Deciphering immune responses: a comparative analysis of influenza vaccination platforms.

Influenza still poses a significant challenge due to its high mutation rates and the low effectiveness of traditional vaccines. At present, antibodies that neutralize the highly variable hemagglutinin antigen are a major driver of the observed variable protection. To decipher how influenza vaccines can be improved, an analysis of licensed vaccine platforms was conducted, contrasting the strengths and limitations of their different mechanisms of protection.

Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study.

Background: As rates of opioid use disorder in the general population have increased, some have questioned whether IV opioids should be used routinely for treatment of acute severe pain in the emergency department (ED).

Objectives: We determined the incidence of persistent opioid use among opioid-naïve patients exposed to IV opioids in the ED.

Methods: This was a prospective observational cohort study conducted in two EDs in the Bronx, NY.

A randomized controlled trial of ibuprofen versus ketorolac versus diclofenac for acute, nonradicular low back pain.

Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medication for acute low back pain (LBP). It is unclear if the choice of NSAID impacts outcomes. We compared ibuprofen, ketorolac, and diclofenac for the treatment of acute, nonradicular LBP.

A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain.

Study Objective: In US emergency departments (EDs), patients with low back pain are often treated with nonsteroidal anti-inflammatory drugs and muscle relaxants. We compare functional outcomes among patients randomized to a 1-week course of naproxen+placebo versus naproxen+orphenadrine or naproxen+methocarbamol.

Methods: This was a randomized, double-blind, comparative effectiveness trial conducted in 2 urban EDs.

Generalizability and Effectiveness of Butterfly Phlebotomy in Reducing Hemolysis.

Objectives: The objective was to test the hypothesis that exclusive use of butterfly needles for phlebotomy, compared with sample collection via intravenous (IV) catheter, will reduce rates of sample hemolysis.

Methods: This was an observational study of hemolysis rates before and after implementation of a "butterfly-only" phlebotomy protocol. Weekly hemolysis rates, generated by the central laboratory, were collected and the proportion of hemolyzed specimens before and after protocol implementation were compared.

Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial.

Importance: Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. These patients are usually treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination.

Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients.

Background And Objectives: Opioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain.

Methods: This was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED with acute severe pain.

Predicting 7-day and 3-month functional outcomes after an ED visit for acute nontraumatic low back pain.

Background: Recent work has shown that two-thirds of patients report functional disability 1 week after an emergency department (ED) visit for nontraumatic musculoskeletal low back pain (LBP). Nearly half of these patients report functional disability 3 months later. Identifying high-risk predictors of functional disability at each of these 2 time points will allow emergency clinicians to provide individual patients with an evidence-based understanding of their risk of protracted symptoms.

One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain.

Study Objective: Nearly 3 million patients present to US emergency departments (EDs) annually with undifferentiated musculoskeletal low back pain. Little is known about short- and longer-term outcomes in this group. We seek to describe the pain and functional outcomes 1 week and 3 months after discharge in a sample of ED patients presenting with undifferentiated musculoskeletal low back pain.

Success of a safe and simple algorithm to reduce use of CT pulmonary angiography in the emergency department.

Objective: The purpose of our study was to determine whether the radiation exposure to patients with suspected pulmonary embolism (PE) could be decreased by safely increasing the use of ventilation-perfusion (V/Q) scanning and decreasing the use of CT pulmonary angiography (CTPA) through an educational intervention.

Materials And Methods: Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments in December 2006 and January 2007 regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE. To reduce radiation exposure, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography.

Randomized clinical trial comparing a patient-driven titration protocol of intravenous hydromorphone with traditional physician-driven management of emergency department patients with acute severe pain.

Study Objective: We test the null hypothesis that the "1+1" hydromorphone patient-driven protocol is clinically and statistically equivalent in safety and efficacy to that of traditional physician-driven administration of opioids for emergency department (ED) treatment of acute severe pain.

Methods: This was a prospective randomized clinical trial of nonelderly adults presenting to an urban academic ED with acute pain of sufficient severity to warrant intravenous (IV) opioids in the judgment of the attending physician. Patients randomized to the 1+1 hydromorphone patient-driven protocol received 1 mg IV hydromorphone followed by a second 1-mg dose 15 minutes later if the patient responded affirmatively to the question, "Do you want more pain medication?" Patients in the physician-driven group received any IV opioid in the dose chosen by the ED attending physician, with any additional analgesia provided at the discretion of that physician.

A randomized trial of diphenhydramine as prophylaxis against metoclopramide-induced akathisia in nauseated emergency department patients.

Study Objective: Akathisia, an adverse effect observed at times after administration of parenteral metoclopramide, is an unpleasant symptom complex characterized by restlessness and agitation. Some try to limit the development of akathisia by coadministering diphenhydramine when using parenteral metoclopramide. The goal of this investigation is to determine whether concomitant administration of diphenhydramine 25 mg decreased the rate of development of akathisia after administration of 10 mg or 20 mg of intravenous metoclopramide.

A randomized placebo-controlled trial of single-dose IM corticosteroid for radicular low back pain.

Study Design: A randomized, double-blind, placebo-controlled trial of patients with radicular low back pain who present to an emergency department (ED) within 1 week of pain onset.

Objective: We hypothesized that a single intramuscular 160 mg dose of methylprednisolone acetate would improve pain and functional outcomes 1 month after ED discharge if the corticosteroid were administered early in disease symptomotology.

Summary Of Background Data: Parenteral corticosteroids are not recommended for acute, radicular low back pain, though their role in this disease process is ill-defined.

Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients.

The Palliative Care Service at Montefiore Medical Center (MMC) established a pilot project in the emergency department (ED) to identify chronically ill older adults in need of palliative care, homecare, and hospice services and to link such patients with these services. Two advance practice nurses conducted consultations on elderly patients who were found to have one or more "palliative care triggers" on initial screening. A standardized medical record abstraction form was developed.

No racial or ethnic disparity in treatment of long-bone fractures.

Studies of data from the 1990s are often cited as evidence of racial and ethnic disparities in pain management. Subsequent evidence supporting this association has not been consistent. The objective was to assess whether there are racial or ethnic disparities in receipt of analgesics for pain from long-bone fractures more recently and in a different region of the United States.

Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness.

Background: On August 14, 2003, the United States and Canada suffered the largest power failure in history. We report the effects of this blackout on New York City's healthcare system by examining the following: 1) citywide 911 emergency medical service (EMS) calls and ambulance responses; and 2) emergency department (ED) visits and hospital admissions to one of New York City's largest hospitals.

Methods: Citywide EMS calls and ambulance responses were categorized by 911 call type.