Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Randomized Controlled Trial Clinical Trial
A randomized clinical trial to assess the efficacy of the Epley maneuver in the treatment of acute benign positional vertigo.
To compare the efficacy of the Epley maneuver with that of a placebo maneuver in patients presenting to the emergency department (ED) with benign positional vertigo (BPV). ⋯ The Epley maneuver is a simple bedside maneuver that appears to be more efficacious than a placebo maneuver in the treatment of acute BPV among ED patients.
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To determine the effect of intravenous (IV) magnesium sulfate on the length of stay (LOS) for children admitted with sickle cell pain crisis. ⋯ IV magnesium appears to decrease the LOS for children with sickle cell pain crisis.
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To determine predictors of asthma morbidity in African American patients with asthma. Proxies for asthma morbidity were emergency department (ED) visits for asthma and hospitalizations for asthma. ⋯ It appears that African American patients with asthma who had previous hospitalizations for asthma within the past year or use a peak flow meter daily (a marker for more severe asthma) are more likely to visit the ED in the future or to be hospitalized for asthma, respectively. These patients need to be targeted and treated more aggressively to improve asthma care and decrease morbidity. The apparent protective effect of the presence of pets on reducing ED visits is unclear at this time, and the findings need to be replicated and evaluated further.
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Observational studies assessing the effect of a particular treatment or exposure may be subject to bias, which can be difficult to eliminate using standard analytic techniques. Multivariable models are commonly used in observational research to assess the relationship between a certain exposure or treatment and an outcome, while adjusting for important variables necessary to ensure comparability between the groups. Large differences in the observed covariates between two study groups may exist in observational studies in which the investigator has no control over who was allocated to each treatment group, and these differences may lead to biased estimates of treatment effect. ⋯ The authors present three methods for integrating propensity scores into observational analyses using a database collected on head-injured trauma patients. The article details the methods for creating a propensity score, analyzing data with the score, and explores differences between propensity score methods and conventional multivariable methods, including potential benefits and limitations. Graphical representations of the analyses are provided as well.
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To describe the loss of paramedic availability to Toronto Emergency Medical Services during a biphasic (SARS-1 and SARS-2) outbreak of severe acute respiratory syndrome (SARS). ⋯ Paramedics were among the health care workers who developed SARS. During SARS-2, WQ optimized the number of days on which paramedics were available for duty. Many paramedics developed SARS-like symptoms without being diagnosed as having SARS. A dedicated paramedic surveillance and quarantine program provided a useful means to manage the paramedic resource during the SARS outbreak.