Articles: emergency-department.
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Randomized Controlled Trial Multicenter Study
MulticEnter trial of Rivaroxaban for early discharge of pUlmonaRY embolism from the Emergency Department (MERCURY PE): Rationale and Design.
Traditionally, patients with pulmonary embolism (PE) are admitted from the emergency department and treated with low-molecular-weight heparin followed by warfarin. Several studies now demonstrate that it is possible to identify low-risk PE patients that can safely be treated as outpatients. The advent of the direct-acting oral anticoagulants such as rivaroxaban has made it easier than ever to manage patients outside of the hospital. This article describes the design of a randomized controlled trial aimed at testing the hypothesis that low-risk PE patients can be safely and effectively managed at home using rivaroxaban, resulting in fewer days of hospitalization than standard-of-care treatment. ⋯ The MERCURY PE study is designed to test the hypothesis that outpatient management of low-risk PE patients with rivaroxaban reduces the number of hospitalization days from venous thromboembolism and bleeding compared with standard care. This article describes the rationale and methodology for this study.
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Variations in syncope management exist. Our objective was to identify the reasons for consultations and hospitalizations and outcomes among emergency department (ED) syncope patients. ⋯ Cardiac syncope, particularly suspected arrhythmia, was the major reason for ED referrals and hospitalization. The majority of patients hospitalized for cardiac monitoring had no identified cause. An important number of patients suffered SAEs, particularly arrhythmias, outside the hospital. Development of a risk-stratification tool and out-of-hospital cardiac monitoring strategy should improve patient safety and save substantial resources.
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Advances in therapy · Nov 2016
Randomized Controlled Trial Multicenter StudyMethoxyflurane Analgesia in Adult Patients in the Emergency Department: A Subgroup Analysis of a Randomized, Double-blind, Placebo-controlled Study (STOP!).
Acute pain remains highly prevalent in the Emergency Department (ED) setting. This double-blind, randomized, placebo-controlled UK study investigated the efficacy and safety of low-dose methoxyflurane analgesia for the treatment of acute pain in the ED in the adult population of the STOP! trial. ⋯ Medical Developments International (MDI) Limited and Mundipharma Research GmbH & Co.KG.
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Repetition of self-harm is common and is strongly associated with suicide. Despite this, there is limited research on high-volume repetition. ⋯ The approach used in this study offers a new method for investigating this problem that could have both clinical and research benefits. The need for early intervention is highlighted by the large number of self-harm episodes per patient, the clustered nature of attendances, and the higher prevalence of death from external causes.
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Multicenter Study
Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study.
Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario. ⋯ Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals.