European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up.
The outpatient population using the emergency department (ED) is increasing and so is the risk of not admitting people who need it. There is, thus, one important question: are the services delivered appropriate to the needs of these ED outpatients? Follow-up of non-admitted patients after a visit to the ED is a prerequisite for the evaluation of these health services. A multicentric follow-up study was thus performed in order to assess the possibility of contacting outpatients after a visit to the ED. ⋯ The success rate was 78.6%, 85.6% and 74% respectively (NS). In each strategy, 50% of patients were contacted at the first telephone call, 20% at the second telephone call and 10% by mail. Thus, in a group of outpatients who gave their consent to be called, the follow-up was found to be feasible with a high success rate whatever the time between the visit and the phone recall.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Flumazenil for hepatic coma in patients with liver cirrhosis: an Italian multicentre double-blind, placebo-controlled, crossover study.
Several factors suggest that endogenous benzodiazepines and gamma-amino-butyric acid may be involved in pathophysiology of hepatic encephalopathy (HE). Contrasting opinions exist on the therapeutic efficacy of flumazenil in the treatment of HE. This study was planned to assess the efficacy of flumazenil by a double-blind, placebo-controlled, crossover design in a large and selected population of cirrhotic patients in stage 4a HE admitted to intensive care units over a 4-year period. ⋯ The presence of benzodiazepines was detected in the serum of three responders and in two non-responders. The presence of diazepam and NN-desmethyl diazepam was documented in two responders; prior intake of synthetic diazepam was later confirmed in these patients. The results of our study suggest that flumazenil is beneficial only in a selected subset of cirrhotic patients with severe HE; the applicability of this treatment to unselected patients with hepatic coma or to cirrhotic patients with less severe HE still remains to be determined.
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Randomized Controlled Trial Comparative Study Clinical Trial
Methamphetamine toxicity: treatment with a benzodiazepine versus a butyrophenone.
Patients with methamphetamine toxicity often present to the emergency department (ED) agitated, violent and psychotic. To determine the efficacy of a benzodiazepine versus a butyrophenone for chemical restraint we conducted a prospective, randomized study at a large urban university ED between January 1995 and January 1997. Patients were randomized to receive either lorazepam or droperidol intravenously. ⋯ Both drugs produced significant reduction in pulse, systolic blood pressure, respiratory rate, and temperature over 60 min. We conclude droperidol produces a more rapid and profound sedation than lorazepam for methamphetamine toxicity. Lorazepam is more likely to require repeat dosing than droperidol.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative study of the efficacy of lysine acetylsalicylate, indomethacin and pethidine in acute renal colic.
The aim of this study was to compare the analgesic efficacy of intravenous lysine acetylsalicylate 1.8 g, indomethacin 100 mg and pethidine 100 mg in acute renal colic in a randomized double-blind clinical trial. One hundred and fifty patients with acute renal colic were divided into three groups. The first group received lysine acetylsalicylate 1.8 g, the second group received indomethacin 100 mg and the third group received pethidine 100 mg. ⋯ Lysine acetylsalicylate was less effective than indomethacin and pethidine. It is concluded that intravenous indomethacin is an effective alternative to intravenous pethidine in the treatment of acute renal colic. Intravenous lysine acetylsalicylate is inferior to intravenous indomethacin in treatment of acute renal colic.
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Randomized Controlled Trial Clinical Trial
Administration of rectal indomethacin does not reduce the requirement for intravenous narcotic analgesia in acute renal colic.
The aim of this study was to compare the total dose of intravenous pethidine required to give satisfactory analgesia to patients with acute renal colic between two groups, one of which was also administered rectal indomethacin on presentation and one which was not. This was a prospective, randomized, unblinded comparison study. Each group contained 39 patients. ⋯ The primary endpoint was total pethidine dose required to achieve analgesia to the patient's satisfaction. No significant difference in total pethidine dose between the groups was found. It was concluded that administration of rectal indomethacin does not reduce the total dose of intravenous pethidine required to relieve the pain of acute renal colic.