Is positive communication sufficient to modulate procedural pain and anxiety in the emergency room? A randomized controlled trial.

Research suggests that therapeutic communication could enhance patient comfort during medical procedures. Few studies have been conducted in clinical settings, with adequate blinding. Our hypothesis was that a positive message could lead to analgesia and anxiolysis, and that this effect would be enhanced by an empathetic interaction with the nurse performing the procedure, compared to an audio-taped message. This study aimed to modulate the contents and delivery vector of a message regarding peripheral intravenous catheter (PIC) placement in the emergency room (ER). This study was a 2 + 2 randomized controlled trial registered on clinicaltrials.gov (NCT03502655). A positive versus standard message was delivered through audio tape (double blind) in the first phase (N = 131) and through the nurse placing the catheter (single blind) in the second phase (N = 120). By design, low practitioner empathic behavior was observed in the first phase (median 1 out of 5 points). In the second phase, higher empathic behavior was observed in the positive than in the standard message (median 2 vs. 3, p < 0.001). Contrary to our hypothesis, the intervention did not affect pain nor anxiety reports due to PIC placement in either phase (all p values>0.2). The positive communication intervention did not impact pain nor anxiety reports following PIC. There might have been a floor effect, with low PIC pain ratings in a context of moderate pain due to the presenting condition. Hence, such a therapeutic communication intervention might not be sufficient to modulate a mild procedural pain in the ER

Lung Ultrasonography for Risk Stratification in Patients with Coronavirus Disease 2019 (COVID-19): A Prospective Observational Cohort Study.

Lung ultrasonography (LUS) is a promising pragmatic risk-stratification tool in coronavirus disease 2019 (COVID-19). This study describes and compares LUS characteristics between patients with different clinical outcomes. Prospective observational study of polymerase chain reaction-confirmed adults with COVID-19 with symptoms of lower respiratory tract infection in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (≤24 hours of ED presentation) between patient groups based on their 7-day outcome (1) outpatients, (2) hospitalized, and (3) intubated/dead. Normalized LUS score was used to discriminate between groups. Between 6 March and 3 April 2020, we included 80 patients (17 outpatients, 42 hospitalized, and 21 intubated/dead). Seventy-three patients (91%) had abnormal LUS (70% outpatients, 95% hospitalized, and 100% intubated/dead; P = .003). The proportion of involved zones was lower in outpatients compared with other groups (median [IQR], 30% [0-40%], 44% [31-70%], 70% [50-88%]; P < .001). Predominant abnormal patterns were bilateral and there was multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%), and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of .80 (95% CI, .68-.92). Systematic LUS has potential as a reliable, cheap, and easy-to-use triage tool for the early risk stratification in patients with COVID-19 presenting to EDs