BACKGROUND: In the recent past, propofol was temporarily removed from the emergency department (ED) for use in procedural sedation. We sought to determine which agents replaced it in clinical practice and the impact this change had on turnaround times (TAT) for sedated patients. METHODS: This study is a retrospective chart review at a level one trauma center. Patients receiving sedative agents (propofol, ketamine, midazolam, and etomidate) were identified by pharmacy codes, and their charts were then reviewed for demographics and TAT. Propofol was unavailable in the emergency department (ED) between May 2010 and February 2011. The study period extended from May 2009 until May 2011. Patients receiving sedation by non-emergency medicine physicians and those receiving sedation related to intubation were excluded. RESULTS: In total 2466 charts were reviewed and 209 met inclusion criteria. When propofol was available, the most commonly used sedative agent was etomidate (40％), followed by propofol (28％), ketamine (20％), and midazolam (6％). When propofol was unavailable, etomidate remained the most commonly used agent (43％), followed by ketamine (41％), and midazolam (11％). When propofol was available, the median TAT for sedated patients was 163 minutes compared to 178 minutes when propofol was unavailable (P=0.83). When propofol was the primary sedative agent used, the median TAT was 166 minutes as compared with a median TAT of 172 minutes for all other sedative agents combined (P=0.87). CONCLUSION: When propofol was unavailable, ketamine became a preferred ED sedation agent. Removal of propofol from the sedation armamentarium did not affect ED TAT.

Whilst Ecological momentary assessment (EMA) can provide important insights over time and across contexts among rotation workers whose work periods alternate with leave at home, it can also be challenging to implement in the resources and construction sectors. This review aimed to provide a summary of the methodological characteristics of EMA studies assessing health outcomes and related behaviors in rotation workers. Systematic searches in PubMed, Medline, EMBASE, CINAHL, PsycINFO, and Scopus were done to include 23 studies using EMA methods in assessing health-related outcomes and behaviors. EMA designs included daily diary: assessments once per day typically fixed at the end of day (47.8%), within day fixed interval time-based design: assessments on multiple times per day at certain times of day (17.4%) and combination of both designs (34.8%). Studies employed paper and pencil diaries (73.9%) and one or more electronic methods (60.9%): wrist-worn actigraphy device (52.2%) and online-based diaries (26.1%) for data collection. Most of the studies (91.3%) did not report prompting -EMAs by schedule alerts or compliance. Daily diary and within day fixed interval dairies designs are common, with the increasing use of electronic EMA delivery techniques. It is unclear how well participants adhere to assessment schedules, as these are inadequately reported. Researchers should report compliance-related information.