Alzheimer's - Dementia, Author Interviews, Emergency Care / 11.08.2014

Dr. Caroline E Stephens PhD Department of Community Health Systems University of California, San FranciscoMedicalResearch.com Interview with: Dr. Caroline E Stephens PhD Department of Community Health Systems University of California, San Francisco Medical Research: What are the main findings of the study? Dr. Stephens: In our national random sample of nursing home residents, we found that mild cognitive impairment (CI) predicted higher rates of ED visits compared to no CI, but interestingly, ED visit rates decreased as severity of cognitive impairment increased.  However, after nursing home residents were evaluated in the ED, severity of CI was not significantly associated with higher odds of hospitalization. Another important finding was that the proportion of nursing home residents using feeding tubes more than tripled in advanced or end-stage dementia, from 9.9% to 33.8%.  Moreover, tube-fed nursing home residents had 73% higher rates of total ED visits, but once evaluated in the ED, they were no more likely to be hospitalized than those without feeding tubes.  This finding is particularly striking given the numerous existing studies that have questioned the utility and appropriateness of using feeding tubes in people with advanced dementia. (more…)
Anesthesiology, Author Interviews, Emergency Care / 01.08.2014

MedicalResearch.com Interview with: Lindsay Cohen MD Department of Emergency Medicine University of British Columbia Medical Research: What are the main findings of the study? Dr. Cohen: In our systematic review of the literature, we sought to synthesize the available evidence on the effect of ketamine on clinical outcomes as compared to other sedative agents in intubated patients. Our outcomes of interest included intracranial and cerebral perfusion pressures, neurologic outcomes, ICU length of stay, and mortality. We included only randomized controlled trials and prospective controlled studies, and identified a total of ten studies that met our inclusion criteria. Due to the lack of homogeneity in the studies, data was analyzed in a qualitative manner. None of the studies reported significant differences between ketamine and other sedative agents for any of our outcomes of interest. (more…)
Addiction, Author Interviews, Emergency Care / 28.07.2014

Wendy Macias Konstantopoulos, MD, MPH Department of Emergency Medicine Division of Global Health & Human Rights Massachusetts General Hospital Harvard Medical SchoolMedicalResearch.com Interview with: Wendy Macias Konstantopoulos, MD, MPH Department of Emergency Medicine Division of Global Health & Human Rights Massachusetts General Hospital Harvard Medical School Medical Research: What are the main findings of the study? Dr. Macias-Konstantopoulos: Nearly two-thirds (64%) of 3240 emergency department (ED) patients who endorsed using drugs in the last 30 days, met criteria for problematic drug use (DAST-10 score ≥3). Of patients who identified their primary drug of use as being a substance other than cannabis, approximately 91% met criteria for problematic drug use, including nearly 94% of those using illicit drugs and 76% of those using pharmaceuticals. Compared to those who used cannabis primarily, primary non-cannabis users had an almost 15 times higher odds of meeting criteria for problematic drug use. Finally, we know from previous studies that drug-using individuals are more likely to access medical care through the ED and more likely to require hospitalization than their non-drug using counterparts. Our study found that drug-using ED patients who met criteria for problematic drug use tended to have ED triage levels associated with higher levels of severity or resource utilization when compared to drug-using ED patients who did not meet criteria for a drug problem. (more…)
Author Interviews, BMJ, Emergency Care / 15.07.2014

MedicalResearch.com Interview with: Jeffrey Allen Kline Vice Chair of Research Department of Emergency Medicine MedicalResearch.com Interview with: Jeffrey Allen Kline Vice Chair of Research Department of Emergency Medicine Indiana University Health Medical Research: What are the main findings of this study? Dr. Kline: We believe that clinicians use information from their patients’ faces to make decisions about diagnostic testing. This is particularly relevant in emergency medicine, where the clinicians make decisions rapidly with limited information. We videotaped patients’ faces who had chest pain and dyspnea and used the most well-known facial scoring system to assess their facial expression variability in response to seeing visual stimuli. We found that patients who ultimately had emergent problems tended to hold their faces in a neutral position and be less likely to show the expression of surprise. The investigators were not surprised at this, but we did find that patients with emergent problems also tended to have less negative affect as well as less positive affect. In other words, patients who were sickest even tended to frown less than patients with no medical problem. (more…)
Author Interviews, BMJ, Emergency Care, Heart Disease / 03.05.2014

Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UKMedicalResearch.com Interview with:  Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK   MedicalResearch.com: What are the main findings of the study? Dr. Body: This paper actually reports the findings of two consecutive, separate studies.  We aimed to derive and then externally validate a clinical decision rule to risk stratify patients with suspected acute coronary syndromes in the Emergency Department (ED).  This rule could then be used to reduce unnecessary hospital admissions while also making judicious use of specialist high dependency resources. In the first study we derived a clinical decision rule that incorporates 8 variables: high sensitivity troponin T, heart-type fatty acid binding protein; ECG ischaemia; worsening angina; hypotension (systolic blood pressure <100mmHg on arrival); sweating observed in the ED; pain associated with vomiting; and pain radiating to the right arm or shoulder.  When we validated the rule at a different centre, we found that its use could have avoided hospital admission for over a quarter of patients while effectively risk stratifying others.  Of the 10% of patients who were identified as 'high risk', approximately 95% had a major adverse cardiac event within 30 days.  The findings suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule could be used to 'rule in' and 'rule out' acute coronary syndromes immediately, using information gathered at the time of initial presentation to the ED.  Before clinical implementation, we recommend that effect of using the MACS rule in practice should first be evaluated in a trial setting.  This will enable us to determine: (a) whether physicians and patients are likely to comply with (and be satisfied with) the MACS rule; (b) the safety of the MACS rule when used in practice; and (c) whether use of the MACS rule leads to cost savings for the health service. (more…)
Author Interviews, Biomarkers, Emergency Care, Heart Disease, JACC, Karolinski Institute / 04.04.2014

Martin J. Holzmann, MD, PHD Department of Emergency Medicine Karolinska University Hospital, HuddingeMedicalResearch.com Interview with: Martin J. Holzmann, MD, PHD Department of Emergency Medicine Karolinska University Hospital, Huddinge   MedicalResearch.com: What are the main findings of the study? Dr. Holzmann: In a cohort of 8900 consecutive patients who sought medical attention for chest pain, we found that an undetectable high-sensitivity cardiac troponin level (<5 ng/l), and an ECG with no ischemic changes has a negative predictive value of 99.8% (95%, 99.7-99.9%). Thus, this will rule out MI with nearly 100% accuracy, and independent of when the troponin was measured in relation to onset of chest pain, and independent of any risk factors for cardiovascular disease. (more…)
Author Interviews, CMAJ, Emergency Care, Gender Differences, Heart Disease, McGill / 20.03.2014

MedicalResearch.com Interview with: Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (MUHC) 687 Pine Avenue West, V Building, Room V2.17 Montreal, QcRoxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology McGill University Health Centre (MUHC) 687 Pine Avenue West, V Building, Room V2.17 Montreal, Qc MedicalResearch.com: What made you want to study this disparity between men and women and heart attacks?  Dr. Pelletier:  Despite enhanced medical treatment and decrease in the incidence of heart diseases, important sex disparities persist in the risk of mortality following a cardiac event: the risk of mortality is higher in women compared to men, and this sex difference is even more important in younger adults. Therefore, we aimed to investigate potential mechanisms underlying this sex difference in mortality. (more…)
Addiction, Author Interviews, Emergency Care, Pain Research, Pharmacology / 16.03.2014

Maryann Mazer-Amirshahi PharmD, MD1MedicalResearch.com Interview with: Maryann Mazer-Amirshahi PharmD, MD The Department of Emergency Medicine, The George Washington University The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC MedicalResearch.com: What are the main findings of the study? Answer: We found a significant increase in the prescribing of opioid pain medications in the emergency department. At the same time, this was not accounted for by a similar increase in pain-related visits and prescribing patterns of non-opioid analgesics did not change. (more…)
Author Interviews, Diabetes, Emergency Care, JAMA / 11.03.2014

Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC.MedicalResearch.com Interview with: Andrew I. Geller, MD Medical Officer in the Division of Healthcare Quality Promotion at CDC. MedicalResearch.com: What are the main findings of the study? Dr. Geller: Using CDC’s national medication safety monitoring system, we estimated that, each year, there were about 100,000 visits made to U.S. emergency departments (EDs) for insulin-related hypoglycemia and errors during 2007-2011, or about half a million ED visits over the 5-year study period.  This is important because many of these ED visits for insulin-related hypoglycemia may be preventable. We also found these ED visits were more common with increasing age:  every year, 1 in 49 insulin-treated seniors (aged 65 years or older) visited the ED because of hypoglycemia while on insulin or because of a medication error related to insulin. Among the very elderly (aged 80 years or older), this number was 1 in 8 annually. (more…)
Author Interviews, Emergency Care / 14.01.2014

Dr. Michael A. LaMantia Regenstrief Institute, Inc. Investigator and Assistant Professor of Medicine Indiana University School of MedicineMedicalResearch.com Interview with: Dr. Michael A. LaMantia Regenstrief Institute, Inc. Investigator and Assistant Professor of Medicine Indiana University School of Medicine MedicalResearch.com: What are the main findings of the study? Dr. LaMantia: We conducted a systematic review of existing studies on delirium in emergency departments and found that neither completely validated delirium screening instruments nor an ideal schedule to perform delirium assessments exist there. (more…)
Allergies, Author Interviews, Emergency Care / 04.12.2013

MedicalResearch.com Interview with: Brian Grunau MD Emergency Physician, St. Paul's Hospital Clinical Assistant Professor, UBC Department of Emergency Medicine MedicalResearch.com: What are the main findings of the study? Dr. Grunau: Among 2819 consecutive Emergency Department visits of patients with allergic reactions or anaphylaxis, five clinically important biphasic reactions were identified (0.18%; 95% confidence interval [CI] 0.07% to 0.44%), with two occurring during the ED visit and three post-discharge. There were no fatalities.  When examining patients who satisfied the definition for anaphylaxis and those who did not separately, clinically important biphasic reactions occurred in 2 patients (0.40%; 95% CI 0.07% to 1.6%) and 3 patients (0.13%; 95% CI 0.03% to 0.41%), respectively. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 06.11.2013

MedicalResearch.com Interview with: Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C. Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C.   MedicalResearch.com: What are the main findings of the study? Dr. Galarraga: This study examined how emergency department (ED) reimbursements for outpatient visits may be impacted by the insurance coverage expansion of the Patient Protection and Affordable Care Act as newly eligible patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted our analyses using the Medical Expenditure Panel Survey, a nationally representative survey managed by the Agency for Healthcare Research and Quality. We found that ED reimbursements for outpatient encounters by the previously uninsured who gain Medicaid insurance may increase by  17 percent and moving Medicaid-expansion ineligible patients to the private insurance market through insurance exchanges may increase reimbursements as high as 39 percent after the act is implemented. (more…)
Author Interviews, Emergency Care / 22.10.2013

Dr. Gina Agarwal Assistant Professor Department of Family Medicine McMaster Family Practice 690 Main Street West Hamilton , Ontario L8S 1A4MedicalResearch.com Interview with: Dr. Gina Agarwal Assistant Professor Department of Family Medicine McMaster Family Practice 690 Main Street West Hamilton , Ontario L8S 1A4 MedicalResearch.com: What are the main findings of the study? Dr. Agarwal: The study findings are just preliminary as of yet, but suggest that the CHAP-EMS program is potentially a feasible and effective health program for seniors housing buildings in urban areas. The program delivered tailored health risk assesments to seniors living in subsidized city housing, also assessing their risk of cardiovascular disease, diabetes and falls using validated tools. Paramedics were trained in how to assess, and deliver risk assessment results and then provide community resource information. Seniors attending the program could drop in any time and were encouraged to come back for follow up sessions. Results of each attendance were forwarded to family doctors to close the loop. At the 5th month of implementation, we have recorded 241 participant visits by 40 unique participants; 37 had 2 or more visits; 70% had elevated BPs initially; 77.8% of those previously diagnosed hypertensive and 55.8% of those undiagnosed hypertensive had elevated BP; 82.5% had moderate to high CANRISK scores. Preliminary data shows a 32% reduction in EMS calls. (more…)
Cost of Health Care, Emergency Care, Pediatrics, University of Michigan / 20.10.2013

Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI 48109-5303MedicalResearch.com Interview with: Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI  48109-5303 MedicalResearch.com: What are the main findings of the study? Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered).  Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time.   (more…)
Author Interviews, Emergency Care, NEJM / 30.05.2013

MedicalResearch.com eInterview with: Adam Z. Tobias, MD, MPH Assistant Professor of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh, PA 15261Adam Z. Tobias, MD, MPH Assistant Professor of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh, PA  15261 MedicalResearch.com: What are the main findings of the study? Answer: We reviewed records of 11,920 in-flight medical emergency calls from five domestic and international commercial airlines to a physician-staffed medical communications center at the University of Pittsburgh.  We found that during the study period, there was one medical emergency per 604 flights (16 per 1 million passengers).  The most common problems were syncope or pre-syncope, respiratory symptoms, and nausea and vomiting.  Aircraft diversion to an alternative landing site occurred just over 7% of the time. About one quarter of patients were transported to a hospital and only 8.6% were admitted. (more…)
Author Interviews, Emergency Care, Stroke / 03.05.2013

MedicalResearch.com eInterview with with Dr. O. James Ekundayo, MD, DrPH Assistant Professor Department of Family & Community Medicine Meharry Medical College 1005 Dr. D.B. Todd Jr. Blvd. Nashville, TN 37208 Written Interview conducted with author by Editor Marie Benz, MD MedicalResearch.com What are the main findings of the study? Answer: The key findings are: ·         One third of stroke patients did not activate Emergency Medical Services (EMS). ·         Subgroups of patients who were less likely to use EMS include younger patients, patients of minority race or ethnicity, and those living in rural communities. ·         Prior history of stroke /TIA does not confer greater likelihood of EMS activation during subsequent stroke. ·         Patients who used EMS had shorter pre-hospital and in-hospital delay. They arrived early, had prompter evaluation, and received more rapid treatment. ·         More patients, who were eligible for clot-busting drug, received them. These happened because EMS gives the receiving hospital pre-notification about the arrival of the patient and the ER staff is ready to act as soon as the patient arrives. (more…)
Author Interviews, Emergency Care, Nature, Weight Research / 02.05.2013

MedicalResearch.com eInterview with Professor David McDonald Taylor Emergency Department, Austin Health PO Box 5555, Heidelberg, Vic. 3084, Australia MedicalResearch.com: What are the main findings of the study? Answer: Overall, obese and non-obese patients have similar experiences during their ED stay. However, while obese patients tend to be younger and less sick, their more frequent presentation with potentially cardiac-related disease is reflected in their management. The excess of liver function tests and abdominal xrays performed on obese patients is likely to reflect examination difficulties and over investigation. Obese patients do experience more attempts at IV cannulation. (more…)
Cost of Health Care, Emergency Care, Stanford / 27.04.2013

Sridhar Sri SeshadriMedicalResearch.com eInterview with: M. Kit Degado, MD, MS Instructor, Emergency Medicine Affiliated Faculty, Centers for Health Policy/Primary Care and Outcomes Research Stanford University School of Medicine [email protected] MedicalResearch.com: What are the main findings of the study? Dr. Degado:
  • We found that if an additional 1.6% of patients flown by helicopter survive or if there is any improvement in disability outcomes, then helicopter EMS should be considered cost-effective over transporting patients by ground EMS. (more…)