To evaluate the investigation and treatment of patients with a diagnosis of transient ischemic attacks (TIA) in the emergency department (ED) a tertiary care teaching hospital with a neuroscience ...referral program.
A chart review was conducted in the hospital. Consecutive ED charts with a diagnosis of TIA were included; each was reviewed by independent coders using a standardized data form.
Two hundred and ninety-three TIA charts were reviewed; the gender ratio was 1:1 with a mean age of 66 years. Most patients (75%; 95% CI: 70, 80) were evaluated by ED physicians; the remaining patients were seen directly by referral services. The median time from symptom onset to ED arrival was 29 hours and the duration of symptoms was 4.6 hours. Most patients received CT scans (81%; 95% CI: 73, 85), complete blood counts (74%; 95% CI: 68, 79), and electrocardiograms (75%; 95% CI: 70, 80) in the ED. In 16% (95% CI: 13, 22) a carotid doppler was performed and in 26% (95% CI: 21, 31) an outpatient doppler was booked. Among those who were discharged (75%; 95% CI: 70, 80), antithrombotic medications were not prescribed to 28% (95% CI: 22, 34).
Practice variation exists with respect to the investigation and treatment of TIAs in this tertiary-care teaching hospital. Carotid doppler investigation and use of anti-platelet therapy for patients with TIA are suboptimal. Clinical practice guidelines and rapid assessment TIA clinics may change these results.
To determine if an educational intervention in the acute stage of whiplash injury may improve the recovery rate.
Consecutive subjects were randomized to one of two treatment groups: educational ...intervention or usual care. The intervention group received an educational pamphlet based on the current evidence. The control group did not receive these materials but received usual emergency department care and a standard nondirected discharge information sheet. Both groups underwent follow-up by telephone interview at two weeks and three months. The primary outcome measure of recovery was the patient's response to the question, "How well do you feel you are recovering from your injuries?"
A total of 112 subjects agreed to participate. Age, gender, precollision employment level and health, initial symptoms, collision parameters, and emergency treatments were similar between the groups. At two weeks postcollision, 7.3% in the treatment group reported recovery compared with 8.8% in the control group (absolute risk difference, -1.5%; 95% confidence interval = -12.6% to 9.7%). At three months postcollision, 21.8% in the treatment group reported complete recovery compared with 21.0% in the control group (absolute risk difference, 0.8%; 95% confidence interval = -14.4% to 16.0%). At three months, there were no clinically or statistically significant differences between groups in severity of remaining symptoms, limitations in daily activities, therapy use, medications used, lost time from work, or litigation.
An evidence-based educational pamphlet provided to patients at discharge from the emergency department is no more effective than usual care for patients with grade 1 or 2 whiplash-associated disorder.
Acute exacerbations of chronic obstructive pulmonary disease are a common problem in the emergency department. Despite considerable research involving the management of this disease over the past ...decade, much remains unclear from an emergency medicine perspective. Increased research would better guide the management of these complex patients from the perspectives of the patient, the caregiver, and society. The major areas of research can be divided into diagnosis, therapy, and education. The reliability and validity of different definitions of acute exacerbations of chronic obstructive pulmonary disease need to be assessed. The utility and performance characteristics of diagnostic testing need to be determined for this difficult patient population. Specific diagnostic tests include measures of dyspnea, spirometry and exercise tolerance, measures of gas exchange, airway inflammation, and chest imaging. It remains unclear which patient-specific therapies (oxygen, bronchodilators, corticosteroids, antibiotics, noninvasive positive pressure ventilation, and methylxanthines) should be used and monitored. Finally, the utility of education of both health care providers and patients and how it may be applied to the acute setting need to be addressed.
Background Patients with frequent asthma exacerbations resulting in emergency department (ED) visits are at increased risk for future exacerbations. We examined the ability of 1 dose of benralizumab, ...an investigational antiinterleukin 5 receptormonoclonal antibody, to reduce recurrence after acute asthma exacerbations. Methods In this randomized, double-blind, placebo-controlled study, eligible subjects presented to the ED with an asthma exacerbation, had partial response to treatment, and greater than or equal to 1 additional exacerbation within the previous year. Subjects received 1 intravenous infusion of placebo (n = 38) or benralizumab (0.3 mg/kg, n = 36 or 1.0 mg/kg, n = 36) added to outpatient management. The primary outcome was the proportion of subjects with greater than or equal to 1 exacerbation at 12 weeks in placebo vs the combined benralizumab groups. Other outcomes included the time-weighted rate of exacerbations at week 12, adverse events, blood eosinophil counts, asthma symptom changes, and health care resource utilization. Results The proportion of subjects with greater than or equal to 1 asthma exacerbation at 12 weeks was not different between placebo and the combined benralizumab groups (38.9% vs 33.3%;P= .67). However, compared with placebo, benralizumab reduced asthma exacerbation rates by 49% (3.59 vs 1.82;P= .01) and exacerbations resulting in hospitalization by 60% (1.62 vs 0.65;P= .02) in the combined groups. Benralizumab reduced blood eosinophil counts but did not affect other outcomes, while demonstrating an acceptable safety profile. Conclusions When added to usual care, 1 dose of benralizumab reduced the rate and severity of exacerbations experienced over 12 weeks by subjects who presented to the ED with acute asthma.
Objectives: This paper describes the temporal and spatial distribution of child pedestrian injury within Edmonton, Alberta for four fiscal years (1995-96 through 1998-99), and compares this pattern ...to temporal and spatial data on traffic volume. Methods: We used injury data obtained through an ongoing emergency department (ED) surveillance system involving all hospitals in Alberta's Capital Health Region. We identified peak times of injury occurrence and the location of high injury incidence as indicated by census tract of residence. Empirical Bayes estimation procedures were used to calculate stable injury incidence ratios. Cartographic and correlation analyses identified the relationship between traffic volume and injury incidence. Results: Child pedestrian injury occurred most frequently during morning (0700-0900 hrs) and late afternoon (1500-1800 hrs) which corresponds with peak periods of vehicular traffic flow. The highest incidence rates occurred in or near areas of high traffic volume, notably in the central and west-central parts of Edmonton. Discussion: These findings emphasize the importance of considering spatial and temporal patterns in pedestrian injury research, as well as the need to incorporate these patterns in prevention strategies. Changing the times that children attend school may reduce the convergence of pedestrian and vehicular traffic. Objectifs : Notre étude décrit la répartition spatiale et temporelle des blessures survenues chez les enfants circulant à pied à Edmonton (Alberta) pendant quatre années financières (1995-1996 à 1998-1999) et compare ce schéma aux données spatio-temporelles sur le débit routier. Méthode : Nos données sur les blessures provenaient du système de surveillance continue des services d'urgence des hôpitaux de la région sanitaire de la capitale albertaine. Nous avons cerné les périodes de pointe pour les blessures et les endroits où elles se produisaient le plus par secteur de recensement. En établissant des estimations empiriques par la méthode de Bayes, nous avons calculé les rapports d'incidence stables des blessures. Des analyses cartographiques et de corrélation ont mis au jour un lien entre le débit routier et l'incidence des blessures. Résultats : Les blessures aux enfants circulant à pied étaient les plus fréquentes le matin (entre 7 h et 9 h) et en fin d'après-midi (entre 15 h et 18 h), ce qui correspond aux heures de pointe de la circulation routière. Les taux d'incidence les plus élevés ont été constatés à l'intérieur ou à proximité des zones de fort débit, tout particulièrement dans le centre-ville et le centre-ouest d'Edmonton. Question à débattre : Ces résultats soulignent l'importance de tenir compte des schémas spatiotemporels dans la recherche sur les blessures aux piétons et de les intégrer dans les stratégies de prévention. En modifiant les heures d'école, on pourrait aussi réduire la convergence de la circulation des piétons et des véhicules.
Background
Exercise‐induced bronchoconstriction (EIB) following strenuous physical exertion afflicts many people. It can be the cause of sub‐optimal performance, symptoms such as cough, dyspnea, ...wheeze and chest tightness, and can lead people to avoid physical activity. Management of EIB focuses on prevention through pharmacotherapy and alternate strategies. Single use, pre‐exercise, beta‐agonists and non‐steroidal antiinflammatory agents are recommended.
Objectives
Bronchodilator medications have been commonly used to prevent narrowing of airways after exercise, but anti‐inflammatory drugs such as nedocromil sodium have also been used. The objective of this review was to assess the effects of a single dose of nedocromil sodium to prevent exercise‐induced bronchoconstriction.
Search methods
We searched the Cochrane Airways Group Specialised Regsiter, the Cochrane Central Register of Controlled Trials, Current Contents, review articles, textbooks and reference lists of articles. We also contacted the drug manufacturer and primary authors for additional citations. Searches have been updated to August 2008.
Selection criteria
Randomised trials comparing a single dose of nedocromil sodium with placebo to prevent exercise‐induced bronchoconstriction in patients with EIB over six years of age.
Data collection and analysis
Trial quality assessment and data extraction were conducted independently by two reviewers. Study authors were contacted for confirmation of data. No new studies were identified in an update search conducted in August 2008.
Main results
The combined results from 20 randomised controlled trials involving 280 participants, show that 4 mg, of nedocromil sodium inhaled 15 to 60 minutes prior to exercise significantly reduce the severity and duration of EIB in both adults and children, when compared to placebo. The maximum percentage fall in FEV1 was improved significantly compared to placebo (weighted mean difference 15.5 %; 95% confidence interval:13.2 to 18.1). For the maximum percentage fall in peak expiratory flow rate (PEFR) the improvement was similar: WMD 15.0%, (95% CI 8.3 to 21.6). Nedocromil shortened the time to recover lung normal function from more than 30 minutes with placebo to less than 10 minutes with the drug. It had a greater effect on those patients with more severe exercise‐induced bronchoconstriction (defined as an exercise‐induced fall in lung function > 30% from baseline). There were no significant adverse effects reported with the short term use of nedocromil. A further search conducted in August 2005 did not yield any further studies.
Authors' conclusions
Nedocromil sodium used before exercise reduces the severity and duration of exercise‐induced bronchoconstriction. This effect appears to be more pronounced in people with severe exercise‐induced bronchoconstriction.
Introduction: This study examined the use of helmets in adults, adolescents, and children in a western Canadian province that has no helmet legislation. Methods: A prospective survey of cyclists in ...two urban Alberta regions was completed. Cyclist demographics, helmet wearing and helmet use were recorded. Results: Helmets were observed in 2,259 (55%; 99% CI: 52-57) of 4,141 cyclists; however, only 75% (CI 71, 78) were wearing the helmet properly. Patterns of use varied according to age: 75% (CI 71, 78) of children, 29% (CI 23, 34) of adolescents, and 52% (CI 49, 55) of adults wore helmets. Percentages were higher in Calgary than Edmonton (63% vs. 45%; p<0.0001) and females wore helmets more often (64% vs. 50%; p<0.0001). Discussion: These results identify large within-and between-region variation in the use of cycling helmets in Alberta. Injury prevention planners need to use these data to adopt interventions that are focused on age groupings, gender, and place of residence. Introduction : Nous avons étudié l'utilisation du casque chez les adultes, les adolescents et les enfants dans une province de l'Ouest canadien où le port du casque n'est pas réglementé. Méthode : Nous avons mené une enquête prospective auprès de cyclistes dans deux zones urbaines de l'Alberta. Les données démographiques des cyclistes, le port du casque et l'utilisation du casque ont été enregistrés. Résultats : Des 4 141 cyclistes à l'étude, 2 259 portaient un casque (55 %; IC de 99 % = 52-57); cependant, seulement 75 % (IC = 71-78) le portaient convenablement. L'utilisation variait selon l'âge : 75 % (IC = 71-78) des enfants, 29 % (IC = 23-34) des adolescents et 52 % (IC = 49-55) des adultes portaient un casque. Les pourcentages étaient plus élevés à Calgary qu'à Edmonton (63 % c. 45 %; p<0,0001), et chez les femmes que chez les hommes (64 % c. 50 %; p<0,0001). Discussion : Ces résultats montrent qu'il existe d'importants écarts inter-et intra-régionaux dans l'utilisation du casque en Alberta. Les planificateurs en prévention des blessures devraient en tenir compte afin d'élaborer des mesures adaptées selon l'âge, le sexe et le lieu de résidence.
Background
A small number of patients with acute severe asthma require intubation and positive pressure ventilation. The beneficial effects of inhaled bronchodilators on acute asthma in spontaneously ...breathing subjects are well established, but there remain important questions regarding inhaled beta2‐agonists, for patients who are intubated and receiving ventilation.
Objectives
To determine the effects of inhaled beta2‐agonists on asthmatic patients who require intubation and mechanical ventilation.
Search methods
Randomized controlled trials were sought from the Cochrane Airways Group Specialised Register. Primary authors and content experts were contacted to identify eligible studies, and bibliographies from known reviews and texts were searched. Searches are current as of September 2011.
Selection criteria
We included randomized, controlled clinical trials involving adult patients with acute asthma, who were intubated and supported with positive pressure ventilation. We included studies of patients treated with beta2‐adrenergic agonist agents and a comparison group of either placebo, no medication, or 'standard' treatment.
Data collection and analysis
Two review authors independently examined all identified references. Two review authors independently reviewed the full text of any potentially relevant article.
Main results
The initial search in 1999 yielded 152 s. Of these, four articles were identified as potential trials. None of the four trials met the inclusion criteria for the review. Further searches up to September 2011 have identified an additional 117 references, none of which were suitable for inclusion.
Authors' conclusions
We did not find any relevant randomized controlled trials. Therefore, as yet no data are available to provide evidence for or against current practices regarding the use of inhaled beta2‐agonists in asthmatic subjects who are intubated and ventilated.
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