Abstract:
:Randomized clinical trials, which aim to determine the efficacy and safety of drugs and medical devices, are a complex enterprise with myriad challenges, stakeholders, and traditions. Although the primary goal is scientific discovery, clinical trials must also fulfill regulatory, clinical, and ethical requirements. Innovations in clinical trials methodology have the potential to improve the quality of knowledge gained from trials, the protection of human subjects, and the efficiency of clinical research. Adaptive clinical trial methods represent a broad category of innovations intended to address a variety of long-standing challenges faced by investigators, such as sensitivity to previous assumptions and delayed identification of ineffective treatments. The implementation of adaptive clinical trial methods, however, requires greater planning and simulation compared with a more traditional design, along with more advanced administrative infrastructure for trial execution. The value of adaptive clinical trial methods in exploratory phase (phase 2) clinical research is generally well accepted, but the potential value and challenges of applying adaptive clinical trial methods in large confirmatory phase clinical trials are relatively unexplored, particularly in the academic setting. In the Adaptive Designs Accelerating Promising Trials Into Treatments (ADAPT-IT) project, a multidisciplinary team is studying how adaptive clinical trial methods could be implemented in planning actual confirmatory phase trials in an established, National Institutes of Health-funded clinical trials network. The overarching objectives of ADAPT-IT are to identify and quantitatively characterize the adaptive clinical trial methods of greatest potential value in confirmatory phase clinical trials and to elicit and understand the enthusiasms and concerns of key stakeholders that influence their willingness to try these innovative strategies.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Meurer WJ,Lewis RJ,Tagle D,Fetters MD,Legocki L,Berry S,Connor J,Durkalski V,Elm J,Zhao W,Frederiksen S,Silbergleit R,Palesch Y,Berry DA,Barsan WGdoi
10.1016/j.annemergmed.2012.01.020subject
Has Abstractpub_date
2012-10-01 00:00:00pages
451-7issue
4eissn
0196-0644issn
1097-6760pii
S0196-0644(12)00110-2journal_volume
60pub_type
杂志文章abstract::Hemodynamically unstable patients will benefit from therapy to control their blood pressure only if this pressure can be determined with accuracy. We compared the accuracy of arterial blood pressure measurements taken aboard helicopters by palpation with a Doppler device and with an oscillometric device. Twenty critic...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80401-3
更新日期:1988-06-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the incidence of serious bacterial infection in infants presenting to the emergency department (ED) with an apparent life-threatening event. METHODS:This was a prospective cohort study of infants younger than 12 months who were treated at an urban children's hospital ED during 1 year and w...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2008.12.037
更新日期:2009-10-01 00:00:00
abstract::Paliperidone, or 9-hydroxy risperidone, is the newest atypical antipsychotic agent to be approved for use by the Food and Drug Administration. Despite being the primary active metabolite of risperidone, paliperidone differs in several ways from risperidone. The most notable difference is that paliperidone is formulate...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.10.015
更新日期:2011-07-01 00:00:00
abstract::Glyburide, a second-generation sulfonylurea hypoglycemic agent, is metabolized by the P-450 hepatic enzyme system. Ciprofloxacin, a widely used quinolone antibiotic, is a recognized P-450 enzyme inhibitor. Conflicting data exist in the medical literature on the ability of quinolone antibiotics to inhibit glyburide hep...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.108617
更新日期:2000-08-01 00:00:00
abstract:STUDY OBJECTIVE:More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic rev...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1999-10-01 00:00:00
abstract::Three children who presented with localized vesicular rash in the diaper area were found to have primary varicella-zoster infections. Primary varicella can closely mimic genital herpes simplex virus (HSV 1 or 2), which may be an indicator of sexual abuse. To avoid unfounded investigation for sexual abuse, primary vari...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70365-9
更新日期:1995-01-01 00:00:00
abstract:STUDY OBJECTIVE:Scorpion envenomation is a common life-threatening hazard in tropical and subtropical countries. Standard treatment is not clearly defined. Many therapies, such as steroids, are prescribed without experimental justification. We sought to assess the efficacy of systematic administration of intravenous hy...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(97)70105-7
更新日期:1997-07-01 00:00:00
abstract::A prospective study was conducted in the emergency departments of two community hospitals to assess the accuracy of Doppler ultrasonography performed by emergency physicians in the evaluation of patients with symptoms suggestive of deep-vein thrombosis. Seventy-eight extremities in 76 patients were evaluated by both D...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82481-3
更新日期:1990-06-01 00:00:00
abstract::We conducted a study to determine the number of items and successful response rate to questions specific to emergency medicine on the National Board of Medical Examiners Test, Part II (NBME-II). The 1979 and 1983 NBME-II examinations were reviewed by a subcommittee of the Society of Teachers of Emergency Medicine. Ite...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80479-6
更新日期:1986-01-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluate the importance of hospital bed occupancy for 30-day mortality, inhospital mortality, readmission for inpatient care within 30 days, and revisits to the emergency department (ED) within 7 days among all adult patients visiting the ED. METHODS:This was an observational cohort study including ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2019.11.009
更新日期:2020-08-01 00:00:00
abstract::A fatal case of ascending tonic-clonic seizure (ATCS) syndrome resulted from the inadvertent, unrecognized use of a hyperosmolar ionic contrast agent during myelography. The patient presented with lower-extremity myoclonic jerking, agitation, hyperthermia, rhabdomyolysis, and disseminated intravascular coagulation. Em...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70045-9
更新日期:1998-11-01 00:00:00
abstract::We present a case of delay in diagnosis of diaphragmatic rupture and herniation in a pregnant 25-year-old woman. The diaphragmatic rupture was secondary to trauma sustained five months prior to presentation. Subsequent to her accident, she was provided medical care on multiple occasions for symptoms of intractable nau...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80780-7
更新日期:1988-04-01 00:00:00
abstract::Breath alcohol analyzers are used to detect ethanol in motorists and others suspected of public intoxication. One concern is their ability to detect interfering substances that may falsely increase the ethanol reading. A 47-year-old-man was found in a public park, acting intoxicated. A breath analyzer test (Intoxilyze...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2009.07.021
更新日期:2010-02-01 00:00:00
abstract::Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is a propionic acid derivative that possesses analgesic and antipyretic properties through inhibition of prostaglandin synthesis. The propionic acids have been considered the least toxic of the NSAIDs, and one, ibuprofen, is currently available as an over-the-co...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80939-4
更新日期:1989-10-01 00:00:00
abstract:STUDY OBJECTIVE:A 2-hour accelerated diagnostic pathway based on the Thrombolysis in Myocardial Infarction score, ECG, and troponin measures (ADAPT-ADP) increased early discharge of patients with suspected acute myocardial infarction presenting to the emergency department compared with standard care (from 11% to 19.3%)...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2016.01.001
更新日期:2016-07-01 00:00:00
abstract::Ketamine produces rapid and consistent pediatric sedation with a predictable onset and recovery time. A wide margin of safety is afforded without the respiratory and cardiovascular depression commonly seen with alternative agents. The efficacy of ketamine is well established in anesthesia and dentistry and has extensi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)82569-7
更新日期:1990-09-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effect of the institution of out-of-hospital albuterol treatments for acute asthma on out-of-hospital time intervals emergency department (ED) morbidity. DESIGN:Retrospective chart and ambulance run report review. PARTICIPANTS:All patients who presented with a diagnosis of asthma on t...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(94)70205-5
更新日期:1994-11-01 00:00:00
abstract::This clinical policy focuses on critical issues in the evaluation and management of patients with acute myocardial infarction or unstable angina. A MEDLINE search for articles published between January 1993 and December 1998 was performed using combinations of the key words chest pain, acute myocardial infarction, uns...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2000.106387
更新日期:2000-05-01 00:00:00
abstract::Maintaining an unobstructed airway and providing adequate oxygenation and CO2 elimination, by artificial means if necessary, are among the highest priorities in all life-threatening circumstances. How this goal can best be met in the prehospital setting has become a controversial issue. The esophageal obturator airway...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80434-5
更新日期:1984-09-01 00:00:00
abstract:STUDY OBJECTIVE:There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associat...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2020.08.010
更新日期:2021-01-01 00:00:00
abstract:STUDY OBJECTIVE:Stress is an emergent occupational problem in modern societies. Among workers, medical practitioners are particularly exposed. However, data objectifying stress levels during work time are scarce. The aim of this study was to establish diurnal salivary cortisol levels in a highly stressful work environm...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2003.109
更新日期:2003-04-01 00:00:00
abstract::Little has been reported in the literature on the characteristics of existing and planned emergency medicine fellowships. To help answer important questions about fellowships, a 28-question survey was developed by representatives from the University Association for Emergency Medicine education and fellowship committee...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80490-6
更新日期:1988-01-01 00:00:00
abstract:STUDY OBJECTIVE:To investigate the ability of laypeople to apply basic CPR techniques after recent training. DESIGN:Cross-sectional assessment of practical CPR skills. TYPE OF PARTICIPANTS:151 laypeople who were trained twice in the preceding 20 to 24 months. MEASUREMENTS AND MAIN RESULTS:Practical skills were teste...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70094-x
更新日期:1994-05-01 00:00:00
abstract::We present the case of a diver who experienced the acute onset of shoulder pain after a rapid ascent. It was determined that the patient had decompression sickness ("the bends") of the right shoulder and pulmonary barotrauma resulting in secondary pneumoperitoneum. He underwent decompression, with prompt resolution of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80240-8
更新日期:1987-11-01 00:00:00
abstract::Mechanical interventions in acute ischemic stroke promise to provide emergency physicians with tools to treat patients in whom conventional thrombolysis might be ineffective or contraindicated, including most patients with stroke who arrive at the emergency department beyond the 3-hour time window for intravenous tiss...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1067/mem.2003.194
更新日期:2003-06-01 00:00:00
abstract::Interest in the development of the specialty of emergency medicine and of emergency health care systems has greatly increased worldwide in the last few years. The guidelines in this article were developed in an effort to assist others in design and evaluation of all types of emergency medicine projects. ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70054-4
更新日期:1997-12-01 00:00:00
abstract:STUDY OBJECTIVE:The emergency department is a problem-focused environment in which routine screening for intimate partner violence (IPV) is difficult. We hypothesized that screening for IPV during computer-based health-risk assessment would be acceptable to patients and improve detection. METHODS:We performed a descri...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.127181
更新日期:2002-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the efficacy of a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines for the management of acute urticaria in outpatients. DESIGN:Prospective, randomized, double-blinded, clinical trial. SETTING:Emergency department of an urban tertiary care teaching hosp...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(95)70002-1
更新日期:1995-11-01 00:00:00
abstract::The Hyatt Regency skywalk collapse (July 17, 1981) provided the emergency medical services system of Kansas City, Missouri, with its greatest challenge ever. Utilizing an EMS-based, centralized, city-wide disaster plan, the rescue operation encountered 113 dead and 188 multiply traumatized patients. The rescue operati...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80203-0
更新日期:1983-10-01 00:00:00
abstract:STUDY OBJECTIVE:This study measures the degree to which parents of patients, in the course of evaluation and treatment in a pediatric emergency department (ED), could report what they were waiting for. METHODS:Brief in-person interviews were conducted with parents of nonemergency patients during an ED visit. After the...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.09.032
更新日期:2008-04-01 00:00:00