ABSTRACT
The incidence of cancer continues to rise, with an estimated 1 in 2 of the UK population born after 1960 diagnosed with malignancy at some point during their lifetime. This is in the context of an ageing population with increasing multimorbidity and polypharmacy. Cancer patients are frequent users of emergency care services and have a high rate of ambulance conveyance and hospital admission after review in emergency departments. Presentations can be a consequence of the cancer, its treatment or coexistent morbidity. Given the expanding armamentarium of cancer therapies, acute and general physicians are faced with a myriad of complex issues and require a knowledge of the broad principles of initial assessment, initial management and timely access to the wider multi-professional cancer team. © 2022
ABSTRACT
Background: The Covid-19 pandemic has brought new challenges to the health systems of Latin America. However, the institutions and mechanisms created by the Social State of Law were unable to confront these new risks. As a result of that, populist governments have used this crisis as an opportunity to deepen the high levels of inequalities through the appropriation of power, wealth and social welfare. Courts have also reacted in order to guarantee the right to health;however, many challenges remain. Objective: To examine the challenges and opportunities of the judicial protection of the right to health in the context of Covid-19 and Populism in Brazil. Methodology: Qualitative, descriptive and exploratory. Documentary research was carried out by reviewing databases such as Scholar, PubMed, and Scopus. Indexed articles, jurisprudence, legislation, and literature were also reviewed. Additional publications were also identified through other sources. Results: There is an inversely proportional relationship between the intensity of the crisis and the level of judicial activism on the part of the Courts. Therefore, the more the scale and intensity of the crisis generated by populist governments in the context of pandemics, uncertainty, and inequality the more reflexive, and strategic courts should be and the more protection, defense and monitoring should be promoted in order to ensure the fulfilment of the right to the highest attainable level of health especially of the most vulnerable. On the other hand, the more compliance through the availability of health goods and services, and the more availability of health workers with better salaries, social security and working conditions the more resilient the State will be to face emergencies, which at the same time will promote fewer restrictions on fundamental rights. Conclusions: Courts play a special role in protecting the right to health, especially in the context of emergencies and crises. States must adopt measures by using the maximum available resources in order to protect the right to the highest attainable standard of health.
ABSTRACT
Rationale: Tixagevimab-cilgavimab is a combination of two monoclonal antibodies against SARS-CoV-2. In December 2021, the FDA issued emergency use authorization for intramuscular injection of tixagevimab-cilgavimab for prophylaxis against SARS-CoV-2 in immunocompromised patients. Shortly thereafter, our clinic distributed tixagevimab-cilgavimab to patients with Common Variable Immunodeficiency (CVID). To our knowledge, no prior study has looked at effects of this monoclonal antibody combination on CVID patients. Methods: 47 patients with CVID were offered tixagevimab-cilgavimab. 23 chose to receive prophylaxis. Comparative outcomes of treatment and non-treatment groups examined: occurrence of SARS-CoV-2 infection, severity of SARS-CoV-2 infection, and other non-SARS-CoV-2 infections. Results: 70% were female;mean age 49. 23 patients received tixagevimab-cilgavimab and 24 did not receive prophylaxis. In the tixagevimab-cilgavimab group, all were vaccinated for SARS-CoV-2 and 22 were receiving immunoglobulin replacement. In the cohort that did not receive prophylaxis, 21 were vaccinated, and all received immunoglobulin replacement. In the prophylaxis group one patient was infected with SARS-CoV-2, no patients required emergency care, and 7 patients had non- SARS-CoV-2 infection. In the group that did not receive prophylaxis 2 patients tested positive for SARS-CoV-2, one patient required emergency care due to SARS-CoV-2 disease severity, and four patients had a non-SARS-CoV-2 infection. None of the results showed statistical significance. Conclusions: Although there is preliminary evidence that tixagevimab-cilgavimab can be protective against SARS-CoV-2 in immunocompromised individuals, our data suggests that this benefit may be blunted in CVID patients on immunoglobulin replacement. The additional benefit of tixagevimab-cilgavimab in immunocompromised patients already receiving replacement therapy requires further exploration.
ABSTRACT
Editor's note: Last week in Mental Health Weekly's Annual 2023 Preview Issue, we featured some of your responses to the most pressing challenges and new opportunities that await you in the new year. Here are more of your responses. Thanks to all who submitted comments.
ABSTRACT
The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.
ABSTRACT
Background: The University of Kentucky HealthCare Anticoagulation Clinic at the Gill Heart and Vascular Institute in Lexington, Kentucky, designed and implemented a drive-up clinic for warfarin management with the goal to minimize person-to-person exposure during the coronavirus disease 2019 (COVID-19) pandemic. Objective: The purpose of this study was to evaluate the effect on warfarin management in a pharmacist-led anticoagulation service when transitioned from an in-person clinic to a drive-up clinic during the COVID-19 pandemic. Methods: This is a retrospective observational cohort study of 68 patients seen in the University of Kentucky HealthCare Anticoagulation Clinic on warfarin therapy for any indication. Patients were included if they had scheduled visits at least 3 times in the period 6 months before, during, and after the initiation of the drive-up clinic. The primary outcome is the difference in time in therapeutic range (TTR) before and during the drive-up clinic. Results: The difference between the mean TTR in period 1 (69.1% ± 23.2%) and period 2 (69.6% ± 19.2%) was not statistically significant (P = 0.882). The mean TTR in period 3 (70.5% ± 20.8%) did not differ in statistical significance from either period 1 (P = 0.688) or period 2 (P = 0.746). Safety outcomes including reported bleeding events and emergency department visits or hospital admissions for bleeding or thrombotic events were consistently low across each period. Conclusion: The results of this study illustrate that a drive-up clinic for warfarin management may be a reasonable alternative approach to providing care for outpatient anticoagulant management and may support nontraditional clinic models for long-term management of anticoagulation and other chronic disease states.
ABSTRACT
OBJECTIVES: Following rapid uptake of telehealth during the COVID-19 pandemic, we examined barriers and facilitators for sustainability and spread of telemental health video (TMH-V) as policies regarding precautions from the pandemic waned. METHODS: We conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. We asked four groups, local clinicians, facility leadership, Veterans, and external partners, about barriers and facilitators impacting patient willingness to engage in TMH-V (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). Interviews were recorded, transcribed, and analyzed using framework analysis. We also observed TMH-V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology. RESULTS: We conducted 35 interviews with ED/UC clinicians and staff (n = 10), clinical and facility leadership (n = 7), Veterans (n = 5), and external partners (n = 13), January-May 2022. We completed 10 observations. All interviewees were satisfied with the TMH-V program, and interviewees highlighted increased comfort discussing difficult topics for Veterans (reach). Clinicians identified that TMH-V allowed for cross-coverage across sites as well as increased safety and flexibility for clinicians (adoption). Opportunities for improvement include alleviating technological burdens for on-site staff, electronic health record (EHR) modifications to accurately capture workload and modality (telehealth vs. in-person), and standardizing protocols to streamline communication between on-site and remote clinical staff (implementation). Finally, interviewees encouraged its spread (maintenance) and thought there was great potential for service expansion. CONCLUSIONS: Interviewees expressed support for continuing TMH-V locally and spread to other sites. Ensuring adequate infrastructure (e.g., EHR integration and technology support) and workforce capacity are key for successful spread. Given the shortage of mental health (MH) clinicians in rural settings, TMH-V represents a promising intervention to increase the access to high-quality emergency MH care.
ABSTRACT
Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.
ABSTRACT
Editor's note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an from each publication.
ABSTRACT
The COVID-19 pandemic has reinforced Australia's need for diagnostic testing frameworks that are well-prepared, well-resourced, responsive, appropriately governed, scalable, interdisciplinary and collaborative.1 Point-of-care (POC) technologies offer diagnostic solutions capable of delivering individual, community and public health benefits in settings where: a) laboratory testing is not available, b) rapid turn-around time is needed, c) high loss to follow-up occurs in high-risk populations with standard of care cascades and/or d) disease transmission rates exceed laboratory response capacity. Key translational research derived from collaborative point-of-care testing networks for a) diabetes management (238 remote health services;3,233 operators;172,069 HbA1c and 51,379 urine albumin:creatinine ratio tests), b) acute care (106 remote health services;2,279 operators;32,950 blood gas, 32,689 cardiac troponin, 46,418 urea/electrolytes, 48,193 international normalised ratio tests), c) hepatitis C virus (HCV) (41 sites;110 operators;5,733 HCV tests;4,978 RNA, 755 antibody), d) syphilis screening (156 sites;1,412 operators), e) chlamydia, gonorrhea or trichomonas (51 sites;795 operators;>50,000 tests) or f) COVID-19 (101 remote health services, 733 operators, 72,624 tests) will be used to highlight operational, clinical, public health, and economic benefits of POC testing. Challenges associated with scale-up and accreditation pathways for decentralised POC testing will be discussed. Reference 1. Revised Testing Framework for COVID-19 in Australia, March 2022 Version 2.1. Communicable Disease Network Australia and Public Health Laboratory Network. Copyright © 2022
ABSTRACT
Introduction: The management of the obstetric patient is a matter of great importance, since it is necessary to guarantee the termination of the pregnancy with satisfactory results for the mother and the child, thus avoiding possible maternal or infant deaths. The general objective of our study was to describe obstetric morbidity and mortality in the emergency department of the Ambato Regional Teaching Hospital during the peak of the COVID-19 pandemic. Methodology: Hospital emergency care records were studied in the period January-September 2020, through an observational, retrospective, descriptive study. In this work, emphasis is placed on the obstetric patient in the period during pregnancy and around childbirth, including the immediate puerperium. Results and Conclusion(s): it was evidenced that in the emergency service of the Ambato Regional Teaching Hospital of a total of 1082 patients treated in the emergency room, 92 of these corre-sponded to obstetric patients. The highest morbidity corre-sponded to eutocic deliveries with 39 patients. In the emergency department, 126 Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests were performed, 92 of them on all the obstetric patients seen in the emergency department, resulting in the virus being identified in 46 patients. The most affected age group in COVID patients was 18 to 33 years old, with overall age of 27 years. COVID morbidity predominated in obstetric patients, in the third trimester of pregnancy, 11 of them with fetal distress. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
ABSTRACT
Introduction: The new coronavirus COVID-19 is a high-risk disease due to its high rate of infection, which makes us aware of its seriousness and the fact that we will have to live with it for a long time. To propose guidelines based on research and analysis of scientific publications and the requirements of professionals, against the risk of contagion by COVID-19. Method(s): We applied qualitative study the technique used was a survey with a 10-question question-naire, applied to 16 professionals graduated from dentistry. Result(s): To obtain the results, we evaluated aspects relat-ed to the cessation of activities during quarantine, the lack of dental biosafety supplies, knowledge about protocols and biosafety barriers against COVID-19, emergency care during quarantine and return to clinical activity, as well as the practice of testing both patients and professionals before dental care before returning to work. Conclusion(s): The lack of ac-curate and timely information reveals the clear deficiencies of the National Public Health System, which has led to a lack of knowledge about biosecurity measures that are currently crucial to halt the spread of the new coronavirus and increase knowledge about the risk of infection. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
ABSTRACT
AIM: To illuminate the meaning of newly graduated registered nurses' experiences of caring for patients in emergency departments during the COVID-19 pandemic. DESIGN: A phenomenological hermeneutical study guided by Lindseth and Norberg. METHODS: In-depth one-on-one interviews with 14 nurses from five hospitals were conducted from March to November 2020 and analysed using thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) were used as the reporting guideline. RESULTS: The findings comprise one main theme Caring through barriers and three themes with sub-themes. In the first theme, having intention to care, participants revealed their dedication to care for patients during the pandemic despite extensive stress, little experience and skills. The second theme, with tied hands in human suffering, illuminates experiences of being disconnected from the patient, overwhelmed by responsibility and unable to relieve suffering. The third theme, feeling inadequate, reveals experiences of lack of support and doubts meaning less space to develop into the nurse one wants to be. CONCLUSION: Findings reveal a new understanding of new nurses' experiences during times of crisis. The essence of caring in the emergency department during the pandemic can be explained as mediated through spatial, temporal and emotional barriers preventing new nurses from providing holistic care. IMPACT: The results may be used as anticipatory guidance for new nurses and inform targeted support interventions to support new nurses entering the profession in crisis conditions. PUBLIC CONTRIBUTION: This study involved new nurses in semi-structured interviews.
ABSTRACT
Background: Triage implementation in resource-limited emergency departments (EDs) has traditionally relied on intensive in-person training. This study sought to evaluate the impact of a novel digital-based learning strategy focused on the Interagency Integrated Triage Tool, a three-tier triage instrument recommended by the World Health Organization. Methods: A mixed methods study utilising pre-post intervention methods was conducted in two EDs in Papua New Guinea. The primary outcome was the mean change in knowledge before and after completion of a voluntary, multimodal training program, primarily delivered through a digital learning platform accessible via smartphone. Secondary outcomes included the change in confidence to perform selected clinical tasks, and acceptability of the learning methods. Findings: Among 136 eligible ED staff, 91 (66.9%) completed the digital learning program. The mean knowledge score on the post-training exam was 87.5% (SD 10.4), a mean increase of 12.9% (95% CI 10.7-15.1%, p < 0.0001) from the pre-training exam. There were statistically significant improvements in confidence for 13 of 15 clinical tasks, including undertaking a triage assessment and identifying an unwell patient.In an evaluation survey, 100% of 30 respondents agreed or strongly agreed the online learning platform was easy to access, use and navigate, and that the digital teaching methods were appropriate for their learning needs. In qualitative feedback, respondents reported that limited internet access and a lack of dedicated training time were barriers to participation. Interpretation: The use of digital learning to support triage implementation in resource-limited EDs is feasible and effective when accompanied by in-person mentoring. Adequate internet access is an essential pre-requisite. Funding: Development of the Kumul Helt Skul learning platform was undertaken as part of the Clinical Support Program (Phase II), facilitated by Johnstaff International Development on behalf of the Australian Government Department of Foreign Affairs and Trade through the PNG-Australia Partnership. RM is supported by a National Health and Medical Research Council Postgraduate Scholarship and a Monash Graduate Excellence Scholarship, while PC is supported by a Medical Research Future Fund Practitioner Fellowship. Funders had no role in study design, results analysis or manuscript preparation.
ABSTRACT
PURPOSE/HYPOTHESIS: Patients with cardiorespiratory dysfunction, such as COPD, have postural instability and increased risk of falls compared to age matched controls. Given that COVID-19 is defined as a respiratory condition, it could be presumed that these patients may demonstrate the same balance deficits. Ninety percent of patients with a history of COVID-19 report at least one neurological symptom, and these neurological symptoms could potentially result in alterations in balance. The act of maintaining upright posture or balance depends on both sensory and motor responses. It has been previously demonstrated that people post-COVID have motor and sensory balance deficits including vestibular dysfunction after leaving the acute care institution. The purpose of this study was to determine and characterize balance in patients COVID recovered (off airborne isolation but not discharged from the hospital). NUMBER OF SUBJECTS: Twenty-five subjects were recruited. Mean age was 55.6 +/- 11.3 years, 17 males, 8 females, mean length of time since diagnosed with COVID-19 was 34 +/- 15 days. All subjects had a primary or secondary diagnosis of COVID-19 during hospitalization and were considered COVID recovered (off-airborne isolation but not discharged from the hospital) and were receiving care in an acute inpatient hospital. MATERIALS AND METHODS: Following consent, subjects completed the Activityspecific Balance Confidence Scale (ABC), a questionnaire about symptoms of dizziness, the Timed Up&Go (TUG) and the modified Clinical Test of Sensory Interaction and Balance (mCTSIB). Subjects had vital signs monitored before, during, and after the examination. RESULT(S): There were no differences in clinical test scores based on age (<65 or >=65) or order of testing. Using age appropriate normative scores, all subjects had abnormal scores on the TUG indicating difficulty with motor balance, 88% had abnormal scores on the ABC indicating low confidence in performing balance activities, and 48% of the subjects had abnormal scores on Condition 4 of the mCTSIB indicating difficulty using vestibular information for balance. There was no correlation between the clinical test scores and age, length of time with COVID-19, or O2changes during testing. Surprisingly, there was no correlation between the scores on the clinical balance tests. CONCLUSION(S): Both young and older adults present with motor and sensory balance deficits acutely following a COVID-19 infection. Subjects have low perceptions of their ability to balance that may impact their function as they are discharged. CLINICAL RELEVANCE: People acutely post-COVID-19 may have balance deficits. These deficits may be due to immobility and deconditioning. It is recommended that people acutely post COVID-19 receive education and interventions to increase mobility, improve balance, and specifically receive activities that stimulate the vestibular system. It is also recommended that people acutely post-COVID-19 have these balance deficits and perceptions of balance function be considered in discharge planning.
ABSTRACT
BACKGROUND AND PURPOSE: Individuals who contract severe COVID-19 are likely to have pulmonary function impairment and in some severe instances develop irreversible lung injury. In certain cases, a lung transplantation can be a life-saving treatment option. Typically, individuals who receive a lung transplant discharge to the community from the acute care hospital. In some cases where functional mobility concerns persist, such as poor endurance and decreased exercise capacity, patients discharge to the acute rehabilitation setting as a bridge to the community. There is a paucity of background information on treatment of individuals with lung transplantation in the acute rehabilitation setting and even less information on lung transplantation status-post COVID-19 diagnosis. The purpose of this case series is to highlight unique concerns of this specific population in the acute rehabilitation setting. CASE DESCRIPTION: Nine patients (Males 5 8, Females 5 1) who received a bilateral lung transplant status-post severe COVID-19 illness were admitted to the acute rehabilitation unit between 2021 to 2022. Average age was 48 years old (SD=10). Patients were noted to have prolonged acute care stays due to various complications prior to transition to acute rehabilitation. Each patient was treated by a multidisciplinary team over the duration of their stay and received a total of 3 hours of therapy per day 5 days per week. All patients were independent with their functional mobility prior to COVID-19 illness. OUTCOME(S): The average length of stay for these patients was 19 days (SD =9) in the acute rehabilitation setting. Patients showed statistically significant changes in functional outcomes as measured by Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) scores of Sit to Stand, Chair/Bed-to-Chair Transfer, Walk 10 ft, Walk 50 ft with 2 turns, and Walk 150 ft from initial evaluation to discharge. Patients also demonstrated statistically significant improvements in gait speed as measured by the 10 Meter Walk Test (10MWT). Seven out of the 9 patients were recommended to have supervision and/or caregiver assist post-discharge. No patients required supplemental oxygen upon discharge. All patients were recommended home health services after discharge due to their immunocompromised status and ongoing COVID-19 pandemic. DISCUSSION: This case series highlights that individuals who received a bilateral lung transplant status-post COVID-19 illness and required additional hospitalization at the acute rehabilitation level have unique mobility concerns. After the acute rehabilitation stay, patients were able to demonstrate notable improvements in functional mobility with intensive therapy. However, patients required a prolonged length of stay and had increased caregiver burden upon discharge. Future research may involve case-matched controls to compare individuals status-post lung transplantation due to a chronic premorbid condition versus individuals status-post lung transplantation due to an acute COVID-19 diagnosis.
ABSTRACT
PURPOSE/HYPOTHESIS: The COVID-19 pandemic has taken a toll on the psychological resilience of healthcare workers across the world but has also had a significant impact on healthcare professionals in training. The pandemic has required educators to adapt how they teach but also to take into consideration innovative learning activities to increase students' resiliency. The purpose of this study was to assess the impact of high-fidelity human simulation (HFHS) sessions on acute care confidence in a critical care setting in physical therapy students' who rate their resiliency at low levels. NUMBER OF SUBJECTS: Eighty-one DPT students. MATERIALS AND METHODS: One week prior to the HFHS sessions each subject completed the Acute Care Confidence Survey (ACCS) and the Brief Resiliency Scale (BRS). All subjects participated in 2 HFHS sessions in a 3-member team and were given objectives and a case history 1 week prior to each HFHS experience. The HFHS used the Laerdal's SimMan 3G manikin equipped with an oxygen delivery system, lines and tubes and a monitor displaying vitals. The format for each simulation lab included a 15-minute pre-brief session, a 20-minute SimMan encounter and an immediate 15-minute debrief session. Following the completion of the HFHS learning experience each student completed a second ACCS. RESULT(S): A Kruskal-Wallis test was used to compare confidence score across low, normal, and high resilience groups. Low and normal resiliency level students had significantly lower confidence in manual skills prior to simulation (P< 05) compared to their high resiliency counterparts. Following simulation, all resiliency groups demonstrated confidence improvement that resulted in no significant differences between the groups. A Wilcoxon Signed Ranks Test revealed significant improvement in all confidence scores for each group following simulation. CONCLUSION(S): Resiliency levels did not impact students' ability to gain confidence from simulation training. HFHS when graded has been shown to increase stress and decrease confidence in students. These HFHS learning activity exposures were not graded which may have allowed those students with lower resiliency to learn in a less stressful environment and still develop confidence. A positive change in student confidence may be more related to a graded exposure to an acute care setting that allows skill development in a low stress environment. CLINICAL RELEVANCE: The simulation sessions increased student confidence by providing a realistic clinical environment and expectations, with confidence being less impacted by a student's resiliency. This low stake learning environment provided a valuable opportunity for students to improve clinical confidence regardless of their self-rated resiliency level.
ABSTRACT
BACKGROUND: Patients presenting to emergency departments (EDs) after a nonfatal opioid-involved overdose are at high risk for future overdose and death. Responding to this risk, the New York City (NYC) Department of Health and Mental Hygiene operates the Relay initiative, which dispatches trained peer "Wellness Advocates" to meet patients in the ED after a suspected opioid-involved overdose and follow them for up to 90 days to provide support, education, referrals to treatment, and other resources using a harm reduction framework. METHODS: In this article, we describe the protocol for a multisite randomized controlled trial of Relay. Study participants are recruited from four NYC EDs and are randomized to receive the Relay intervention or site-directed care (the control arm). Outcomes are assessed through survey questionnaires conducted at 1-, 3-, and 6-months after the baseline visit, as well as through administrative health data. The primary outcome is the number of opioid-related adverse events, including any opioid-involved overdose or any other substance use-related ED visit, in the 12 months post-baseline. Secondary and exploratory outcomes will also be analyzed, as well as hypothesized mediators and moderators of Relay program effectiveness. CONCLUSION: We present the protocol for a multisite randomized controlled trial of a peer-delivered OD prevention intervention in EDs. We describe how the study was designed to minimize disruption to routine ED operations, and how the study was implemented and adapted during the COVID-19 pandemic. This trial is registered with ClinicalTrials.gov [NCT04317053].
Subject(s)
COVID-19 , Drug Overdose , Opiate Overdose , Opioid-Related Disorders , Humans , Analgesics, Opioid/therapeutic use , Drug Overdose/prevention & control , Emergency Service, Hospital , Opiate Overdose/drug therapy , Opioid-Related Disorders/drug therapy , Pandemics , Randomized Controlled Trials as Topic , Multicenter Studies as TopicABSTRACT
Objective: This study compared the aerosol-generating and non-aerosol-generating endodontic emergency procedures' success and assessed the outcome of endodontic treatments initiated before a pandemic but could not be completed in the targeted time. Material(s) and Method(s): Emergency treatments were performed according to symptoms of teeth. Treatment success or failure was determined according to patients whether not re-referral with untimely pain. Short-term outcome and complications arising from teeth, which endodontic treatments were prolonged were also recorded. A chi-square test was used in the statistical analysis, and p<0.05 was considered significant. Result(s): The aerosol-generating procedure group's success rate was 86.2%, while it was 70.0% in the non-aerosol generating procedure group (p=0.050). The short-term survival rate of teeth was 83.7% in patients whose endodontic treatment had been prolonged. Conclusion(s): Considering the pros and cons, each emergency patient should be evaluated case-by-case. Copyright ©Meandros Medical and Dental Journal, Published by Galenos Publishing House.