scholarly journals Clinical Equipoise and Treatment Decisions in Cervical Spondylotic Myelopathy

2007 ◽  
Vol 34 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Michael Benatar
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Controlled Trial ◽  
Treatment Decisions ◽  
Clinical Findings ◽  
Primary Objective ◽  
Cervical Cord ◽  
Clinical Equipoise ◽  
Cross Sectional ◽  
Orthopedic Surgeons ◽  
Secondary Objective

Objective:The primary objective of this study is to evaluate clinician attitudes towards the treatment of cervical spondylotic myelopathy (CSM) in order to determine whether clinical equipoise exists for a segment of this patient population. The secondary objective is to examine the factors that influence treatment decisions.Methods:Cross-sectional internet-based survey of neurologists, neurosurgeons and orthopedic surgeons.Results:Between 40-60% of respondents recommended surgery for (1) patients with minimal or no symptoms, but incidentally discovered increased T2 signal within the cervical cord on MRI, (2) patients with mild symptoms and indentation of the cervical cord but without increased T2 signal and (3) those with at least moderately severe clinical findings accompanied by MRI showing effacement of the thecal sac but without indentation of the cord or increased T2 signal. The severity of the radiological abnormalities most strongly influence treatment decisions.Conclusion:We conclude that clinical equipoise does exist for certain groups of patients with CSM, suggesting that a randomized controlled trial could be performed in this population.

scholarly journals Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 763
Author(s):  
Daniele Roberto Giacobbe ◽  
Chiara Russo ◽  
Veronica Martini ◽  
Silvia Dettori ◽  
Federica Briano ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Bloodstream Infections ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Sectional Study ◽  
Cross Sectional ◽  
First Line Therapy ◽  
Large Teaching Hospital ◽  
Secondary Objective ◽  
Medical Wards

A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response.

scholarly journals Smartphone use and primary headache

2020 ◽  
Vol 10 (6) ◽  
pp. 473-479 ◽  
Author(s):  
Pratik Uttarwar ◽  
Deepti Vibha ◽  
Kameshwar Prasad ◽  
Achal Kumar Srivastava ◽  
Awadh Kishor Pandit ◽  
...  
Keyword(s):  
Poor Response ◽  
Primary Headache ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Cross Sectional ◽  
Acute Medication ◽  
Secondary Objective ◽  
Smartphone Use ◽  
Lower Education ◽  
New Onset

ObjectiveTo determine the association of smartphone use with occurrence of new-onset headache and/or increased severity of headaches in patients with primary headache.MethodsIn a cross-sectional study between June 2017 and December 2018, patients with primary headache were divided into 2 groups: smartphone users (SUs) and non-smartphone users (NSUs). A questionnaire was administered for headache characteristics and treatment taken. The primary objective was to determine the association of smartphone use with new-onset headache or increase severity. The secondary objective was to determine any differences in the requirement of acute medication and prophylaxis.ResultsFour hundred patients were included in the study, of which 194 were NSUs and 206 were SUs. The NSUs were older with lower education and socioeconomic status. The headache characteristics were similar in both the groups, except for higher occurrence of aura (NSUs: 15 [7.7%] vs SUs: 36 [17.5%]; p = 0.003) in the SU group. There was, however, higher proportion of patients taking analgesics (NSUs: 157 [80.9%] vs SUs: 197 [95.6%]; p < 0.001), with less relief in headache with medication in the SU group. This was driven by increased pill count (low SUs: 5.0 [3.0; 10.0] vs high SUs: 10.0 [5.0; 15.0]; p = 0.007) and poor response to medication in the high SU group.ConclusionsThe use of smartphone was associated with increase in requirement of acute medication and less relief with acute medication. Longitudinal studies may be required to confirm these findings.

scholarly journals Effect of dexamethasone in patients with ARDS and COVID-19 – prospective, multi-centre, open-label, parallel-group, randomised controlled trial (REMED trial): A structured summary of a study protocol for a randomised controlled trial

2021 ◽  
Author(s):  
Jan Maláska ◽  
Jan Stašek ◽  
František Duška ◽  
Martin Balík ◽  
Jan Máca ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Primary Objective ◽  
Efficacy And Safety ◽  
Open Label ◽  
Parallel Group ◽  
Secondary Objective ◽  
Randomised Controlled

Abstract ObjectivesThe primary objective of this study is to test the hypothesis that administration of dexamethasone 20 mg is superior to a 6 mg dose in adult patients with moderate or severe ARDS due to confirmed COVID-19. The secondary objective is to investigate the efficacy and safety of dexamethasone 20 mg versus dexamethasone 6 mg. The exploratory objective of this study is to assess long-term consequences on mortality and quality of life at 180 and 360 days.

scholarly journals Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students (Preprint)

2018 ◽  
Author(s):  
Lorna Cook ◽  
Mohammod Mostazir ◽  
Edward Watkins
Keyword(s):  
University Students ◽  
Usual Care ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Primary Objective ◽  
Effect Sizes ◽  
Phase Iii ◽  
Web Based ◽  
Randomized Controlled ◽  
Secondary Objective

BACKGROUND Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. OBJECTIVE The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. METHODS To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. RESULTS Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. CONCLUSIONS Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention. CLINICALTRIAL ISRCTN Registry ISRCTN12683436; https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at http://www.webcitation.org/77fqycyBX) INTERNATIONAL REGISTERED REPOR RR2-10.1186/s13063-015-1128-9

scholarly journals Physician burnout and professional satisfaction in orthopedic surgeons during the COVID-19 Pandemic

Work ◽  
2021 ◽  
pp. 1-8
Author(s):  
Alexander L. Lazarides ◽  
Elshaday S. Belay ◽  
Albert T. Anastasio ◽  
Chad E. Cook ◽  
Oke A. Anakwenze
Keyword(s):  
Primary Objective ◽  
Healthcare Outcomes ◽  
Professional Satisfaction ◽  
Physician Burnout ◽  
Orthopedic Surgeons ◽  
Secondary Objective ◽  
Professional Fulfillment ◽  
And Coping ◽  
Study Participants ◽  
Threshold Criteria

BACKGROUND: Burnout and professional satisfaction is an often an overlooked component for healthcare outcomes; the COVID-19 pandemic represents an unprecedented stressor that could contribute to higher levels of burnout. OBJECTIVES: Our primary objective was to evaluate the association of a battery of fulfillment, job satisfaction change, COVID-19 concerns, and coping measures. Our secondary objective was to determine whether the fulfillment and coping measures differed by gender and by experience levels among a battery of physician specialties. METHODS: The study was a purposive sample of convenience. Study participants included all trainees and attending orthopedic surgeons from our academic institution; all participants were invited to complete a survey built around a validated measure of professional fulfillment aimed at assessing response to acute change and stressors. We performed univariate statistics and a matrix correlational analysis to correlate different survey domains with variables of interest. RESULTS: The survey was sent electronically to 138 individuals; 63 surveys were completed (response rate = 45.7%). Twenty-seven (42.8%) individuals met the threshold criteria for fulfillment whereas 10 (15.9%) met the threshold for burnout. We found that surgeon perspectives on COVID-19 were not associated with burnout or professional fulfillment. Burnout was inversely associated with professional fulfillment (R = –0.35). Support seeking was noted to be correlated with professional fulfillment (R = 0.37). CONCLUSIONS: Stressors related to COVID-19 pandemic were not correlated with physician burnout and fulfillment. This held true even when stratifying by gender and by attending vs. trainee. Continued efforts should be implemented to protect against physician burnout and ensure professional fulfillment for Orthopedic surgeons.

scholarly journals 83 Electrocardiogram in Syncope: An old habit or clinically helpful?

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e34-e34
Author(s):  
Anas Manouzi ◽  
Quynh Doan ◽  
Shubhayan Sanatani
Keyword(s):  
High Risk ◽  
Heart Defects ◽  
Vasovagal Syncope ◽  
Primary Objective ◽  
Practice Pattern ◽  
Survey Study ◽  
Clinical Equipoise ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Syncope affects up to 50% of individuals by age 21 years and accounts for 1% of presentations to the emergency department (ED). Cardiac causes of syncope, including structural heart defects and rhythm disorders, cannot always be ruled out by an electrocardiogram (ECG) as this test lacks sensitivity and specificity. Conflicting recommendations for the role of ECG in evaluation of pediatric syncope underscore the clinical equipoise of how ECG findings influence physicians’ clinical decisions. Objectives The primary objective of this study is to determine how ECG findings affect ED physicians’ management of children presenting with vasovagal syncope. Our secondary objective is to document the practice pattern variation among ED physicians regarding their decision to obtain an ECG for the evaluation of vasovagal syncope in children. Design/Methods We conducted a prospective cross-sectional survey study using the REDCap platform. Our sample frame consisted of practicing emergency physicians enrolled in the Pediatric Emergency Research Canada (PERC) network. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation (low/high risk). We also evaluated which specific ECG findings were likely to change physicians’ management and explored factors influencing the decision to perform or not perform the ECG. Results We obtained data from 105/225 (47%) potential respondents. In a clinical scenario presenting a vasovagal syncope, 52% of respondents would order an ECG. Forty-five percent changed their management if the ECG interpretation was anything other than “Normal ECG”. In a high-risk syncope scenario, an ECG was performed by 96% of respondents. Cardiology referral was requested by 93% of respondents, despite normal ECG findings. Borderline ECG findings led to significant practice variation in management, for both low and high-risk presentations scenarios. Overall, 66% of respondents stated that performing an ECG is not important to rule out a cardiac etiology in a typical vasovagal syncope presentation, but 64% stated that performing an ECG is important to reassure the patient. Conclusion There is substantial practice pattern variation among emergency physicians with regards to the frequency and motivations to order ECGs, and how ECG findings impact the management of pediatric syncope in the ED. Information provided by an ECG can lead to unnecessary change to clinical management, additional testing, and referrals to specialists for typical vasovagal syncope. This reinforces the importance of better knowledge translation surrounding evidence-based management of vasovagal syncope among ED physicians.

scholarly journals Which Strategy to Manage Severe Vaso-occlusive Crisis in Patients with Sickle Cell Disease in Countries with Limited Healthcare Capacities?

2021 ◽  
pp. 7-13
Author(s):  
Lydie Ocini Ngolet ◽  
Chelsea Jayne Bango ◽  
Peggy Mawandza ◽  
Alexis Elira Dokekias
Keyword(s):  
Pain Relief ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Controlled Trial ◽  
Primary Objective ◽  
Cell Disease ◽  
Patient Controlled Analgesia ◽  
Secondary Objective ◽  
The Mean ◽  
The Republic

We evaluated the treatment of morphine by intravenous patient controlled analgesia versus intermittent subcutaneous routes on patients with sickle cell disease developing severe vaso-occlusivecrisis. Objectives: The primary objective was to compare intravenous patient controlled analgesia (PCA) versus intermittent subcutaneous injection of morphine (SC) on sickle cell patients developing severe vaso-occlusive crisis during the first 24 hours of admission. The secondary objective was to assess the side effects of morphine in both regimens. Methods: A randomized controlled trial of 77 patients in the PCA and 81 in the SC group was conducted at the Sickle Cell Center of Brazzaville in the Republic of Congo. Participants aged from 15 to 45 years old with severe vaso-occlusive crisis were included in the study. Results: Both regimens provided pain relief. However, a significant pain reduction was observed 30 minutes after the administration of morphine in the PCA group (P= 0.001). The mean scores in the PCA and SC regimens were respectively: 1.16±1.40 and 4.30±2.32. The total median dose of morphine administered in the PCA regimen was markedly lower: 24,6±4,16 mg versus 36.6±3.1 mg in the SC group (P=0.01). Morphine administered by PCA provided pain relief during 24 hours while intermittent severe pain was experienced in the SC group (P=0.014). Sedation score S2, S3 was significantly observed in the SC group (P< 0.05).

scholarly journals Decision to delivery interval in emergency LSCS and its impact on fetal outcome

2019 ◽  
Vol 8 (9) ◽  
pp. 3679
Author(s):  
Vidhu V. Nair ◽  
Sobha S. Nair ◽  
Prasanna Venugopalan
Keyword(s):  
Caesarean Section ◽  
Fetal Outcome ◽  
Primary Objective ◽  
Cross Sectional ◽  
Apgar Scores ◽  
Standard Criterion ◽  
Secondary Objective ◽  
Nicu Admission ◽  
Sectional Analysis ◽  
Fetal Compromise

Background: Emergency LSCS can be categorized based on RCOG guidelines into category I and II which indicates maternal or fetal compromise. Here an urgent delivery and the DDI (decision to delivery interval) within 30 and 45 minutes respectively is needed.Methods: This is a retrospective cross-sectional analysis conducted on a sample of 630 patients who underwent caesarean section over a year, from June 2016 to June 2017. The DDI were further classified into ≤30 and >30 minutes for category I, ≤45 and >45 minutes for category II LSCS. The primary objective is to determine whether DDI in Category I and II emergency LSCS has an impact on fetal outcome and secondary objective is to ensure that DDI is within the standard criterion as per RCOG protocol.Results: Out of 630 samples of caesareans, it was found that 173 falls in Category I and 189 falls in Category II. Out of 87 (50.29%) patients delivered within 30 minutes in Category I, 29 babies required NICU admission. DDI was more than 30 minutes in 86 (49.71%) cases in Category I out of which 38 babies got admitted in NICU with low APGAR scores. Out of 176 (93.12%) patients who delivered within 45 minutes in Category II, 56 babies required NICU admission. DDI was more than 45 minutes in 13 (6.88%) cases in Category II and all these babies got admitted in NICU.Conclusions: Decision -delivery interval has a significant impact on fetal outcome.

scholarly journals Investigating paramedic student professional identity

2020 ◽  
Vol 17 ◽  
Author(s):  
Tania Johnston ◽  
Natalia Bilton
Keyword(s):  
Professional Identity ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
The Self ◽  
University Campus ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Health Occupations ◽  
First Choice ◽  
Secondary Objective

IntroductionA robust professional identity is a known predictor of personal and professional satisfaction and is viewed as foundational to successful practice in health occupations. Despite this, there is a gap in the research on paramedic identity (PI). Using the Macleod Clark Professional Identity Scale (MCPIS-9), the primary objective of this study was to measure the self-reported professional identity of paramedic students during their university studies. A secondary objective was to determine potential predictor variables for professional identity.MethodA convenience sample of 102 paramedic students at a single university campus participated in this descriptive cross sectional study. An electronic, purpose designed survey recorded demographic information, background characteristics as well as the self-reported strength of student PI using the MCPIS-9. Results66.7% of participants were women and 46% were between the ages of 19–24 years; 75% reported no prior education in health care and 82% indicated paramedicine was their first choice of study. Most students (82%) had no prior paramedic-related work or volunteer experience. The mean MCPIS-9 score was 38.8/45 with a standard deviation of 4.9. There were no statistical differences associated with PI scores and demographics or background factors, however, some interesting trends were observed in the data. The only variable found as a significant predictor of MCPIS-9 scores was the student’s year of study. Conclusion Paramedic students in our study reported a strong sense of professional identity which had a tendency to increase from year-to-year. There appears to be a predictive relationship between year of study and strength of professional identity. We found that the self-reported strength of paramedic students’ identity does not specifically correlate with gender or previous education. However, those with prior paramedic type experience who selected paramedicine as their first choice of study may experience a stronger professional identity. Further studies and subsequent replication of our findings will determine whether or not we can make solid inferences from our sample to paramedic students in general. 

scholarly journals EVALUATION OF KNOWLEDGE, AWARENESS, AND PRACTICE OF PHARMACOVIGILANCE AMONG PRACTICING DOCTORS

2016 ◽  
Vol 9 (9) ◽  
pp. 283
Author(s):  
Santhosh Kumar Madhusudhan ◽  
Shashikala Gh
Keyword(s):  
Common Factor ◽  
Cross Sectional Study ◽  
Continuous Medical Education ◽  
Primary Objective ◽  
Cross Sectional ◽  
Validated Questionnaire ◽  
Post Test ◽  
Knowledge Practice ◽  
Secondary Objective ◽  
Knowledge And Practice

ABSTRACTObjective: The primary objective of the study was to assess the awareness, knowledge, and practice of pharmacovigilance (PV) among the practicingdoctors. The secondary objective was to ascertain the reason for underreporting of adverse drug reactions (ADRs) in India.Methods: A cross-sectional study was conducted using a pretested and validated questionnaire. The questionnaire was designed to assess theseparameters of PV. These questionnaires were distributed among 90 doctors to ascertain the answers. In addition, the same parameters werereassessed (post-questionnaires) after sensitizing the doctors about PV.Results: Only 52 doctors took the posttest, a response rate of 57%. The mean awareness, knowledge, and practice of PV among doctors were 4.70,3.60, and 2.90, respectively, which significantly increased in post-test questionnaire (p<0.05). The Pearson correlations revealed that the level ofawareness among the respondents was significantly related to the knowledge and the practice of PV, linearly, and positively. In other words, higher theawareness more was the knowledge and better was the methods of application. The most common factor discouraging doctors from reporting ADRswas they found it difficult to decide whether ADR has occurred or not (32.69%).Conclusion: There was a significant positive correlation between awareness, knowledge, and practice of PV. In spite of these findings, the ADRreporting rate is negligible in India. To bring about a strong culture of reporting among doctors, it is mandatory to continuously expose doctors to theconcepts of PV by continuous medical education, workshops, seminars and to make reporting mandatory in India.Keywords: Pharmacovigilance, Adverse drugs reactions, Awareness, Knowledge, Practice.

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