Food is tastier and therefore easier to swallow with a grain of salt , so this idiom claims that if someone is telling you something that is … The per-protocol analysis (11,780 patients) also produced similar results (Tables S5 and S6 in the Supplementary Appendix). Grain of Salt's signature assorted platter with chicken tikka, hariyali murg tikka, badami tikka, fish tikka, lamb boti kabaab, and jhinga tandoori. Nephrol Dial Transplant 2010;25:3911-3918. Information and tools for librarians about site license offerings. Ann Emerg Med 2017;69(1):24-33.e2. By Larry Husten. 22. 1* Multivariable models were adjusted for age, sex, race, admitting service, and time (days since trial initiation). 28. Owing to the pragmatic design that used data collection from the electronic medical record, more detailed information about patient characteristics was not available. The content of this site is intended for health care professionals. During balanced-crystalloids months, clinicians had the option of choosing either lactated Ringer’s solution or Plasma-Lyte A. Clinicians and patients were aware of the treatment assignments. Shaw AD, Bagshaw SM, Goldstein SL, et al. In a sensitivity analysis, we limited the trial population to the first emergency department visit among unique patients. On the basis of historical data from the trial emergency department, we estimated that approximately 14,000 patients would be enrolled in 16 months, with the saline group having a mean (±SD) of 24±4 hospital-free days. 30. Information, resources, and support needed to approach rotations - and life as a resident. Sensitivity analyses that were adjusted for period effect and that limited the trial population to patients without end-stage renal disease at presentation in the emergency department (13,112 patients), to patients with a measured baseline serum creatinine value (8681 patients), and to the first emergency department visit among unique patients in the trial (10,573 patients) all produced results similar to those of the primary analysis (Table S4 in the Supplementary Appendix). Patients with end-stage renal disease who were receiving long-term renal-replacement therapy at presentation were not eligible to meet renal outcomes, including new renal-replacement therapy, persistent renal dysfunction, and acute kidney injury. To convert the values for creatinine to micromoles per liter, multiply by 88.4. Each model was adjusted for the following baseline characteristics: age, sex, race, admitting inpatient service, and days elapsed since the initiation of the trial.20. Hospital-free days were analyzed with a multivariable proportional-odds model. But Take the News With a Grain of Salt ... the Lancet and the New England Journal of Medicine… Concise summaries and expert physician commentary that busy clinicians need to enhance patient care. 9. Serum Electrolyte Concentrations in the First 72 Hours after Arrival in the Emergency Department (ED). Clinical Outcomes According to Assigned Treatment Group in the Intention-to-Treat Analysis. Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS. Take It with a Grain of Salt This interactive case features a 56-year-old woman who presents to the ED with a 1-week history of frontotemporal headaches and nausea. Self WH, Semler MW, Wanderer JP, et al. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge. Zampieri FG, Azevedo LCP, Corrêa TD, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Myburgh JA, Mythen MG. Resuscitation fluids. In the last week of October (between October 25 and 31) 1,978 tests were completed, according to … Semler MW, Wanderer JP, Ehrenfeld JM, et al. (Certain details changed for privacy.) The trial included three key secondary outcomes: major adverse kidney events within 30 days, acute kidney injury of stage 2 or higher, and in-hospital death. A new study, published in JAMA Internal Medicine, offers fresh evidence that current sodium recommendations should be taken with, well, a grain of salt.Guidelines recommend that for many people at increased risk, including everyone over age 50, sodium intake should be below 1500 mg/day, but this … Print Subscriber? Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery. ED denotes emergency department, and IQR interquartile range. 1. 10. 26. 8. Patients in the balanced-crystalloids group had a lower incidence of major adverse kidney events within 30 days than those in the saline group (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01). Our trial, the Saline against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT-ED) trial, was a single-center, pragmatic, unblinded, multiple-crossover trial that compared balanced crystalloids and saline among consecutive noncritically ill adults treated with intravenous crystalloids in the emergency department before hospitalization outside the ICU. Patients who were admitted to an ICU from the emergency department were defined as critically ill and were enrolled in a separate trial that compared balanced crystalloids and saline among critically ill adults, the Isotonic Solutions and Major Adverse Renal Events Trial (SMART), reported in this issue of the Journal.16 Patients who received less than 500 ml of crystalloids in the emergency department were excluded owing to the low dose of exposure to the intervention.15 The unit of analysis was unique emergency department visit, with individual patients potentially contributing multiple visits. Owing to the assigned crystalloid Group assigned crystalloid Group collection from the New England Journal Medicine…... We limited the trial with waiver of informed consent the Departments of emergency Medicine ( W.H.S.,,... And ketamine for induction during rapid sequence intubation of adult trauma patients of routine clinical.... 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