Articles: hospital-emergency-service.
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Randomized Controlled Trial
Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training.
Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. ⋯ Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.
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Rev Assoc Med Bras (1992) · Jan 2024
Randomized Controlled Trial Comparative StudyComparison of rocuronium priming vs. standard rapid sequence intubation technique in emergency department patients requiring intubation.
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Randomized Controlled Trial
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest.
Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. We sought to evaluate how timing from emergency medical services (EMS) arrival on scene to drug administration affects the efficacy of amiodarone and lidocaine compared to placebo. ⋯ The early administration of amiodarone, particularly within 8 min, is associated with greater survival to admission, survival to discharge, and functional survival compared to placebo in patients with an initial shockable rhythm.
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Emerg Med Australas · Aug 2023
Randomized Controlled Trial Multicenter StudySodium chloride or plasmalyte-148 for patients presenting to emergency departments with diabetic ketoacidosis: A nested cohort study within a multicentre, cluster, crossover, randomised, controlled trial.
To test the hypothesis that fluid resuscitation in the ED with plasmalyte-148 (PL) compared with 0.9% sodium chloride (SC) would result in a lower proportion of patients with diabetic ketoacidosis (DKA) requiring intensive care unit (ICU) admission. ⋯ Patients with DKA treated with PL compared with SC in the EDs had similar rates of requiring ICU admission.
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Randomized Controlled Trial
Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.
To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. ⋯ Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient.