The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia.
We conducted a prospective double-blind study of accelerated dose titration of olanzapine in the treatment of newly admitted acutely agitated patients with schizophrenia. Patients were randomized to either oral olanzapine (10 mg per day) or oral haloperidol (10 mg per day), plus lorazepam as needed (up to 12 mg per day). ⋯ Significant within-group improvement was demonstrated in PANSS Agitation scores for both groups as early as 1 hour after initiating therapy (-5.79 +/- 6.30 for olanzapine and -4.89 +/- 6.05 for haloperidol, P <.001). This study demonstrated that accelerated dose titration of oral olanzapine is as efficacious as oral haloperidol in reducing acute agitation in patients with schizophrenia.
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Multicenter Study Clinical Trial Controlled Clinical Trial
Uptake of validated clinical practice guidelines: experience with implementing the Ottawa Ankle Rules.
This study examined whether emergency physicians (EPs) exposed to multiple dissemination strategies for the Ottawa Ankle Rules (OARs) would reduce extremity radiography use. We conducted a prospective cohort study comparing intervention (n = 2) with control (n = 2) hospitals over a 2-year period. All EPs received the paper-based rules during the run-in phase; EPs in the intervention hospitals were also subjected in sequence to valid dissemination approaches. ⋯ Sequential directed education and personalized feedback strategies failed to reduce radiographic ordering rates (P =.54) or the ordering of both foot and ankle radiographs (P =.11) over time. The use of radiography did not decrease despite the use of a variety of dissemination strategies. Additional research is required to determine the most effective methods of incorporating guidelines into emergency practice.
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This study characterizes the use of complementary and alternative medicines (CAM) among ED patients and demonstrates patterns of healthcare utilization among users and nonusers of CAM therapies. A cross-sectional observational study was performed by administering questionnaires to ED patients at a university teaching hospital. Of the 356 patients surveyed, more than half (55%) had tried at least one complementary and alternative therapy within the past 12 months and 17% had tried CAM for their presenting medical problem. ⋯ After controlling for age, ethnicity, education level, religion, income, and self-report of overall health status, users of CAM had more frequent visits to outpatient physicians (odds ratio [OR], 1.06; 95% CI, 1.02-1.1; P <.01), had no difference in their rates of hospitalization, but trended toward spending fewer days in the hospital when they were admitted (OR,.96; 95% CI,.92-1.0; P =.06). Complementary and alternative medicines are being used by a majority of ED patients with a significant number having used CAM for their presenting complaint before visiting the ED. CAM users do not differ in their utilization of the ED when compared with nonusers, but do have a significantly increased frequency of outpatient physician visits.
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Comparative Study
Real-time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT).
We hypothesize that EPs can decrease the time to disposition when performing examinations for deep venous thrombosis (DVT) compared with disposition times using imaging specialists (IS). We performed a prospective, single-blind observational study at an academic ED over the course of 1 year. Patients were enrolled based on study physician availability. ⋯ EPs and ISs had excellent agreement (kappa = 0.9). Compression ultrasound performed by EPs resulted in a significant decreased time to disposition. Agreement with ISs was excellent.
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Comparative Study
Can nurses appropriately interpret the Ottawa Ankle Rule?
The objective of this study was to determine if ED triage nurses could appropriately interpret the Ottawa Ankle Rules (OAR). We conducted a prospective, observational trial of a clinical decision rule in a suburban ED on a convenience sample of ED patients, aged >17 years with acute ankle injuries. Nurses and EPs were trained in the appropriate use of the OAR. ⋯ Sensitivity of the EP's utilization of the OAR for fracture was 92%, specificity 47% with a negative predictive value 94%, and a positive predictive value 38%. Nurses showed only a moderate ability to interpret the overall OAR for ordering of x-rays. Nurses' understanding of the individual criterion were variable.