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Browsing by Author "Hunter, Benton"
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Item Are Antibiotics a Feasible Alternative to Surgery for Acute Appendicitis?(Elsevier, 2016-05) Gottlieb, Michael; Hunter, Benton; Department of Emergency Medicine, IU School of MedicineItem Design and rationale of a randomized trial: Using short stay units instead of routine admission to improve patient centered health outcomes for acute heart failure patients (SSU-AHF)(Elsevier, 2018-09) Fish-Trotter, Hannah; Collins, Sean; Danagoulian, Shooshan; Hunter, Benton; Li, Xiaochun; Levy, Phillip D.; Messina, Frank; Pressler, Susan; Pang, Peter S.; School of NursingNearly 85% of acute heart failure (AHF) patients who present to the emergency department (ED) with acute heart failure are hospitalized. Once hospitalized, within 30 days post-discharge, 27% of patients are re-hospitalized or die. Attempts to improve outcomes with novel therapies have all failed. The evidence for existing AHF therapies are poor: No currently used AHF treatment is known to improve long-term outcomes. ED treatment is largely the same today as 40 years ago. Admitting patients who could have avoided hospitalization may contribute to adverse outcomes. Hospitalization is not benign; patients enter a vulnerable phase post-discharge, at increased risk for morbidity and mortality. When hospitalization is able to be shortened or avoid completely, certain risks can be mitigated, including risk of medication errors, in-hospital falls, delirium, nosocomial infections, and other iatrogenic complications. Additionally, patients would prefer to be home, not hospitalized. Furthermore, hospitalization and re-hospitalization for AHF predominantly affects patients of lower socioeconomic status (SES). Avoiding hospitalization in patients who do not require admission may improve outcomes and quality of life, while reducing costs. Short stay unit (SSU: <24 h, also referred to as an ‘observation unit’) management of AHF may be effective for lower risk patients. However, to date there have only been small studies or retrospective analyses on the SSU management for AHF patients. In addition, SSU management has been considered ‘cheating’ for hospitals trying to avoid 30-day readmission penalties, as SSUs or observation units do not count as an admission. However, more recent analyses demonstrate differential use of observation status has not led to decreases in re-admission, suggesting this concern may be misplaced. Thus, we propose a robust clinical effectiveness trial to demonstrate the effectiveness of this patient-centered strategy.Item Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial(Elsevier, 2018) Russell, Frances M.; Ehrman, Robert R.; Ferre, Robinson; Gargani, Luna; Noble, Vicki; Rupp, Jordan; Collins, Sean P.; Hunter, Benton; Lane, Kathleen A.; Levy, Phillip; Li, Xiaochun; O'Connor, Christopher; Pang, Peter S.; Emergency Medicine, School of MedicineBackground Medical treatment for acute heart failure (AHF) has not changed substantially over the last four decades. Emergency department (ED)-based evidence for treatment is limited. Outcomes remain poor, with a 25% mortality or re-admission rate within 30 days post discharge. Targeting pulmonary congestion, which can be objectively assessed using lung ultrasound (LUS), may be associated with improved outcomes. Methods BLUSHED-AHF is a multicenter, randomized, pilot trial designed to test whether a strategy of care that utilizes a LUS-driven treatment protocol outperforms usual care for reducing pulmonary congestion in the ED. We will randomize 130 ED patients with AHF across five sites to, a) a structured treatment strategy guided by LUS vs. b) a structured treatment strategy guided by usual care. LUS-guided care will continue until there are ≤15 B-lines on LUS or 6h post enrollment. The primary outcome is the proportion of patients with B-lines ≤ 15 at the conclusion of 6 h of management. Patients will continue to undergo serial LUS exams during hospitalization, to better understand the time course of pulmonary congestion. Follow up will occur through 90 days, exploring days-alive-and-out-of-hospital between the two arms. The study is registered on ClinicalTrials.gov (NCT03136198). Conclusion If successful, this pilot study will inform future, larger trial design on LUS driven therapy aimed at guiding treatment and improving outcomes in patients with AHF.Item Effect of Vapocoolant on Pain During Peripheral Intravenous Cannulation(Elsevier, 2016-11) Gottlieb, Michael; Hunter, Benton; Department of Emergency Medicine, IU School of MedicineMethods Data Sources The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Literatura Latino Americana em Ciencias da Saude, Cumulative Index to Nursing and Allied Health Literature, and ISI Web of Science were searched from inception to May 2015 without language restriction. Trial registries were searched, including clinicaltrials.gov, controlled-trials.com, and trialscentral.org. Additionally, the authors hand searched the references of retrieved articles and abstracts of the American Society of Anesthesiologists. Study Selection This review included all randomized controlled trials comparing vapocoolant to placebo or no treatment for analgesia associated with intravenous cannulation. Studies of adults, children, and healthy volunteers were eligible. Titles and abstracts were reviewed by at least 2 authors, and potentially relevant studies underwent full text review. Discrepancies in study selection were resolved by consensus. Data Extraction and Synthesis Three authors independently extracted data, using a standardized data extraction form. Discrepancies in extracted data were resolved by consensus. Studies were assessed as low, unclear, or high risk of bias in each of 6 domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, and selective reporting. Data reported on a 100-point visual analog scale (VAS) were reported as mean difference. When data were measured with different scales, they were combined with standardized mean difference. A fixed-effect model was used when the I2 statistic was less than 40%; otherwise, a random-effects model was used.