Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

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Use of Urinary Catheters in U.S. EDs 1995-2009: A Potentially Modifiable Cause of Catheter-Associated Urinary Tract Infection? Gibson Chambers, J MS, Schuur, JD MD MHS. University of New England College of Osteopathic Medicine, Biddeford, ME; Brigham and Women’s Hospital, Dept of Emergency Medicine, Boston, MA. Background: Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection. In 2007, the Centers for Disease Control (CDC) published guidelines for reducing CAUTI, including appropriateness criteria for urinary catheters (UCs). The objective of this study was to calculate frequency and trends of UC placement and potentially avoidable UC (PAUC) placement in US EDs and identify predictors of ED UC placement in admitted patients. Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of US ED visits, from 1995-2009 for use of UCs in adults. UCs were classified as PAUC if the primary diagnosis did not meet CDC appropriateness criteria. Predictors of ED placement of UC for admitted patients were assessed with multivariate logistic regression, results shown as odds ratio (OR) and 95% CI. Statistics controlled for the survey sampling design. Results: UC placement varied from 22 to 33 per 1000 adult ED visits, peaking in 2003. Overall, 1.6% (CI 1.5 - 1.7%) of discharged patients and 8.5% (CI 7.9 - 9.1%) of admitted patients received UCs. The most common reasons for visit among patients receiving UCs included stomach and abdominal pain, cramps and spasms, urinary dysfunctions, shortness of breath and chest pain and related symptoms. More than half of ED-placed UCs were for potentially avoidable diagnoses. The most common discharge diagnoses among patients receiving UCs included genitourinary symptoms, urinary tract infections, abdominal pain and congestive heart failure. Predictors of UCs in admitted patients included increasing age (≥80y vs. 18-59y, OR 3.1, CI 2.7 - 3.6), female gender (OR 1.3, CI 1.2 - 1.4), race (Hispanic vs. white, 0.8, CI 0.6 - 0.9), arrival by ambulance (OR 2.5, CI 2.3 - 2.8), increasing urgency (≥2h vs. immediate, OR 0.8, CI 0.6 - 1.1) and longer ED visits(≥4h vs.
Lessons to Be Learned: Changing Perspectives in Acupuncture Research Methodology Translated to Osteopathic Manipulative Therapy Clinical Trials McCallister, A, BA, OMSIV; .Ferrill, H, D.O. 1 , Dobos, G, M.D. 2 , Tao, I, M.D. 2 1 UNECOM, Department of Osteopathic Manipulative Medicine, Biddeford, ME 2 University of Duisburg-Essen, Department of Integrative Medicine, Essen, Germany Introduction: Osteopathic Manipulative Therapy (OMT) research faces many methodological challenges, especially when placed into an atmosphere dominated by the Randomized Control Trial (RCT). Two central postulates of RCTs are randomization and control. Any intervention is thus thought to be divided into characteristic (specific) and incidental (placebo, non-specific) effects. But does it make sense to split complex interventions such as OMT into characteristic and incidental effects? Recent research has shown that elements categorized as “incidental” in drug trials are integral to interventions such as acupuncture. Since OMT also cannot separate its characteristic and incidental effects, we may learn something from recently suggested shifts in acupuncture methodology. The field of acupuncture is moving away from the explanatory design and shifting towards pragmatic trials to better study acupuncture as it is actually performed in practice. As a field, they have also developed research reporting guidelines (the STRICTA standards) to improve transparency of research design and results. In the same vein, OMT research would also benefit from standardization of research reporting. Methods: This work is based on a PubMed literature search in the fields of acupuncture and OMT research methodology and is a translational work across these two fields. Results: Three suggestions to improve research transparency are presented here. The first would be to implement a set of reporting guidelines, specifically tailored to OMT research that would be designed from acupuncture’s STRICTA guidelines. The second would be to use a questionnaire for research participants to determine the believability of the chosen control condition, similar to the questions proposed by Fulda et al. The third is implementing a graphing method designed by Thorpe et al. to consolidate aspects of OMT trial design. This tool will better determine where each study falls on the pragmatic-explanatory spectrum and would also demonstrate the external validity of each study. Conclusion: The goal of these proposed measures is not to dictate research methodology but to increase transparency with clinical trial study design and findings. These tools should improve the quality of manuscript reporting and allow OMT researchers to look objectively at the appropriateness of research paradigms currently employed for OMT research.
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