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The Hennepin Ketamine Study Investigators’ Reply
- Jeffrey D. Ho, Jon B. Cole, Lauren R. Klein, Travis D. Olives, Brian E. Driver, Johanna C. Moore, Paul C. Nystrom, Annie M. Arens, Nicholas S. Simpson, John L. Hick, Ross A. Chavez, Wendy L. Lynch, James R. Miner
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- Journal:
- Prehospital and Disaster Medicine / Volume 34 / Issue 2 / April 2019
- Published online by Cambridge University Press:
- 03 May 2019, pp. 111-113
- Print publication:
- April 2019
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We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine
- Travis D. Olives, Paul C. Nystrom, Jon B. Cole, Kenneth W. Dodd, Jeffrey D. Ho
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 6 / December 2016
- Published online by Cambridge University Press:
- 19 September 2016, pp. 593-602
- Print publication:
- December 2016
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Background
Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear.
ObjectiveThe goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol.
MethodsThis was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation.
ResultsOverall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a high degree of provider-dependent variability.
ConclusionsPrehospital ketamine is associated with a high rate of endotracheal intubation in profoundly agitated patients; however, ketamine dosing is not associated with intubation rate when adjusted for potential confounders. It is likely that factors not included in this analysis, including both provider comfort with post-ketamine patients and anticipated clinical course, play a role in the decision to intubate patients who receive prehospital ketamine.
,Olives TD ,Nystrom PC ,Cole JB ,Dodd KW .Ho JD Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine . Prehosp Disaster Med.2016 ;31 (6 ):593 –602 .
24 - Propositions linking organizations and careers
- Edited by Michael B. Arthur, Douglas T. Hall, Barbara S. Lawrence
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- Book:
- Handbook of Career Theory
- Published online:
- 05 June 2012
- Print publication:
- 25 August 1989, pp 490-505
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Summary
How do organizations affect careers? And how do careers affect organizations? This integrating chapter begins to answer these questions by setting forth 155 propositions. We extracted or refined these propositions by thoroughly searching the chapters in Parts I and II of this handbook.
Given the editors' laudable aim to focus this handbook on theory rather than on measurement issues or practical applications, this chapter engages in theory building. Theories evolve as scholars develop propositions. Preferably, these propositions will specify sequential or determinant laws of interactions between continuous variables rather than merely delineating categories (Dubin, 1978).
The hundreds of variables mentioned in the previous chapters emanate from a diverse array of theories rooted in different academic disciplines. Authors address divergent issues, they use partially incompatible terminologies, and they anchor their endeavors in partially inharmonious values and beliefs. In the past, career theory has been fractionated (Schein, 1986; Sonnenfeld and Kotter, 1982), with scholars in each academic discipline tending to ignore ideas about careers developed by scholars in other disciplines. This chapter seeks integration between disciplines that contribute to our understanding of careers. To foster this integration, our chapter articulates propositions and arrays them in ways that we think will enable readers to form their own cross-disciplinary insights. We hope that this chapter will serve as a useful reference source for doctoral students and faculty who conduct research about careers.
PROPOSITIONS
Tables 24.1–24.4 contain propositions that treat organizational attributes as the independent variables or determinants and treat career attributes as the dependent variables or outcomes.