Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
-
Randomized Controlled Trial
Use of Prestudy Heparin Did Not Influence the Efficacy and Safety of Rivaroxaban in Patients Treated for Symptomatic Venous Thromboem-bolism in the EINSTEIN DVT and EINSTEIN PE Studies.
In the EINSTEIN DVT and EINSTEIN PE studies, the majority of patients received heparins to bridge the period during venous thromboembolism (VTE) diagnosis confirmation and the start of the study. In contrast to vitamin K antagonists (VKAs), rivaroxaban may not require initial heparin treatment. ⋯ Although the majority of patients in the EINSTEIN studies received prestudy heparin, there were no notable differences in treatment effect of rivaroxaban versus enoxaparin/VKA in those who did and did not receive it.
-
The objectives were to estimate the frequency of pregnancy testing in emergency department (ED) visits by reproductive-aged women administered or prescribed teratogenic medications (Food and Drug Administration categories D or X) and to determine factors associated with nonreceipt of a pregnancy test. ⋯ A minority of ED visits by reproductive-aged women included pregnancy testing when patients were prescribed category D or X medications. Interventions are needed to ensure that pregnancy testing occurs before women are prescribed potentially teratogenic medications, as a preventable cause of infant morbidity.
-
The authors measured the effect of a traumatic or unsuccessful lumbar puncture (LP) on the management of febrile infants. ⋯ Low-risk infants aged 28 to 60 days with traumatic or unsuccessful LPs are more frequently hospitalized, although SBI rates were similar to those of infants with normal LPs.
-
The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals. ⋯ Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more commonly to large teaching hospitals with greater resources. The large number of transfer partners indicates a possible lack of stable transfer relationships between U.S. hospitals.
-
Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire. ⋯ Electromagnetic hand and instrument motion analysis is technically feasible for assessing competence in US-guided insertion of a CVC guidewire in a simulation setting. In showing that it discriminates between the performances of nonexperts and experts, this study has provided evidence for construct validity. It also shows excellent correlation with a modified version of a previously validated GRS, providing evidence of concurrent validity.