scholarly journals Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

2021 ◽  
Author(s):  
Samuel Galvagno ◽  
James Cloepin ◽  
Jeannie Hannas ◽  
Kurt Rubach ◽  
Andrew Naumann ◽  
...  
Keyword(s):  
Ease Of Use ◽  
Stable Patient ◽  
Randomized Controlled ◽  
Medication Delivery ◽  
Medication Dosage ◽  
Wide Variability ◽  
Infusion Technique ◽  
Manual Calculation ◽  
Dosage Errors ◽  
Intravenous Medication

Abstract BackgroundLimited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a pragmatic, randomized, controlled, crossover study comparing two different techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and multiple linear regression were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal, fewer mid-infusion adjustments, and greater ease of use. Conclusions Use of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery.

scholarly journals Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel M. Galvagno ◽  
James Cloepin ◽  
Jeannie Hannas ◽  
Kurt S. Rubach ◽  
Andrew Naumann ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Ease Of Use ◽  
Standard Group ◽  
Improvement Project ◽  
Randomized Controlled ◽  
Medication Dosage ◽  
Wide Variability ◽  
Standard Calculation ◽  
Infusion Technique ◽  
Dosage Errors

Abstract Background Limited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a quality improvement project that utilized a randomized, controlled, crossover study design to compare two different educational techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 min, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and a repeated measures mixed linear regression model were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal (median 34 s [IQR, 22–54] vs 50 s; [IQR 38–61 s], P = 0.006) and fewer mid-infusion adjustments. Ease of use was reported to be significantly higher for the metronome group (median ranking 5, IQR 4–5) compared to the standard group (median ranking 2, IQR 2–3; P < 0.001). Conclusions Knowledge regarding a metronome technique may help EMS clinicians provide safe and effective IV infusions. Such a technique may be beneficial for learners and educators alike.

scholarly journals An Analysis of Patient Acceptance and Safety of a Prefilled Insulin Injection Device

2009 ◽  
Vol 3 (6) ◽  
pp. 1439-1441 ◽  
Author(s):  
Lisa Kroon
Keyword(s):  
Insulin Injection ◽  
Ease Of Use ◽  
Patient Acceptance ◽  
Delivery Device ◽  
Injection Device ◽  
Randomized Controlled ◽  
Clinical Advantage ◽  
Injection Force

This article summarizes and interprets the findings of Carter and colleagues in this issue of Journal of Diabetes Science and Technology, a study of the real world use of a prefilled insulin pen device. In this observational study, people with type 1 and type 2 diabetes rated their experience with the SoloSTAR pen device after 6–10 weeks of use. Data on patient satisfaction, product technical complaints, and adverse effects were reported. Randomized, controlled trials are needed that compare the various pen devices and the vial/syringe in terms of accuracy of dosing, adherence to therapy, and ease of use (including patient perception of injection force required) to assess whether a particular method of insulin delivery or pen delivery device provides a clinical advantage over another.

scholarly journals Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

2007 ◽  
Vol 12 (1) ◽  
pp. 13-21 ◽  
Author(s):  
DE Moulin ◽  
AJ Clark ◽  
I Gilron ◽  
MA Ware ◽  
CPN Watson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Ease Of Use ◽  
Control Group ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Analgesic Agents ◽  
Third Line

Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

Comparative effectiveness of a serious game and usual supervised work for postpartum hemorrhage management: a crossover randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Sandrine Voillequin ◽  
Patrick Rozenberg ◽  
Katell Le Tutour ◽  
Anne Rousseau
Keyword(s):  
Randomized Controlled Trial ◽  
Student Satisfaction ◽  
Postpartum Hemorrhage ◽  
Controlled Trial ◽  
Ease Of Use ◽  
Serious Game ◽  
Case Vignette ◽  
Secondary Outcome ◽  
Decision Algorithm ◽  
Randomized Controlled

UNSTRUCTURED Purpose: Because serious games promote learning and cognitive skill development, they may be useful for teaching students to manage postpartum hemorrhage (PPH) and its complex decision algorithm. This study aimed to compare the effectiveness of a serious game with usual supervised work in producing knowledge and satisfaction. Methods: This two-center two-stage crossover randomized controlled trial included student midwives. One group underwent the serious game intervention in the first period (January 2018) and the usual supervised classroom work in the second (May 2018); the other group followed the reverse chronology. The primary outcome was knowledge of the PPH management algorithm, assessed by responses to a case vignette after each intervention session. Satisfaction was the secondary outcome. Results: The serious game-supervised work (SG-SW) chronology was allocated to 48 students, and its inverse (SW-SG) to 47; knowledge did not differ between the two groups (respectively, 89.5% versus 83.5%, P=0.3). Satisfaction was significantly higher for the game for its overall grade (6.8 vs 6.1, P=0.009), engagingness (very good 82.1% vs 24.3%, P<.001), and ease of use (very good 77.9% vs 46.1%, P<.001) Conclusion: The serious game did not produce more knowledge than supervised work, but is probably educationally useful because of greater student satisfaction.

scholarly journals P063: Ultrasound-guided peripheral intravenous access in the emergency department: a randomized controlled trial comparing single and dual-operator technique

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S79-S79
Author(s):  
A. Hart ◽  
J. Chenkin ◽  
B. Craig ◽  
R. Simard ◽  
C. Alexandre
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Ease Of Use ◽  
Operator Technique ◽  
Dual Operator ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Patient Pain ◽  
Single Operator

Introduction: Ultrasound-guided intravenous (UGIV) insertion performed by nurses has been shown to be more effective than the blind approach for patients with difficult intravenous (IV) access in the emergency department (ED). While both the single-operator (SO) (where a single operator holds the IV and probe) and dual-operator (DO) (where a second operator holds the probe) techniques have been described, the DO is more resource-intensive, requiring a second operator to be present. The objective of this study is to compare the first-attempt cannulation success rates between a SO and DO technique in ED patients with predicted difficult access. Methods: We conducted a randomized controlled non-inferiority trial using a convenience sample of adult ED patients. Participating ED nurses received a one-hour UGIV training session including didactic and practical training on simulated arms. Patients were enrolled if they met any of three criteria for difficult access: (1) history of difficult access, (2) no visible or palpable veins, or (3) two failed blind attempts. Patients requiring active resuscitation, lack of suitable veins on US, or those unable to consent or comply with the procedure were excluded. Eligible patients were randomized to the SO or DO technique and a maximum of two UGIV attempts were allowed. The primary outcome was first-attempt success rate. Additional outcomes included overall success rate, number of attempts, time to successful cannulation, patient pain scores, operator ease of use scores, and complications 30 minutes after insertion. The chi-square test was used to compare success rates between groups and t-tests used for all other secondary outcomes. Results: 42 eligible patients have been approached for our study. 14 were excluded due to lack of visible veins on US or due to ongoing resuscitation. A total of 33 UGIV attempts were performed on 28 patients (17 in SO group, 16 in DO group). There was no statistically significant difference in first attempt success rates between the SO group of 76.5% (95% CI [50.1% to 93.2%]) and the DO group of 68.8% (95% CI [41.3% to 89%]) (p=0.62). There were also no statistically significant differences between the SO and DO groups in time to cannulation (140 vs 165 seconds, p=0.36), patient preference on a 10-point scale (7.0 vs 7.9, p=0.49), patient pain score (6.3 vs 6.6, p=0.87) or nursing ease of use (5.3 vs 6.5 p=0.23) respectively. There were no complications noted in either arm of the study. Conclusion: To date, the SO technique appears to be non-inferior to the DO technique for successful UGIV cannulation. Our results support the use of the SO technique, reducing the need for additional nursing resources when performing this procedure.

scholarly journals Effectiveness of m-learning HiSense APP-ID in enhancing knowledge, empathy, and self-efficacy in caregivers of persons with intellectual disabilities: a randomized controlled trial

2019 ◽  
Vol 9 (5) ◽  
pp. 893-901
Author(s):  
Evelien van Wingerden ◽  
Mirjam Wouda ◽  
Paula Sterkenburg
Keyword(s):  
Randomized Controlled Trial ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Ease Of Use ◽  
Theoretical Knowledge ◽  
Multiple Choice Questions ◽  
Randomized Controlled ◽  
Mixed Effects Modeling ◽  
Flexible Form ◽  
Social Empathy

Abstract M-learning is a flexible form of digital education that can benefit professional caregivers. The m-learning intervention ‘HiSense APP-ID’ was developed to support caregivers of persons with intellectual disability (ID). The intervention focuses on improving knowledge about sensitive and responsive caregiving for persons with ID. This randomized controlled trial of 101 professional caregivers of persons with moderate or mild ID evaluated whether m-learning improves practical and theoretical knowledge about secure attachment in persons with ID, and increases empathy and self-efficacy. The ‘HiSense APP-ID’ consists of 120 multiple-choice questions relating to attachment theory and the experience of persons with ID. Participants answer four questions each day for 30 days. In pre-, post-, and follow-up assessments, all participants completed a series of questionnaires concerning social validity, knowledge, self-efficacy, and empathy. Linear mixed effects modeling was then used to assess the effectiveness of the intervention. Users rated the app positively on usefulness, ease of use, design, and development of their own skills. Knowledge improved in the group of participants who followed m-learning. An interaction effect was found for empathic concern, but no significant effect was found for social empathy or self-efficacy. Thus, m-learning is a useful and flexible educational tool for professional caregivers of persons with ID, and the ‘HiSense APP-ID’ was able to improve theoretical knowledge in very short sessions spaced over a longer period of time.

scholarly journals Effectiveness of Ondansetron versus Metoclopramide in Hyperemesis Gravidarum

2014 ◽  
Vol 9 (2) ◽  
pp. 27-32
Author(s):  
M Chhetry ◽  
A Thakur ◽  
P Basnet ◽  
R Joshi ◽  
H Sangraula ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Small Sample Size ◽  
Supportive Therapy ◽  
Small Sample ◽  
Controlled Study ◽  
P Value ◽  
Weight Changes ◽  
Randomized Controlled ◽  
To Receive ◽  
Intravenous Medication

Aims: The aim was to evaluate the effectiveness of intravenous ondansetron as compared to intravenous metoclopramide in hyperemesis gravidarum. Methods: Sixty-eight patients with hyperemesis gravidarum were randomized to receive either intravenous ondansetron or intravenous metoclopramide according to randomization group, till they started tolerating orally along with supportive therapy and various treatment parameters were compared. Results: No statistically significant differences were found in the number of doses of intravenous medication used (three doses of ondansetron vs four doses of metoclopramide; p value 0.77), weight changes (ondansetron - 0 kg vs. metoclopramide – 1 kg; p value 0.11) during treatment, duration of intravenous fluids (ondansetron – 24 hours vs. metoclopramide- 24 hours; p value 0.48) in the two groups. The duration of hospital stay of the patients in the two groups was comparable (ondansetron - 3 days vs. metoclopramide - 3 days; p value 0.83).Conclusions: Metoclopramide and ondansetron appear to be equally effective to treat hyperemesis gravidarum. Although this was a prospective randomized controlled study, it had a small sample size and the results should be confirmed in a larger and powered study.DOI:http://dx.doi.org/10.3126/njog.v9i2.11753

Use of Intravenous Medication Dosage

1986 ◽  
Vol 6 (2) ◽  
pp. 127???128
Author(s):  
Francisco Fernandez ◽  
Frank Adams
Keyword(s):  
Medication Dosage ◽  
Intravenous Medication
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