scholarly journals Timing of Initial Antibiotic Treatment for Febrile Neutropenia in the Emergency Department: The Need for Evidence-Based Guidelines

2014 ◽  
Vol 12 (11) ◽  
pp. 1569-1573 ◽  
Author(s):  
Demetrios N. Kyriacou ◽  
Borko Jovanovic ◽  
Olga Frankfurt
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Antibiotic Treatment ◽  
Evidence Based ◽  
Evidence Based Guidelines

scholarly journals Peripheral Intravenous Cannula Usage in the Emergency Department

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Adam K Stanley ◽  
Ashton Barnett-Vanes ◽  
Matthew J Reed
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Regional Variation ◽  
Evidence Based ◽  
Failure Rates ◽  
Intravenous Cannula ◽  
Hospitalised Patients ◽  
The Uk ◽  
Evidence Based Guidelines

Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.

scholarly journals P113: Examining emergency physicians’ self-reported opioid prescribing practices for the treatment of acute pain: A Newfoundland perspective

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S106
Author(s):  
P. Doran ◽  
G. Sheppard ◽  
B. Metcalfe
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Oral Morphine ◽  
Prescribing Patterns ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Ensure Patient Safety ◽  
Evidence Based Guidelines

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.

Management of Bronchiolitis in the Emergency Department: Impact of Evidence-Based Guidelines?

PEDIATRICS ◽  
2013 ◽  
Vol 131 (Supplement 1) ◽  
pp. S103-S109 ◽  
Author(s):  
Lara W. Johnson ◽  
Janie Robles ◽  
Amanda Hudgins ◽  
Shea Osburn ◽  
Devona Martin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Evidence Based ◽  
Evidence Based Guidelines

Successful implementation of evidence‐based guidelines in a regional emergency department for children presenting with acute asthma

2019 ◽  
Vol 27 (6) ◽  
pp. 557-562
Author(s):  
Heinrich Weber ◽  
Gaylene Bassett ◽  
Doris Bartl ◽  
Mohd Mohd Yusof ◽  
Sukhwinder Sohal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Asthma ◽  
Successful Implementation ◽  
Evidence Based ◽  
Evidence Based Guidelines

Adult and Pediatric Mild and Moderate Head Injury Management in Scandinavian Countries

Neurotrauma ◽  
2018 ◽  
pp. 123-128
Author(s):  
Zandra Olivecrona ◽  
Johan Undén
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Head Injuries ◽  
Ct Scanning ◽  
Evidence Based ◽  
Initial Management ◽  
Injury Management ◽  
Neurosurgical Society ◽  
Evidence Based Guidelines ◽  
To Receive

The Scandinavian Neurotrauma Committee (SNC) was initiated by the Scandinavian Neurosurgical Society to improve the care of neurotrauma patients. The SNC has presented evidence-based guidelines for initial management of minimal, mild, and moderate head injuries. Separate guidelines are presented for children and adults. The biomarker S100β‎ is included in the adult guidelines in an attempt to reduce computed tomography (CT) usage and costs. The aim of the guidelines is to guide physicians in the emergency department during initial management of adult and pediatric patients with minimal, mild, and moderate head injuries, specifically to decide which patients are to receive CT scanning, admission, or discharge from the emergency department.

How oncologists adhere to evidence-based G-CSF-guidelines to prevent febrile neutropenia: A sample survey in hospitals and practices in Germany.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6591-6591 ◽  
Author(s):  
Hartmut Link ◽  
Josef Nietsch ◽  
Markus Kerkmann ◽  
Petra Angelika Ortner ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Sample Size ◽  
Malignant Lymphoma ◽  
Sample Survey ◽  
Evidence Based ◽  
Intermediate Risk ◽  
Evidence Based Guidelines

6591 Background: Primary G-CSF prophylaxis after chemotherapy is recommended in evidence based guidelines (GL), if the risk of febrile neutropenia (FN) is high (≥20%), or intermediate (≥ 10% - 20%) in case of risk factors. The aim was to evaluate, if G-CSF is used as proposed by GL, to identify determinants of GL implementation and adherence. Methods: The sample size was calculated at 2% of the incidence of malignant lymphoma, breast and lung cancer in Germany. Pts who had received 3-9 cycles of chemotherapy with a FN risk ≥10% between 5/2011 to 4/2012 were documented retrospectively. Results: 286 lymphoma, 666 lung cancer and 976 breast cancer pts were collected from 87 hospitals and 59 oncology practices with 195 physicians participating. Adherence to GL was higher in physicians up to 10 than over 10 years of experience. Conclusions: The adherence to and acceptance of GL for G-CSF may not be sufficient. Patient risk factors are underestimated therefore resulting in a possible underuse of G-CSF. Physicians may underestimate FN risk in pts who have an intermediate risk of FN and they overestimate their adherence to the GL. [Table: see text]

Necrosis of the leg after intraarterial drug injection

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 163-166 ◽  
Author(s):  
Betz ◽  
Steinbauer ◽  
Uhl ◽  
Toepel
Keyword(s):  
Emergency Department ◽  
Drug Abuse ◽  
Femoral Artery ◽  
Vascular System ◽  
Major Amputation ◽  
Current Evidence ◽  
Evidence Based ◽  
Drug Injection ◽  
Left Femoral Artery ◽  
Evidence Based Guidelines

Inadvertent intraarterial injections in the context of drug abuse can cause damage to the vascular system. The clinical picture depends on the drug properties and ranges from partial ischemia to necrosis of the affected extremity. There are no current evidence-based guidelines regarding the management of intraarterial drug injections. In many cases the concept of solving vasospasm after injection is based on the use of intraarterial application of prostaglandins. We report a case in which a mixture of drugs was injected into the left femoral artery. The patient arrived 24 hours later with ischemia of the left leg at our emergency department. Angiography showed that there was no blood flowing in the leg. Despite intraarterial application of vasodilatators, regional neurolysis and thrombolyis with urokinase major amputation was unavoidable. The outcome after inadvertent injection depends on certain drug properties and the delay between injection and the beginning of therapy.

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