Acupuncturist perceptions of serving as a clinical trial practitioner.

OBJECTIVE: This article describes the experience of four acupuncturists in terms of what it meant for them to be a practitioner in a recently completed sham-controlled acupuncture randomized control trial (RCT) with a standardized protocol. DESIGN: At the completion of the RCT for women with ovarian dysfunction, study acupuncturists (2 male MD/acupuncturists and 2 female professional acupuncturists) were queried about their perceptions of participating in the RCT using both written responses to 5 open-ended questions and a focus group interview. Data was analyzed to categorize responses and identify themes. SETTING: Virginia, USA. RESULTS: The acupuncturists' experience of participating in a RCT was generally very positive, including: usual practitioner/participant relationships, collegial sharing, and increased patient volume and diversity. There was angst expressed about the unknown RCT results. While there were concerns about standardizing the acupuncture session ("dilutes the power of acupuncture therapeutics"), the acupuncturists' were supportive of the pre-established protocol. The acupuncturists overall did not have concerns with a sham intervention arm because the sham recipients did not know their treatment arm and felt as satisfied with study participation as the true acupuncture recipients. CONCLUSIONS: Despite initial misgivings about both a standardized protocol and a sham arm, all practitioners discovered positive aspects of being a study acupuncturist. The analysis highlights the need for communication before, during and after a clinical trial between the study investigators and the intervention practitioners. As stake holders in the perception of CAM therapies with the public and with conventional medicine practitioners, it would benefit future research on CAM to similarly assess experiences of being a CAM study practitioner in order to enhance provider recruitment and reduce provider drop-out.

Aeromedical evacuation of rural victims of nontraumatic cardiac arrest.

STUDY OBJECTIVES: To determine if the deployment of a helicopter-borne nurse/paramedic team contributed to survival of victims of nontraumatic cardiac arrest in a rural setting. DESIGN: Retrospective chart review. SETTING: A university hospital-based helicopter aeromedical program serving a primarily rural region with a volunteer basic life support/advanced life support ground emergency medical services system. PARTICIPANTS: Victims of nontraumatic cardiac arrest, older than 15 years, in cardiac arrest at the time of request for air evacuation. MEASUREMENTS AND MAIN RESULTS: Eighty-four patients were identified who met the study inclusion criteria between January 1, 1986, and December 31, 1989. Basic life support care was always available before aeromedical crew arrival; advanced life support care was available in 58% of cases before helicopter arrival. Resuscitative efforts were terminated in the field in 55 cases; of 29 patients transported to the emergency department, only ten (12%) survived to hospital admission. Only one patient (1%) survived to hospital discharge; this patient was resuscitated by ground advanced life support providers before helicopter arrival. CONCLUSION: Despite providing improved availability of advanced life support care in some cases, deployment of aeromedical teams had a negligible effect on patient survival from nontraumatic cardiac arrest in a rural setting.

Effect of "standard order" deletion on emergency department coagulation profile use.

STUDY OBJECTIVES: To determine whether the test ordering of physicians working in a teaching hospital emergency department could be influenced by modification of automated laboratory order sets. DESIGN: Prospective, using data from the same ED before and after intervention. SETTING: A 58,000-visit public university hospital ED. TYPE OF PARTICIPANTS: Emergency physicians caring for adult patients admitted from the ED to the ward medical services. INTERVENTION: Beginning July 1, 1989, coagulation studies were deleted from the automated admission order sets used in the study hospital ED. MEASUREMENTS AND MAIN RESULTS: Patient charts were examined to assess the effect of coagulation study deletion on the frequency and appropriateness of coagulation test ordering. A tripling of the percentage of patients who did not receive coagulation parameter testing was noted (P less than .0001, chi 2). In no case were the tests omitted when a high-yield indication for their use was present. This resulted in an estimated reduction of $20,000 per year in patient charges. CONCLUSION: Modification of ED "standard orders" can result in reduction of laboratory use without an adverse effect on patient care.