A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

STUDY OBJECTIVE: In acute exacerbations of asthma in children, corticosteroids reduce relapses, subsequent hospital admission, and the need for ß2-agonist bronchodilators. Prednisolone is the most commonly used corticosteroid, but prolonged treatment course, vomiting, and a bitter taste may reduce patient compliance. Dexamethasone has a longer half-life and has been used safely in other acute pediatric conditions. We examine whether a single dose of oral dexamethasone is noninferior to prednisolone in the emergency department (ED) treatment of asthma exacerbations in children, as measured by the Pediatric Respiratory Assessment Measure (PRAM) at day 4. METHODS: We conducted a randomized, open-label, noninferiority trial comparing oral dexamethasone (single dose of 0.3 mg/kg) with prednisolone (1 mg/kg per day for 3 days) in patients aged 2 to 16 years and with a known diagnosis of asthma or at least 1 previous episode of ß2-agonist-responsive wheeze who presented to a tertiary pediatric ED. The primary outcome measure was the mean PRAM score (range of 0 to 12 points) performed on day 4. Secondary outcome measures included requirement for further steroids, vomiting of study medication, hospital admission, and unscheduled return visits to a health care practitioner within 14 days. RESULTS: There were 245 enrollments involving 226 patients. There was no difference in mean PRAM scores at day 4 between the dexamethasone and prednisolone groups (0.91 versus 0.91; absolute difference 0.005; 95% CI -0.35 to 0.34). Fourteen patients vomited at least 1 dose of prednisolone compared with no patients in the dexamethasone group. Sixteen children (13.1%) in the dexamethasone group received further systemic steroids within 14 days after trial enrollment compared with 5 (4.2%) in the prednisolone group (absolute difference 8.9%; 95% CI 1.9% to 16.0%). There was no significant difference between the groups in hospital admission rates or the number of unscheduled return visits to a health care practitioner. CONCLUSION: In children with acute exacerbations of asthma, a single dose of oral dexamethasone (0.3 mg/kg) is noninferior to a 3-day course of oral prednisolone (1 mg/kg per day) as measured by the mean PRAM score on day 4.

The impact of social media on a major international emergency medicine conference.

OBJECTIVE: To report on the presence and use of social media by speakers and attendees at the International Conference on Emergency Medicine (ICEM) 2012, and describe the increasing use of online technologies such as Twitter and podcasts in publicising conferences and sharing research findings, and for clinical teaching. METHODS: Speakers were identified through the organising committee and a database constructed using the internet to determine the presence and activity of speakers on social media platforms. We also examined the use of Twitter by attendees and non-attendees using an online archiving system. Researchers tracked and reviewed every tweet produced with the hashtag #ICEM2012. Tweets were then reviewed and classified by three separate authors into different categories. RESULTS: Of the 212 speakers at ICEM 2012, 41.5% had a LinkedIn account and 15.6% were on Twitter. Less than 1% were active on Google+ and less than 10% had an active website or blog. There were over 4500 tweets about ICEM 2012. Over 400 people produced tweets about the conference, yet only 34% were physically present at the conference. Of the original tweets produced, 74.4% were directly related to the clinical and research material of the conference. CONCLUSIONS: ICEM 2012 was the most tweeted emergency medicine conference on record. Tweeting by participants was common; a large number of original tweets regarding clinical material at the conference were produced. There was also a large virtual participation in the conference as multiple people not attending the conference discussed the material on Twitter.

Intermetatarsal angle after first metatarsophalangeal joint arthrodesis for hallux valgus.

BACKGROUND: First metatarsophalangeal (MTP) joint arthrodesis is commonly done for hallux valgus with an arthritic joint. In patients with a wide preoperative first intermetatarsal (IM) angle an important question is whether the metatarsus varus will be corrected by the first MTP joint fusion alone or whether an additional basal osteotomy is necessary. METHODS: The charts and radiographs of 20 patients who had arthrodesis of the first MTP joint were retrospectively reviewed. All 20 patients were female with a mean age of 54.2 (range 42 to 78) years. Either a Hallu-S plate (Integra Life Sciences, Nudeal, France) or two crossed screws were used to stabilize the arthrodesis. The IM angles were measured independently by two individuals on weightbearing preoperative, 6-week postoperative, and final followup films. The final followup radiographs were taken at an average of 13.7 (range 6 to 30) months after surgery. A Student t-test was used to evaluate the changes in the IM angle and interobserver variations. RESULTS: The mean preoperative IM angle was 16.65 (range 12 to 26) degrees. The mean postoperative IM angle was 10.35 (range 6 to 15) degrees. The mean IM angle at final followup was 8.67 (range 5 to 12) degrees. The mean change between preoperative IM angle and IM angle at final followup was 8.22 (range 4 to 14) degrees. This change of the IM angle was statistically significant (p < 0.0001). CONCLUSIONS: These results indicate that in patients with severe hallux valgus and first MTP joint degeneration arthrodesis can significantly correct the IM angle without the addition of a basal osteotomy.