Biomedical subjects

J V Weigand

Publications and source records attributed to J V Weigand.

4 recordsLinked to original sources

PubMed2001

Preventive care in the emergency department: should emergency departments institute a falls prevention program for elder patients? A systematic review.

OBJECTIVE: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. METHODS: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. RESULTS: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. CONCLUSIONS: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.

Accidental Falls↗

PubMed2001

Intranasal lidocaine for the treatment of migraine headache: a randomized, controlled trial.

OBJECTIVE: To evaluate the effect of intranasal lidocaine for immediate relief (5 minutes) of migraine headache pain. METHODS: A randomized, double-blind, placebo-controlled clinical trial at two university-affiliated community teaching hospitals enrolled patients 18-50 years old with migraine headache as defined by the International Headache Society. Patients who were pregnant, lactating, known to abuse alcohol or drugs, or allergic to one of the study drugs, those who used analgesics within two hours, or those with a first headache were excluded. Statistical significance was assessed by using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables. Patients rated their pain on a 10-centimeter visual analog scale (VAS) prior to drug administration and at 5, 10, 15, 20, and 30 minutes after the initial dose. Medication was either 1 mL of 4% lidocaine or normal saline (placebo) intranasally in split doses 2 minutes apart and intravenous prochlorperazine. Medications were packaged so physicians and patients were unaware of the contents. Successful pain relief was achieved if there was a 50% reduction in pain score or a score below 2.5 cm on the VAS. RESULTS: Twenty-seven patients received lidocaine and 22 placebo. No significant difference was observed between groups in initial pain scores, 8.4 (95% CI = 7.8 to 9.0) lidocaine and 8.6 (95% CI = 8.0 to 9.2) placebo (p = 0.75). Two of 27 patients (7.4%, 95% CI = 0.8, 24.3) in the lidocaine group and three of 22 patients (13.6%, 95% CI = 2.8 to 34.9) in the placebo group had immediate successful pain relief (p = 0.47), with average pain scores of 6.9 (95% CI = 5.9 to 7.8) and 7.0 (95% CI = 5.8 to 8.2), respectively. No difference in pain relief was detected at subsequent measurements. CONCLUSION: There was no evidence that intranasal lidocaine provided rapid relief for migraine headache pain in the emergency department setting.

Administration, Intranasal↗

PubMed1990

Quality assurance in emergency medical service systems.

EMS quality assurance programs can help guarantee that the provision of prehospital care is medically accountable. The establishment and management of such a program, although time consuming, are critically important. It is essential that the medical director or a designee responsible for quality assurance activities be allotted the necessary time to carry them out properly. Incident reports, critique sessions, audits, education (training) sessions, observation or debriefing in the emergency department, as well as on-line medical control all play a role in inputting data into the system. The quality assurance program forms a continuous action loop starting and ending with protocols and education. Documentation of variance or compliance with protocols forms the basis for analysis of the quality of care delivered. Any intervention must be based on carefully documented information and should include praise for good work, as well as education when needed, and restriction of function when necessary.

Emergency Medical Services↗

PubMed1986

A pediatric curriculum for emergency medicine training programs.

Surveys of current training show that many areas of pediatric emergency medicine are not taught in emergency medicine residencies. Furthermore, published recommendations for minimum pediatric core content in emergency medicine are scant and conflicting. To address this issue we have compiled from a variety of sources a detailed pediatric emergencies curriculum for emergency residency training. This curriculum is complete, and yet may be carried out with currently available resources.

Curriculum↗