Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care / 19.03.2017

MedicalResearch.com Interview with: Marleen Boerma MD Department of Emergency Medicine Elisabeth-Tweesteden Hospital Tilburg, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24 hours after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED. This study shows that there were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5)(p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor.
Addiction, Author Interviews, Emergency Care, Opiods / 02.03.2017

MedicalResearch.com Interview with: Alexander Diaz Bode M.D. Candidate University of Miami Leonard M. Miller School of Medicine Miami, FL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our country is in the midst of an opiate epidemic. This is particularly evident in the emergency department (ED), which continues to see an alarmingly large number heroin overdose. With the shutdown of “pill-mills”, where opioid prescriptions would be prescribed indiscriminately, Florida has seen particularly large increases in opiate use and overdose. In Miami, we noticed that during the summer of 2016, there was a disproportionate increase in heroin overdose being treated at our hospital relative to previous years. Our recently published study showed that fentanyl or fentanyl analog laced heroin likely contributed to this massive spike in heroin overdose observed during the summer of 2016. Fentanyl and its synthetic analogs are opioid receptor agonists that bind with hundreds of times higher affinity than diamorphine, aka heroin. Naloxone, better known by the brand name Narcan®, is used to reverse heroin overdose in the ED. This drug works by competitively inhibiting the opioid receptor, effectively “knocking off” the bound heroin. Using naloxone dosing as a surrogate marker of heroin purity, our study found that during the investigated spike there was a disproportionate increase in the amount of naloxone used in our ED to reverse overdose relative to the increase in opiate overdose. This indicated that a stronger opioid receptor agonist, such as fentanyl or fentanyl analogs, likely was involved in the massive spike in overdose observed during the summer of 2016.
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Infections / 07.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31808" align="alignleft" width="200"]Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA Dr. Anish Agarwal[/caption] Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The morbidity and mortality of severe sepsis has been well studied and documented. An aggressive approach to protocolized care for patients suffering from severe sepsis and septic shock has been shown to improve mortality and should be started as early in the time course of a patient's presentation. Emergency departments (ED) are designed to deliver time-sensitive therapies, however, they also may suffer from crowding due to multiple factors. This study aimed to assess the impact of ED crowding upon critical interventions in the treatment of severe sepsis including time to intravenous fluids, antibiotics, and overall delivery of a protocolized bundle of care. The study found that as ED crowding increased, time to critical therapies significantly increased and the overall implementation of procotolized care decreased. More specifically as ED occupancy and total patient hours within the ED increased, time to intravenous fluids decreased and time to antibiotics increased as occupancy, hours, and boarding increased.
Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente / 25.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31510" align="alignleft" width="156"]Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 Dr. Adam Sharp[/caption] Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 MedicalResearch.com: What is the background for this study? Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known. The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging. Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.
Author Interviews, Emergency Care, JAMA, Stroke, Surgical Research / 13.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31220" align="alignleft" width="181"]Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto Dr. Vitor Mendes Pereira[/caption] Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?
Accidents & Violence, Author Interviews, BMJ, Emergency Care, Pediatrics / 21.12.2016

MedicalResearch.com Interview with: Dr Jamie G Cooper Consultant in Emergency Medicine Aberdeen Royal Infirmary Aberdeen UK MedicalResearch.com: What is the background for this study? [caption id="attachment_30632" align="alignleft" width="200"]MedicalResearch.com Interview with: Jamie Cooper Consultant in Emergency Medicine Aberdeen Royal Infirmary Aberdeen MedicalResearch.com: What is the background for this study? Response: Choking in children can be fatal and regularly grapes can be the cause. We believe that public awareness of the choking hazard posed by grapes (and other similarly shaped foods, such as cherry tomatoes) is not wide spread. By publishing this article we aimed to highlight the problem to health professionals who look after children and also to the public at large in an attempt to reduce the number of future episodes. MedicalResearch.com: What are the main findings? Response: With parental consent we published the cases of three small children who suffered choking episodes as a result of whole grapes, two of whom died as a result. In each case it was not possible to dislodge the grape using first aid techniques. MedicalResearch.com: What should readers take away from your report? Response: Small children are at risk from choking because they have smaller airways, reduced ability to chew foods, underdeveloped swallowing coordination and can be easily distracted when eating. Grapes are a healthy and popular snack but are ideally suited to cause airway obstruction, particularly if inhaled whole. Small children (up to 5 years) should always be supervised by adults while eating; and grapes should be halved, or ideally quartered, before consumption. We hope that by drawing attention to this issue that consideration will be given at a political level to wider dissemination of this information so as to prevent further occurrences. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: BMJ The choking hazard of grapes: a plea for awareness Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com Grapes
Wikipedia image[/caption] Response: Choking in children can be fatal and regularly grapes can be the cause.  We believe that public awareness of the choking hazard posed by grapes (and other similarly shaped foods, such as cherry tomatoes) is not wide spread.  By publishing this article we aimed to highlight the problem to health professionals who look after children and also to the public at large in an attempt to reduce the number of future episodes.
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease, Kidney Disease / 21.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29537" align="alignleft" width="144"]Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada Dr. Paul E Ronksley[/caption] Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada MedicalResearch.com: What is the background for this study? Response: Prior studies have observed high resource use among patients with chronic kidney disease (CKD), which is related to the medical complexity of this patient population. However, there has been limited exploration of how patients with CKD use the emergency department (ED) and whether utilization is associated with disease severity. While the ED is essential for providing urgent or emergent care, identifying ways of improving ED efficiency and decreasing wait times has been recognized as a priority in multiple countries. Improving coordination and management of care for patients with multiple chronic conditions (the norm for CKD) in an outpatient setting may meet health care needs and ultimately improve patient experience and outcomes while reducing the burden currently placed on the ED. However, this requires an understanding of ED use among patients with CKD and the proportion of use that is amenable to outpatient care. Using a large population-based cohort we explored how rates of ED use vary by kidney disease severity and the proportion of these events that are potentially preventable by high quality ambulatory care. We identified all adults (≥18 years) with eGFR<60 mL/min/1.73m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of ED encounters, and followed until death or end of study (March 31, 2013). Within each CKD category we calculated adjusted rates of overall  emergency departmentt use, as well as rates of potentially preventable ED encounters (defined by 4 CKD-specific ambulatory care sensitive conditions (ACSCs); heart failure, hyperkalemia, volume overload, malignant hypertension).
Author Interviews, Emergency Care, Geriatrics, Infections / 15.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29656" align="alignleft" width="150"]John P. Haran, MD Assistant Professor Department of Emergency Medicine University of Massachusetts Medical School UMass Memorial Medical Group Worcester, MA Dr. John P. Haran[/caption] John P. Haran, MD Assistant Professor Department of Emergency Medicine University of Massachusetts Medical School UMass Memorial Medical Group Worcester, MA MedicalResearch.com: What is the background for this study? Response: In 2014, the Infectious Disease Society of America (IDSA) updated their guidelines for the management of skin and soft tissue infection in response to high MRSA infection rates as well as high treatment failure rates for skin and soft tissue infections. Greater than 1 in 5 patients treated for a skin abscess will fail initial treatment. Historically antibiotics have been shown to be unnecessary in the treatment of uncomplicated purulent infections. This notion has been recently challenges when authors published a randomized control trial using trimethoprim-sulfamethoxazone in the NEJM that demonstrated a minimal increase in cure rates for outpatient treatment of uncomplicated skin purulent skin infections. In this study they did not follow IDSA-guidelines nor model or stratify their analysis. It is possible their findings may be due to at-risk patient groups that did not receive antibiotics. Many widely used clinical decision rules incorporate age into their decision algorithms, however the IDSA did not do this with their recent guidelines.
Author Interviews, Emergency Care, Kidney Disease, Kidney Stones, UCSF / 04.11.2016

MedicalResearch.com Interview with: Ralph Wang, MD, MAS Associate Clinical Professor, Department of Emergency Medicine University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Medical expulsive therapy, most notably tamsulosin, has been studied extensively to improve stone passage in patients diagnosed with ureteral stone. Prior trials and meta-analyses have identified a benefit. In fact, tamsulosin is recommended by the American Urologic Association for patients diagnosed with ureteral stones < 10mm that do not require intervention. However, recent well-conducted multi-center randomized trials have not found any improvement in stone passage. Thus we conducted a systematic review and meta-analysis of all double blinded, placebo controlled randomized trials of tamsulosin to determine whether it improves stone passage.
Author Interviews, Cost of Health Care, Emergency Care, Pediatrics / 26.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29187" align="alignleft" width="150"]Yunru Huang Ph.D. Candidate in epidemiology Department of Pediatrics University of California Davis, Sacramento, CA Yunru Huang and Dr. James Marcin (left)[/caption] Yunru Huang Ph.D. Candidate in epidemiology Department of Pediatrics University of California Davis, Sacramento, CA MedicalResearch.com: What is the background for this study? Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses. We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.
Author Interviews, Emergency Care, Nursing / 02.09.2016

MedicalResearch.com Interview with Mathew Douma, RN BSN ENC(C) CNCC(C) Emergency Department, Royal Alexandra Hospital Edmonton, Alberta, Canada; Masters of Nursing Student University of Toronto, Toronto MedicalResearch.com: What is the background for this study? Response: Many emergency departments experience crowding, which is typically defined as a situation where demands for service exceed the ability of the emergency department to provide quality care in a timely fashion. Typically when patients are waiting in a waiting room they do not undergo diagnostics or treatments. In an effort to speed the process up and reduce the amount of time the patient spends in the emergency department, some facilities have created protocols for diagnostics or treatments typically outside the traditional scope of practice of nursing staff. Our emergency department had protocols like this for almost 15 years, though we had never evaluated their effectiveness. So an interdisciplinary group in our emergency department updated them and then we set out to evaluate them.
Anesthesiology, Author Interviews, Emergency Care, JAMA, Pediatrics / 31.08.2016

MedicalResearch.com Interview with: Marc Auerbach, MD, FAAP, MSc Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education) Director, Pediatric Simulation Yale Center for Medical Simulation; MedicalResearch.com: What is the background for this study? What are the main findings? Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores. The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation.
Author Interviews, Cost of Health Care, Emergency Care, JAMA, Kidney Disease / 22.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27209" align="alignleft" width="122"]Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation Dr. Rachel Patzer[/caption] Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation MedicalResearch.com: What is the background for this study? Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization.
Author Interviews, Cost of Health Care, Emergency Care / 09.08.2016

MedicalResearch.com Interview with: Jessica Moe MD, MA, PGY5 FRCPC Emergency Medicine, University of Alberta MSc (Candidate) Clinical Epidemiology MedicalResearch.com: What is the background for this study? What are the main findings? Response: Frequent visitors are common in many urban emergency departments (ED). They represent high resource-utilizing patients; additionally, existing literature demonstrates that they experience higher mortality and adverse health outcomes than non-frequent ED users. Interventions targeting frequent ED users therefore may potentially prevent adverse outcomes in this high risk patient group. The purpose of this study was to provide an up-to-date review of the existing literature on the effectiveness of interventions for adult frequent ED users. This systematic review summarizes evidence from 31 interventional studies. The majority evaluated case management and care plans; a smaller number of studies examined diversion strategies, printout case notes, and social work visits. Overall, the studies were considered to have moderate to high risk of bias; however, 84% of before-after studies found that ED visits significantly decreased after the intervention. Additionally, studies examining interventions for homelessness consistently found that interventions improved stable housing. Overall, effects on hospital admissions and outpatient visits were unclear. In summary, the available evidence is encouraging and suggests interventions targeted towards frequent ED users may be effective in decreasing ED visit frequency and improving housing stability.
Author Interviews, Emergency Care, Neurological Disorders, NYU/NYMC, Pain Research / 30.06.2016

MedicalResearch.com Interview with: [caption id="attachment_15303" align="alignleft" width="159"]Dr. Mia T. Minen, MD, MPH Director, Headache Services at NYU Langone Medical Center Assistant professor, Department of Neurology Dr. Mia T. Minen[/caption] Mia Minen, MD, MPH Assistant Professor of Neurology NYU Langone Medical Center MedicalResearch.com Editor’s note: The American Headache Society has issued new guidelines on “The Management of Adults With Acute Migraine in the Emergency Department” (1,2) Dr. Minen, Director of Headache Services at NYU Langone Medical Center, discusses these new guidelines below. MedicalResearch.com: What is the background for these new guidelines? How common/severe is the issue of migraine or headache presentation to the ER? Dr. Minen: These guidelines were needed because previous research shows that there are about 1.2. million visits to the emergency department (ED) each year for migraine, and over 25 different medications are sometimes used for treatment. Many of these medications don’t have evidence-based data to back their usage, and opioids are especially likely to be prescribed in between 60 and 70 percent of these cases, despite their lack of efficacy and risks. The American Headache Society convened an expert panel to review the existing evidence on all the medications used to treat migraines in the ED, and we developed these new treatment guidelines.
Accidents & Violence, Author Interviews, Emergency Care / 15.06.2016

MedicalResearch.com Interview with: [caption id="attachment_25094" align="alignleft" width="222"]Angela Sauaia MD PhD Professor of Public Health, Medicine, and Surger University of Colorado Denver Dr. Angela Sauaia[/caption] Angela Sauaia MD PhD Professor of Public Health, Medicine, and Surgery University of Colorado Denver MedicalResearch.com: What is the background for this study? What are the main findings? Authors: Americans mourn firearm related fatalities every day. Mass shootings are just the tip of the iceberg of the daily tragedy witnessed by trauma surgeons in emergency rooms. Industries strive to reduce the perils associated with motor vehicles, pedestrian and bicycles accidents, just to cite a few, through technology and education. Firearms move in the exact opposite direction. They are becoming progressively more dangerous and we have done little in terms of education to prevent accidents. The same trend is true for monitoring statistics. It is not difficult to obtain statistics on which type of car was associated with more accidents or fatalities. Conversely, trying to obtain data on which type of firearms are more likely to result in accidents or death is extremely difficult. We used the best data we could find and found that, contrary to every other injury mechanism, firearm injuries are becoming more lethal. In simple words, if you get into a car accident today, you are more likely to survive it due to improvements in trauma care and safety of vehicles than 10 years ago. On the other hand, if you get shot today, you are more likely to die than if you were shot 10 years ago, despite our excellent trauma care.
Author Interviews, Emergency Care, Heart Disease, Opiods / 05.05.2016

MedicalResearch.com Interview with: [caption id="attachment_24067" align="alignleft" width="200"]William Eggleston, PharmD Fellow in Clinical Toxicology/Emergency Medicine Upstate Medical University Upstate New York Poison Center Dr. William Eggleston[/caption] William Eggleston, PharmD Fellow in Clinical Toxicology/Emergency Medicine Upstate Medical University Upstate New York Poison Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Eggleston: The case series describes two deaths associated with loperamide abuse with supportive post-mortem findings. It adds to the growing body of literature reporting cardiac toxicity after loperamide abuse and demonstrates the deadly consequences. It also highlights the growing trend of loperamide abuse amongst opioid addicted patients looking to get high or stave off withdrawal symptoms. MedicalResearch.com: What should readers take away from your report? Dr. Eggleston: Readers should recognize that loperamide is an OTC opioid medication that acts similarly to morphine or heroin in the body after high doses. The drug is easily abused due to its low cost, ease of accessibility, legal status, and lack of social stigma associated with its possession. Most importantly, loperamide is a cardiac toxin that causes conduction disturbances in high doses and can produce deadly dysrhythmias.
Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory / 29.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22065" align="alignleft" width="150"]Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto Dr. Suzanne Schuh[/caption] Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto Medical Research: What is the background for this study? Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home. The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.
Annals Internal Medicine, Author Interviews, Emergency Care, Gout, Pharmacology / 23.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21670" align="alignleft" width="120"]Professor Timothy H Rainer MD MBBCh Director, Accident & Emergency Medicine Academic Unit The Chinese University of Hong Kong Prof. Timothy Rainer[/caption] Professor Timothy H Rainer  MD MBBCh Director, Accident & Emergency Medicine Academic Unit The Chinese University of Hong Kong  Medical Research: What is the background for this study? What are the main findings? Prof. Rainer: Gout is a type of arthritis characterised by periodic attacks of acute joint swelling and severe pain, and  often treated with colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs).  Two recent randomized, controlled trials showed that oral prednisolone, a corticosteroid, was as effective as NSAIDs in the treatment of acute gout, but these studies involved small numbers of patients.  The researchers investigatedwhether oral prednisolone was as effective and safe as indomethacin (a NSAID) in a larger sample of patients who had acute gout symptoms and who were seen in the emergency department (ED) setting. Patients in both the prednisolone and indomethacin groups had clinically meaningful decreases in their pain levels during the 2 hours they were observed in the ED as well as during the 14-day follow-up period. Both groups had a similar decrease in pain levels. No major adverse events were reported in either group although there were more minor adverse events in the indomethacin group.
Author Interviews, Emergency Care, Surgical Research, Weight Research / 19.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21803" align="alignleft" width="200"]Junaid A. Bhatti, MBBS, MSc, PhD Sunnybrook Health Sciences Centre Research Institute Toronto, Canada Dr. Junaid Bhatti[/caption] Junaid A. Bhatti, MBBS, MSc, PhD Sunnybrook Health Sciences Centre Research Institute Toronto, Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Bhatti: Weight loss surgeries are consistently increasing in the US. While the positive impact of surgery on patient’s health are undebatable, limited information is available about long-term healthcare utilization, especially, emergency care utilization in bariatric surgery patients. This study compared emergency care utilization in bariatric patients three years following surgery to that of three years prior to surgery. Overall, we found that emergency care utilization increased by about 17% following surgery compared to the before surgery period. While complaints related to cardiovascular, ear, respiratory, and dermatology decreased, the complaints related to gastrointestinal, genitourinary, mental health, and substance misuse increased following surgery. 
Author Interviews, Emergency Care, Mental Health Research / 19.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21790" align="alignleft" width="144"]Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary, AB Canada Dr. Paul Ronksley[/caption] Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary, AB Canada Medical Research: What is the background for this study? Response: Numerous studies have shown that high users of the emergency department (ED) are often patients with complex medical needs and limited personal and social resources. It is also recognized that high users are a heterogeneous group driven by variability in the operational definition used to define this patient population. “High use” of ED services is often defined by the number of visits per year (namely ≥3 or ≥4 visits to the ED in a 1-year period) with little exploration of the distribution/pattern of these visits over time. The purpose of our study was to examine patient and encounter-level factors and costs related to periods of short-term resource intensity (clustered ED visits) among high users of the ED within a tertiary-care teaching facility. This is important as it may inform interventions that can focus on a more defined group with the goal of providing the needed care in a setting outside of the ED. Medical Research: What are the main findings? Response: Our main findings demonstrate that among high  emergency department users (i.e. patients with 3 or more ED visits in a 1-year period), approximately 1 in 7 patients had a period of high-intensity ED use (3 or more visits clustered within a week). These patients with clustered visits were more likely to be homeless, require psychiatric emergency services, and revisit the  emergency department for the same presenting complaints. The high-intensity users were also less likely to be admitted, more likely to leave without being seen and had lower costs per encounter, although their total ED cost across all visits was higher.
Author Interviews, Cost of Health Care, Emergency Care / 30.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21141" align="alignleft" width="200"]Jonathan Pinkney MD FRCP Professor of Medicine Plymouth University and Peninsula Schools of Medicine and Dentistry Centre for Clinical Trials and Population Studies Plymouth Science Park Phase 1 Honorary Consultant Physician Diabetes and Endocrinology University Medicine Derriford Hospital Plymouth Hospitals NHS Trust Plymouth UK Prof. Jonathan Pinkney[/caption] Jonathan Pinkney MD FRCP Professor of Medicine Plymouth University and Peninsula Schools of Medicine and Dentistry Centre for Clinical Trials and Population Studies Plymouth Science Park Phase 1 Honorary Consultant Physician Diabetes and Endocrinology University Medicine Derriford Hospital Plymouth Hospitals NHS Trust Plymouth UK Medical Research: What is the background for this study? Dr. Pinkney: The background is that the study was funded by the National Institute for Health Research in response to a call for research on the problem of unscheduled emergency admissions to hospitals in the UK. The rates of patient attendance at emergency departments and subsequent acute admissions to hospitals have risen year on year. Rising numbers of admissions have significant knock-on effects for acute hospitals including crowding in emergency departments, pressures on staffing, and disruption of elective treatment because of high rates of bed occupancy. The increase in admissions has been associated largely with increased short stay admissions. As a result, there has been an increasing view that a significant proportion of acute medical admissions may not be necessary, and in this respect may be said to be avoidable. There had been relatively limited research on how hospitals can best reduce these avoidable admissions. The main aims of the study were to investigate how senior staff in four major acute hospitals in south west England endeavour to avoid unnecessary acute admissions, and to examine a range of different systems in place in different hospitals to avoid unnecessary admissions. We called this project the "3A" or Avoidable Acute Admissions study. The 3A study was a mixed methods study with a strong emphasis on the narrative experience of patients, carers and healthcare professionals in the emergency departments and associated units of these four acute hospitals. The quantitative component of the study was an application of Value Stream Mapping (VSM), a technique from lean theory, and this was used to identify and measure points of delay in the patient journey.
Author Interviews, Emergency Care, Social Issues / 29.01.2016

MedicalResearch.com Interview with: Jessica Moe MD, MA, PGY4 FRCPC Emergency Medicine MSc (Candidate) Clinical Epidemiology RCPS Emergency Medicine Residency Program University of Alberta Edmonton, Alberta Medical Research: What is the background for this study? What are the main findings? Dr. Moe: Patients who leave the emergency department (ED) prior to completing their care account for a substantial number of annual visits; some of these patients are at high medical risk. We used the National Hospital Ambulatory Medical Care Survey from 2009-2011 to examine a nationally representative sample of patients who left the ED prior to completing care. Our work suggests that, among patients who leave the ED prematurely, the degree of medical risk may be related to whether or not these patients saw a medical professional prior to leaving the ED. Patients who leave prior to medical evaluation are generally younger and present with lower acuity visits, whereas patients who leave after medical evaluation tend to be older, are more likely to arrive by ambulance and have higher acuity visits.
Author Interviews, Emergency Care, Hepatitis - Liver Disease, NYU/NYMC / 26.01.2016

Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016MedicalResearch.com Interview with: Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Allison: It was found that among 383 baby boomers presenting to a large urban emergency department in New York City the prevalence of HCV antibody reactivity was 7.3%. Only four patients were successfully linked to care and only one patient was started on HCV treatment. The study highlights the possibility that there may be problems in linking patients to care from the ED compared to other clinical settings such as primary care and inpatient settings. It was concluded that only with strategies to improve linkage to care could a screening program for baby boomers be recommended in the ED where the study was carried out. The study additionally had a qualitative component and, via structured interviews, evaluated knowledge about HCV infection amongst baby boomers presenting to the ED. Overall knowledge was good but some misconceptions about transmission persisted and many patients mistakenly believed that there is a vaccine for hepatitis C.
Annals Internal Medicine, Author Interviews, Emergency Care, Opiods, Pain Research / 29.12.2015

[caption id="attachment_20345" align="alignleft" width="177"]Dr. Marc LaRochelle MD MPH Dr. LaRochelle[/caption] MedicalResearch.com Interview with: Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston Medical Center Boston, MA  Medical Research: What is the background for this study? What are the main findings? Dr. Larochelle: More than 16 thousand people in the United States die from prescription opioid overdose each year. However, morbidity extends well beyond fatal overdose - nearly half a million emergency department visits each year are related to prescription opioid-related harms. Emergency department visits for misuse of opioids represent an opportunity to identify and intervene on opioid use disorders, particularly for patients who receive prescriptions for opioids to treat pain. We examined a cohort of nearly 3000 commercially insured individuals prescribed opioids for chronic pain who were treated for a nonfatal opioid overdose in an emergency department or inpatient setting. We were interested in examining rates of continued prescribing after the overdose and the association of that prescribing with risk of repeated overdose. We found that 91% of individuals received another prescription for opioids after the overdose. Those continuing to receive opioids at high dosages were twice as likely as those whose opioids were discontinued to experience repeated overdose.
Author Interviews, Biomarkers, Emergency Care, Heart Disease / 21.12.2015

[caption id="attachment_20261" align="alignleft" width="177"]Florence Leclercq, MD, PhD Department of Cardiology Arnaud de Villeneuve Hospital University hospital of Montpellier Montpellier,France Dr. Leclercq[/caption] MedicalResearch.com Interview with: Florence Leclercq, MD, PhD Department of Cardiology Arnaud de Villeneuve Hospital University hospital of Montpellier Montpellier,France Medical Research: What is the background for this study? What are the main findings? Response: Patients with history of coronary artery disease (CAD) are considered as a population with high risk of further coronary events. However, frequent pre-existing ECG changes observed in these patients result in difficulty interpreting new ECG aspects in case of chest discomfort. Furthermore, anxiety frequently induced non-cardiac causes of chest pain in these patients, leading to unjustified admission to cardiology units.  Moreover, levels of troponin are usually higher in patients with previous CAD compared to patients without history of angina, resulting in difficulty interpreting baseline values in this population.  Conversely, copeptin may be influenced by the severity of myocardial ischemia and resulting endogenous stress, and could be a useful additional marker to exclude severe coronary stenosis in high-risk patients with recent chest pain. This propective monocentric study evaluates the incremental value of copeptin associated with high-sensitivity cardiac T troponin (hs-cTnT) to exclude severe coronary stenosis in 96 patients with coronary artery disease  (CAD) and acute chest pain.   Mean age of patients was 60 +/- 13.8 years and the mean time between chest pain onset and blood samples of copeptin was 4.2 +/-2.7 hours. According to clinical decision, coronary angiography was performed in 71 patients (73.9 %) and severe stenosis diagnosed in 14 of them (14.6%). No ischemia was detected on SPECT imaging (n=25). Among the 69 patients with a negative kinetic of hs-cTnT and a negative baseline copeptin, 5 (7.4%) had a severe stenosis (NPV 0.93; 95% CI: 0.87-0.99), 4 of them related to in-stent restenosis (NPV for exclusion of native coronary stenosis: 0.98; 95% CI: 0.93-1). We can conclude that in patients with preexisting CAD, and once Acute Myocardial Infarction (AMI) is excluded, copeptin increases the NPV of  hs-cTnT  to rule out severe coronary stenosis or significant myocardial ischemia. Coronary stenosis not detected with this strategy concerned exclusively in-stent restenosis or stenosis related to infarcted -related  coronary artery without myocardial viability.
Author Interviews, Biomarkers, Emergency Care, Heart Disease / 10.12.2015

MedicalResearch.com Interview with: Justin A. Ezekowitz, MBBCh MSc Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Cardiologist  and Director, Heart Function Clinic Nariman Sepehrvand, MD Research Fellow & Graduate Student Mazankowski Alberta Heart Institute University of Alberta Edmonton, Canada  Medical Research: What is the background for this study? Dr. Ezekowitz: Major practice guidelines recommend the use of natriuretic peptide (NP) testing for diagnosing acute heart failure (HF) in emergency departments (ED). Despite these guidelines, the majority of healthcare regions all around the world (except for the United States and New Zealand) have restricted access to NP testing due to concerns over cost to healthcare systems. In the province of Alberta, Canada, however, a province-wide access to NP testing was provided for all EDs in 2012. This study investigates the factors that are related to the utilization of NP testing in EDs. Medical Research: What are the main findings? Dr. Ezekowitz: There was a substantial geographic variation in testing for NPs, despite having a single payer system and the universal availability of NP testing in Alberta. Several factors (including male sex, some comorbidities like prior heart failure, urban residence, type of care provider and ED clinical volume) influenced the utilization of testing for NPs in routine ED practice. Interestingly, patients with heart failure who were tested for NPs at ED, had a higher rate of hospital admission and lower 7 day and 90 day repeat ED visit rates compared to those who were not tested.
Anesthesiology, Author Interviews, Emergency Care, Pain Research / 09.12.2015

[caption id="attachment_19946" align="alignleft" width="72"]Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX Dr. April[/caption] MedicalResearch.com Interview with: Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX  Medical Research: What is the background for this study? What are the main findings? Dr. April: Anesthesia research studies have found that nasal inhalation of isopropyl alcohol has efficacy in treating nausea among post-operative patients. We sought to study this agent among Emergency Department patients with nausea or vomiting. We found that patients randomized to inhale isopropyl alcohol had improved self-reported nausea scores compared to patients randomized to inhale saline (placebo). MedicalEditor's note:  Do Not Do This Without Medical Supervision!
Author Interviews, Cleveland Clinic, Emergency Care, JAMA, Stroke, Telemedicine / 08.12.2015

[caption id="attachment_19812" align="alignleft" width="200"]Ken Uchino, MD FAHA FANA Director, Vascular Neurology Fellowship Research Director, Cerebrovascular Center, Cleveland Clinic Associate Professor of Medicine (Neurology) Cleveland Clinic Lerner College of Medicine of CWRU Cleveland, OH 44195 Dr. Ken Uchino[/caption] MedicalResearch.com Interview with: Ken Uchino, MD FAHA FANA Director, Vascular Neurology Fellowship Research Director, Cerebrovascular Center, Cleveland Clinic Associate Professor of Medicine (Neurology) Cleveland Clinic Lerner College of Medicine of CWRU Cleveland, OH 44195 Medical Research: What is the background for this study? What are the main findings? Dr. Uchino: Treatment for acute ischemic stroke is time dependent. Multiple studies have reported strategies to improve time to treatment after arrival in the hospital. Mimicking pre-hospital thrombolysis of acute myocardial infarction pioneered 30 years ago, two groups in Germany have implemented pre-hospital ischemic stroke thrombolysis using mobile stroke unit (“stroke ambulance”) that includes CT scan and laboratory capabilities. These units have been demonstrated to provide stroke treatment earlier than bringing patients to the emergency departments. Our report extends the concept mobile stroke unit further by using telemedicine for remote physician presence. The other mobile stroke units were designed to have at least one physician on board. This allows potential multiple or geographically distant units to be supported by stroke specialists. The study demonstrates that after patient arrival in the ambulance, the time to evaluation (CT scanning and blood testing) and to thrombolytic treatment is as quick or better as patient arrival in emergency department door. We are reporting the overall time efficiency after emergency medical service notification (911 call) in a separate paper.
Author Interviews, Blood Pressure - Hypertension, Emergency Care, Vanderbilt / 24.11.2015

[caption id="attachment_19585" align="alignleft" width="144"]Candace D. McNaughton, Dr. McNaughton[/caption] MedicalResearch.com Interview with: Candace D. McNaughton, MD MPH FACEP Assistant Professor Emergency Medicine Research Department of Emergency Medicine, Research Division Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. McNaughton: Hypertension, or high blood pressure, affects 1/3rd of adults in the United States and more than 1 billion people worldwide.  It is also the #1 risk factor for cardiovascular disease such as heart attack and stroke, so it is very important to treat. The burden of hypertension in the emergency department is not well understood.  The ER is not usually thought of as a place where perhaps we could or should be addressing hypertension; that has traditionally be left up to primary care providers. Through this study, our goals were to gain a better understanding of how many ER visits were either related to hypertension or were solely because of hypertension, and to determine whether this changed from 2006 to 2012. We found that emergency room visits related to or solely for hypertension were common and that they both rose more than 20% from 2006 to 2012. Visits to the emergency department specifically for hypertension were more common among patients who were younger, healthier, and less likely to have health insurance. Despite increases in the number of ER visits related to hypertension, the proportion of patients who were hospitalized did not increase; this suggests that doctors in emergency departments may be more aware of hypertension and/or may be managing it without having to hospitalize patients.