best Practices Emergency Department Research Outcomes 123

RebelEM

JUNE 22, 2023

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). Blinding procedures were well constructed as to mask group allocation. Prior vaccination was not an exclusion criteria.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

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? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Hospitals 83

Sensible Medicine

AUGUST 30, 2024

When the medical outcomes of my patients are bad, I am sometimes haunted by the lack of a counterfactual. I also knew his family well, most of them were my patients. When things go well in medicine, we never second guess our decision making. We don’t know how things would have turned out had we made different decisions.

Hospice 87

Hospice Dehydration Wellness Outcomes 87

Taming the SRU

JUNE 28, 2024

In 2018, Cheskes et al in Canada decided to examine these therapies and compare their outcomes. They utilized paramedic services to compare outcomes of dual sequence vs vector change defibrillation in regards to survival to hospital discharge as well as termination of v fib, rates of ROSC, and neurologic outcome at discharge.

Shock 73

Shock Hospitals Outcomes CPR 73

Sensible Medicine

SEPTEMBER 12, 2024

We find the letter to be well-argued. 3 Another meta-analysis in HF patients indicated that higher doses of ACEIs and ARBs, compared to lower doses, significantly improved outcomes. 4 The study's open-label design increases the risk of differential misclassification of outcomes and performance biases. JACC Heart Fail.

Academics 62

Academics Outcomes Hospitals Wellness 62

American Medical Compliance

JUNE 13, 2024

Quick and effective response after a trip can drastically improve outcomes and prevent further complications. This course will cover the critical steps to take immediately after a fall, including assessing the situation, providing appropriate care, and ensuring the safety and well-being of the individual.

Outcomes 52

Outcomes Wellness 52

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 73

Outcomes Best Practices EMS Shock 73

Sensible Medicine

OCTOBER 2, 2023

The general concept is how trials measure, report and interpret outcomes. Before any experiment, choices have to be made about which outcome(s) to measure. People will argue about the choices, but a steadfast rule should be that reporting outcomes should be consistent over time. More on the specifics in a moment. The HR was 1.3

Stroke 96

Stroke Outcomes Wellness 96

Emergency Medicine Cases

FEBRUARY 13, 2024

How can we utilize virtual care to make it work for us and our patients well? How can we integrate systems thinking into the daily operations of EDs to improve patient flow and outcomes? How can we improve our EMS systems? How can we change the system to prevent emergency provider burnout? and many more.

EMS 77

EMS Operations Outcomes Wellness 77

Taming the SRU

MARCH 27, 2024

The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. Secondary outcomes included mean arterial pressure (MAP), heart rate, vasoactive inotropic score (VIS) – a weighted score of different cardiovascular active agents, VIS/MAP, and pulmonary artery catheter (PAC) monitoring. Hill, J.

Resuscitation 96

Resuscitation Outcomes CPR Hospitals 96

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Demographics were well balanced in the two groups.

Outcomes 104

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 104

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. to 53.54, p=0.053).

Stroke 78

Stroke Administration Outcomes Documentation/Coding 78

Sensible Medicine

JUNE 11, 2024

The innovation of such a tool is well described by the rapid adoption of ChatGPT, which reached 1 million users in just five days and 100 million users in two months. This responsibility extends to patients as well, ensuring that their voices and needs are central to the innovation process.

Documentation/Coding 70

Documentation/Coding Wellness Outcomes Research 70

Sensible Medicine

AUGUST 19, 2024

One of the core ideas in cardiology is that improving blood flow to a heart with severe reduction of flow due to coronary stenoses will improve outcomes. The addition of patients with a weak heart muscle makes it even more likely that improvement of blood flow should improve outcomes— over medical therapy. The median EF was 28%.

Outcomes 86

Outcomes Ultrasounds Wellness 86

EMDocs

JULY 20, 2023

A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.

Stroke 73

Stroke Outcomes Head Injuries Psychiatric 73