ABSTRACT
OBJECTIVES: This study was used to test the effect on planned safe use of over-the-counter (OTC) analgesics of adding information about the potential for nonsteroidal anti-inflammatory drug (NSAID) interaction with antihypertensive medications, the potential for interaction of alcohol and acetaminophen, and NSAID ceiling effects to the Federal Drug Administration's (FDA's) OTC analgesics pamphlet. DESIGN: A randomized posttest-only double-blind experimental design was used to test an intervention with a comparison group reading the FDA pamphlet, and treatment group reading the pamphlet with added information. SAMPLE: Participants included 137 adults. INTERVENTION: Participants read the treatment or the comparison pamphlet. RESULTS: Both groups responded with similar planned use of OTC analgesics. The majority were likely to read the label before taking an OTC analgesic, but were unlikely to give acetaminophen to a family member using antihypertensive medication. CONCLUSIONS: Reading additional information about OTC analgesics resulted in no greater intention to safely use analgesics. Responses indicated reluctance to use OTC analgesics, and the potential need for increased health teaching regarding use of OTC analgesics with antihypertensive medication. Public health teaching should include the importance of treating pain and selecting the safest OTC analgesics for the clinical situation.
Subject(s)
Analgesics/adverse effects , Nonprescription Drugs/adverse effects , Pamphlets , Patient Education as Topic/methods , Safety Management , Self Medication , Acetaminophen/adverse effects , Adult , Alcohol Drinking/adverse effects , Analysis of Variance , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Antihypertensive Agents/adverse effects , Attitude to Health , Chi-Square Distribution , Comprehension , Double-Blind Method , Drug Interactions , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Safety Management/methods , Self Medication/adverse effects , Self Medication/methods , Self Medication/psychology , Surveys and Questionnaires , United States , United States Food and Drug AdministrationABSTRACT
Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset. However, the American College of Cardiology/American Heart Association guideline for percutaneous coronary intervention door-to-balloon time (<90 minutes) in patients with STEMI is a infrequently accomplished goal. This study enrolled 277 patients with STEMI who were self-transported or transported by emergency medical services to NorthEast Medical Center for primary percutaneous coronary intervention. This study tested the hypothesis that prehospital wireless transmission of an electrocardiogram to a cardiologist's hand-held device results in shorter emergency department door-to-reperfusion time. A comparison was made between patients whose electrocardiogram was successfully transmitted during the intervention phase with (1) patients transported by the emergency medical services in the preintervention, (2) patients self-transported in the intervention phase, and (3) patients whose wireless transmission failed in the intervention phase. During the preintervention phase (2001 to 2003), 48 patients were enrolled. During the intervention phase (2003 to 2005), the following patients were enrolled: 101 self-transported patients, 24 patients with successful electrocardiographic transmission, and 19 patients for whom transmission failed. The median door-to-reperfusion time for patients with successful electrocardiographic transmission was 50 minutes, which was significantly shorter than a preintervention time of 101 minutes (p <0.0001), an intervention phase self-transport time of 96 minutes (p <0.0001), and a failed transmission time of 78 minutes (p <0.0001). In conclusion, prehospital wireless electrocardiographic transmission to a cardiologist's hand-held device significantly decreased emergency department door-to-reperfusion time, thus achieving the American College of Cardiology/American Heart Association guideline for patients with STEMI.
Subject(s)
Cardiology , Computers, Handheld , Electrocardiography , Emergency Medical Service Communication Systems , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Aged , Angioplasty, Balloon, Coronary , Artificial Intelligence , Coronary Stenosis/diagnosis , Coronary Stenosis/therapy , Endpoint Determination , Equipment Design , Female , Humans , Male , Middle Aged , Myocardial Reperfusion , North Carolina , Pilot Projects , Prospective Studies , Signal Processing, Computer-Assisted , Time Factors , Transportation of Patients , Treatment OutcomeABSTRACT
BACKGROUND: Use of intravenous fibrinolytic agents and percutaneous coronary interventions produce the greatest benefit when they are implemented in the first 2 hours after symptom onset. Further delays in the time to treatment typically lead to reduced benefits and poorer outcomes. METHODS: Cabarrus County Emergency Medical Service personnel complete an acute myocardial infarction case report form and assess a 12-lead electrocardiogram (ECG) to determine if ST elevation of at least 1 mV in at least 2 contiguous leads is present and then to transmit the ECG wirelessly to the emergency department (ED). The ECG is then forwarded wirelessly from the ED to the on-call cardiologist who is carrying the IPAQ handheld computer. RESULTS: Five representative patients managed using this system during the initial year of its implementation are presented. CONCLUSION: The examples included in this article illustrate that the system and technology can work if applied in a coordinated fashion using multiple disciplines including emergency medical service, cardiologists, ED personnel, and the hospital cardiac care team, which includes the catheterization laboratory call team, acute coronary care nurses, and clerical support staff.
