20 research outputs found
Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department
Objective Test if therapy dogs reduce anxiety in emergency department (ED) patients. Methods In this controlled clinical trial (NCT03471429), medically stable, adult patients were approached if the physician believed that the patient had âmoderate or greater anxiety.â Patients were allocated on a 1:1 ratio to either 15 min exposure to a certified therapy dog and handler (dog), or usual care (control). Patient reported anxiety, pain and depression were assessed using a 0â10 scale (10 = worst). Primary outcome was change in anxiety from baseline (T0) to 30 min and 90 min after exposure to dog or control (T1 and T2 respectively); secondary outcomes were pain, depression and frequency of pain medication. Results Among 93 patients willing to participate in research, 7 had aversions to dogs, leaving 86 (92%) were willing to see a dog six others met exclusion criteria, leaving 40 patients allocated to each group (dog or control). Median and mean baseline anxiety, pain and depression scores were similar between groups. With dog exposure, median anxiety decreased significantly from T0 to T1: 6 (IQR 4â9.75) to T1: 2 (0â6) compared with 6 (4â8) to 6 (2.5â8) in controls (P<0.001, for T1, Mann-Whitney U and unpaired t-test). Dog exposure was associated with significantly lower anxiety at T2 and a significant overall treatment effect on two-way repeated measures ANOVA for anxiety, pain and depression. After exposure, 1/40 in the dog group needed pain medication, versus 7/40 in controls (P = 0.056, Fisherâs exact test). Conclusions Exposure to therapy dogs plus handlers significantly reduced anxiety in ED patients
Multicenter registry of United States emergency department patients tested for SARS-CoV-2
This paper summarizes the methodology for the registry of suspected COVIDâ19 in emergency care (RECOVER), a large clinical registry of patients from 155 United States (US) emergency departments (EDs) in 27 states tested for SARSâCoVâ2 from MarchâSeptember 2020. The initial goals are to derive and test: (1) a pretest probability instrument for prediction of SARSâCoVâ2 test results, and from this instrument, a set of simple criteria to exclude COVIDâ19 (the COVIDâ19 RuleâOut Criteriaâthe CORC rule), and (2) a prognostic instrument for those with COVIDâ19. Patient eligibility included any ED patient tested for SARSâCoVâ2 with a nasal or oropharyngeal swab. Abstracted clinical data included 204 variables representing the earliest manifestation of infection, including week of testing, demographics, symptoms, exposure risk, past medical history, test results, admission status, and outcomes 30 days later. In addition to the primary goals, the registry will provide a vital platform for characterizing the course, epidemiology, clinical features, and prognosis of patients tested for COVIDâ19 in the ED setting
Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial
Resprouting trees drive understory vegetation dynamics following logging in a temperate forest
Removal of canopy trees by logging causes shifts in herbaceous diversity and increases invasibility of the forest understory. However, disturbed (cut) trees of many species do not die but resprout from remaining parts. Because sprouts develop vigorously immediately after disturbances, we hypothesized that sprouts of logged trees offset the changes in species richness and invasibility of the herbaceous layer by eliminating the rise in the resource availability during the time before regeneration from seeds develops. To test this, we analyzed data on herbaceous vegetation and sprout biomass collected in a broadleaved temperate forest in the Czech Republic before and for 6 years after logging. Sprouts that were produced by most of the stumps of logged trees offset large rises in species richness and cover of herbaceous plants and the resource availability that followed logging, but they affected the alien plants more significantly than the native plants. The sprouting canopy effectually eliminated most of the alien species that colonized the forest following a logging event. These findings indicate that in forests dominated by tree species with resprouting ability, sprouts drive the early post-disturbance dynamics of the herbaceous layer. By offsetting the post-disturbance vegetation shifts, resprouting supports forest resilience.ISSN:2045-232
The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods
Associations between young adults' recollections of their childhood experiences with parents and observations of their interaction behavior with best friends
Clinical prediction rule for SARS-CoV-2 infection from 116 U.S. emergency departments 2-22-2021.
Objectives
Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care.
Methods
Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables.
Results
Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation75% probability with +5 or more points).
Conclusion
Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints