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Medicine Research (medicine + research)
Selected AbstractsEmergency Medicine Research,A Time to Celebrate, Contemplate, and PropagateACADEMIC EMERGENCY MEDICINE, Issue 5 2001Brian J. Zink MD President No abstract is available for this article. [source] Characteristics and Trends of Published Emergency Medicine ResearchACADEMIC EMERGENCY MEDICINE, Issue 7 2007Michael P. Wilson MD Objectives:Despite its importance in improving patient care, the state of published emergency medicine (EM) research is poorly understood. The countries of origin, methodological characteristics, sources of funding, and ongoing trends in this research are unknown. Knowledge of these characteristics has important policy, research, and clinical implications for academic EM. Methods:The National Library of Medicine's PubMed database was searched for all articles published from 1996 to 2005 that originated from EM departments. The date and journal of publication, country of origin, study methodology, and, in the case of U.S. articles, acknowledgment of National Institutes of Health (NIH) grant support were noted. Journal impact factors of the publishing journal were assigned to each article. The aggregated data were then analyzed for country, journal of origin, and trend. Results:Of the 14,605 articles originating from EM departments, the United States published 8,550 (58.54%), followed by the United Kingdom with 1,222 (8.37%) and Japan with 663 (4.54%). Significant publication growth was detected worldwide (116.6 articles per year; 95% confidence interval = 101.1 to 132.1; p < 0.0001) and in 17 of the top 20 EM research,producing countries. Among published U.S. studies, the NIH funded 388 (4.5%). Of all articles, 6,152 (41.8%) were published in dedicated EM journals. Conclusions:Emergency medicine research output is increasing worldwide. The United States is the largest producer of EM research, only a small fraction of which is supported by the NIH. The majority of research published by emergency researchers is published in non-EM journals. [source] Charlson Index Is Associated with One-year Mortality in Emergency Department Patients with Suspected InfectionACADEMIC EMERGENCY MEDICINE, Issue 5 2006Scott B. Murray MD Abstract Objectives: A patient's baseline health status may affect the ability to survive an acute illness. Emergency medicine research requires tools to adjust for confounders such as comorbid illnesses. The Charlson Comorbidity Index has been validated in many settings but not extensively in the emergency department (ED). The purpose of this study was to examine the utility of the Charlson Index as a predictor of one-year mortality in a population of ED patients with suspected infection. Methods: The comorbid illness components of the Charlson Index were prospectively abstracted from the medical records of adult (age older than 18 years) ED patients at risk for infection (indicated by the clinical decision to obtain a blood culture) and weighted. Charlson scores were grouped into four previously established indices: 0 points (none), 1,2 points (low), 3,4 points (moderate), and ,5 points (high). The primary outcome was one-year mortality assessed using the National Death Index and medical records. Cox proportional-hazards ratios were calculated, adjusting for age, gender, and markers of 28-day in-hospital mortality. Results: Between February 1, 2000, and February 1, 2001, 3,102 unique patients (96% of eligible patients) were enrolled at an urban teaching hospital. Overall one-year mortality was 22% (667/3,102). Mortality rates increased with increasing Charlson scores: none, 7% (95% confidence interval [CI] = 5.4% to 8.5%); low, 22% (95% CI = 19% to 24%); moderate, 31% (95% CI = 27% to 35%); and high, 40% (95% CI = 36% to 44%). Controlling for age, gender, and factors associated with 28-day mortality, and using the "none" group as a reference group, the Charlson Index predicted mortality as follows: low, odds ratio of 2.0; moderate, odds ratio of 2.5; and high, odds ratio of 4.7. Conclusions: This study suggests that the Charlson Index predicts one-year mortality among ED patients with suspected infection. [source] Subgroup Hypotheses: Clinician's Friend or Researcher's Fiction?ACADEMIC EMERGENCY MEDICINE, Issue 8 2009Peter C. Wyer MD Abstract Researchers and clinicians may be tempted to consider apparent differences in effects of interventions in subgroups of study populations for the purposes of individualizing care or directing subsequent focused research efforts. Such "subgroup hypotheses" have a high propensity of being artifacts of chance and are rarely supported when stringent criteria are applied. Subgroup hypotheses emerging from single trials should rarely if ever be considered for application. This article describes published criteria for evaluating the believability of a subgroup hypothesis and presents a conceptual framework for understanding the principles underlying those criteria. Examples of both failed and validated subgroup hypotheses drawn from emergency medicine research are given. [source] Lidocaine/Monoethylglycinexylidide Test, Galactose Elimination Test, and Sorbitol Elimination Test for Metabolic Assessment of Liver Cell BioreactorsARTIFICIAL ORGANS, Issue 6 2010Jörg C. Gerlach Abstract Various metabolic tests were compared for the performance characterization of a liver cell bioreactor as a routine function assessment of cultures in a standby for patient application in clinical studies. Everyday quality assessment (QA) is essential to ensure a continuous level of cellular functional capacity in the development of hepatic progenitor cell expansion systems providing cells for regenerative medicine research; it is also of interest to meet safety requirements in bioartificial extracorporeal liver support systems under clinical evaluation. Quality criteria for the description of bioreactor cultures were developed using primary porcine liver cells as a model. Porcine liver cells isolated by collagenase perfusion with an average of 3 × 109 primary cells were used in 39 bioreactors for culture periods up to 33 days. Measurements of monoethylglycinexylidide synthesis and elimination of lidocaine, galactose elimination, and sorbitol elimination proved to be useful for routine QA of primary liver cell cultures. We demonstrate two methods for dispensing test substances, bolus administration and continuous, steady-state administration. Bolus test data were grouped in Standard, Therapy, Infection/Contamination, and Cell-free control groups. Statistical analyses show significant differences among all groups for every test substance. Post hoc comparisons indicated significant differences between Standard and Cell-free groups for all elimination parameters. For continuous tests, results were categorized according to number of culture days and time-dependent changes were analyzed. Continuous administration enables a better view of culture health and the time dependency of cellular function, whereas bolus administration is more flexible. Both procedures can be used to define cell function. Assessment of cellular function and bioreactor quality can contribute significantly to the quality of experimental or clinical studies in the field of hepatic bioreactor development. [source] U.S. Federal Regulations for Emergency Research: A Practical Guide and CommentaryACADEMIC EMERGENCY MEDICINE, Issue 1 2008Andrew McRae MD Abstract Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. [source] Qualitative Data Collection and Analysis Methods: The INSTINCT TrialACADEMIC EMERGENCY MEDICINE, Issue 11 2007William J. Meurer MD Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source] 2007 SAEM Annual Meeting AbstractsACADEMIC EMERGENCY MEDICINE, Issue 2007Article first published online: 5 SEP 200 The editors of Academic Emergency Medicine are pleased and privileged to present the Original Research Abstracts from the Annual Meeting of the Society for Academic Emergency Medicine, May 16,19, 2007, in Chicago. The exciting trends of emergency medicine research are reflected in these brief summaries as are the talent, creativity, and enthusiasm of novice as well as more experienced academicians. This year, 1,172 research abstracts were submitted and 545 were selected for presentation at the Meeting (not including the 78 Innovations in Emergency Medicine Education Exhibits, which were submitted sepa-rately). Each abstract was independently reviewed by up to six designated topics experts who were blinded to the authors. Final determination for scientific presentation was made by the Scientific Subcommittee, chaired by O. John Ma, MD, and the SAEM Program Committee, chaired by Debra Houry, MD, MPH. The decision for presentation was based on the final review score and the space available for presentation at the meeting. We present these abstracts as they were received electronically from the authors, who are solely responsible for their content. They appear as they were received; we have done only minimal proofreading of these abstracts. Any questions you may have on their content should be directed to their authors. Presentation numbers precede the abstract titles. An index of key words and authors begins on page S220. Abstracts marked as late breakers (numbers 462 and 527) are prospective research projects, such as a clinical trial still in the midst of data collection or patient enrollment at the January 8 abstract deadline, but that will be completed, including analysis, by April 15, 2007. On behalf of the membership of SAEM, the editorial board of AEM, and the leadership of our specialty, we express our sincere gratitude to these academicians and the SAEM Program Committee for their continuing efforts to improve our patients' care by advancing emergency medicine research and education. [source] | ||||||||||