Randomized evaluation of octreotide vs prochlorperazine for ED treatment of migraine headache.

UNLABELLED: Patients with headaches account for approximately 2% of all ED visits, with migraines being the most common defined primary headache syndrome. Our goals were to evaluate the efficacy of intravenous octreotide (OC) for the treatment of migraines, when compared to standard therapy with prochlorperazine. METHODS: The study was conducted as a double-blinded, randomized controlled trial. Each subject received either 100 microg of octreotide or 10 mg of prochlorperazine intravenously for a 2-minute period. RESULTS: Comparison of the change in median visual analog scale scores for 60 minutes demonstrated that octreotide was less effective at reducing pain (P = .03) and producing clinical success (P < .01). Restlessness consistent with akathisia was noted by 35% of the PC group and 8% of the OC group (P < .01). At 60 minutes, rescue medication was required by 48% of the patients in the OC group, whereas 10% of the PC group required such therapy (P < .01). All 44 patients were contacted for follow-up at 48 to 72 hours after enrollment. At that time, 10% of the prochlorperazine and 25% of the octreotide patients had experienced some headache recurrence (P = .1). CONCLUSION: Prochlorperazine was statistically superior to octreotide in clinical success rate and decrease in pain in migraine patients but caused more restlessness and sedation.

Isopropyl alcohol pad use for blood ethanol sampling does not cause false-positive results.

This was a retrospective analysis of prospective data collected from a study of blood ethanol levels after the use of the alcohol-based hand sanitizer (ABHS). A total of 5 male volunteers were enrolled. Eight of the 10 total blood ethanol level measurements were drawn after skin preparation with Kendall WEBCOL Alcohol Preps (APP) containing 70% isopropyl alcohol. All had an initial and post-ABHS application blood alcohol level (BAL) drawn, for a total of 10 BAL measurements. Measurements upon completion of the study were <5 mg/dL in all 5 study participants and in each of the 10 blood draws regardless of skin preparation technique. This study demonstrates that the use of isopropyl skin prep pads is unlikely to cause significant false-positive blood ethanol levels.

A descriptive analysis of authorship within medical journals, 1995-2005.

INTRODUCTION: The emphasis on publications for promotion in academic medicine would lead one to the theory that authorship numbers would increase proportionally with this emphasis. To investigate authorship trends across a number of periodicals, we performed a descriptive study comparing two full years of published articles spaced ten years apart from five medical journals. METHODS: Physician reviewers each reviewed all articles of one medical journal for the 1995 and 2005 publication years. Reviewed journals included Academic Emergency Medicine (AEM), Annals of Emergency Medicine (AnnEM), Annals of Internal Medicine (AIM), Journal of Trauma (JT), and New England Journal of Medicine (NEJM). Data collected for each article were number of authors, ordinal number of the corresponding author, type of study described, whether the described study was a multicenter trial, whether authorship listed included a "study group," and whether any author was also an editor of the journal. RESULTS: A total of 2927 articles were published in the five journals in 1995, and of these, 1401 (47.9%) were analyzed after the exclusion criteria had been applied; for 2005 a total of 3630 articles were published and of these, 1351 (37.2%) were included in the analysis. Across all five journals the mean number of authors per article increased from 4.66 to 5.73 between 1995 and 2005 (P < 0.0001), and four of the five journals individually had statistically significant increases in the number of authors per article. More articles had a journal editor as an author in 2005 (increased from 7.8% to 11.0%, P = 0.004), though no single journal had a statistically significant increase. CONCLUSION: We describe a trend of increasing mean authors, editorial authorship, study groups, and multicenter trials over time with fewer solo authors now publishing original research or case reports. The academic medical community must pursue an authorship requirement consensus to assure that a standard of contribution for all authors on a given paper is met.

Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study.

BACKGROUND: Ethanol-based hand sanitizers (EBHSs) are used in most health care facilities in the United States. Infection control personnel advocate the use of generous quantities of EBHS before and after contact with patients. Although it is assumed that little systemic absorption of ethanol occurs during EBHS use, many alcohols are absorbed to varying degrees via the transdermal route. Ethanol intoxication by employees in the medical workplace is a potentially serious finding, and it is of forensic and medical-legal importance to elucidate the effects of frequent use of EBHS upon serum blood ethanol levels (BELs). To investigate the effect of frequent use of EBHS upon serum blood ethanol concentrations, we prospectively studied 5 volunteers undergoing frequent application of EBHS. METHODS: Enrolled subjects applied 5 mL of the product (62% denatured ethyl alcohol manufactured by Kimberley-Clark, Roswell, GA) to both hands and rubbed until dry. This activity was repeated 50 times over 4 hours. Participants had their blood drawn before as well as after completing the study. Each participant was without alcohol exposure during the 12 hours preceding the study. RESULTS: Five volunteers were enrolled. All had an initial blood ethanol level of less than 5 mg/dL. All 5 participants completed the 4-hour study. There were no noted adverse reactions during the study. Blood ethanol level upon completion of the 50 applications of EBHS was less than 5 mg/dL in all 5 study participants. CONCLUSION: The results of this study demonstrate that use of ethanol-based hand sanitizers, when frequently used in accordance with labeling, do not raise serum blood ethanol levels.