Next to the common cold, traumatic wounds are the most common reasons people seek medical care in the United States. An estimated 3.9 billion dollars of charges are incurred yearly to treat simple lacerations alone. Most of our knowledge and recommendations regarding the treatment of wounds is based on old dogma related to basic science research that has little clinical relevance. There is a lack of clinical outcomes research to determine the most efficient method to treat traumatic wounds. The purpose of the proposed application is to develop the candidate into an independent career clinical-outcomes researcher through formal training and practical experience. The training goal of the candidate will be to complete a Masters of Clinical Research (MCR) at the University of California, San Francisco (UCSF). The MCR requires 36 quarter-hours of didactic courses tailored to the candidates needs and publication of an original scientific paper in lieu of a Masters thesis. It involves strong preceptor relationships with faculty mentors. The practical-experience goal will be achieved by completing two scientific projects during the course of the award. Early in the course of the award, the candidate will develop and implement a clinical research unit (CRU) in emergency medicine at UCSF. Through implementing this program to screen, recruit and enroll patients a randomized trial to determine the best way to treat simple hand lacerations will be completed. In this trial conservative management (non-suture closure) will be compared to traditional suture management. The primary outcome will be three month cosmesis and wound healing, with secondary outcomes of pain, time and patient satisfaction also being assessed. In the later years of the award, as the candidate completes his MCR and fully develops his local CRU, he will become a multi-center clinical-trials investigator. This will be accomplished by using his formal training and with the help of his mentor, Dr Cummings, the Director of the University of Califomia Coordinating Center (UCCC). The UCCC is specifically designed to help run multi center clinical trials. With the use of the UCCC resources a trials network utilizing common databases and data collection techniques will be used to undertake a multi-center clinical trial on the use of prophylactic antibiotics for the management of dog bites. In this study amoxicillin/clavulanic acid will be compared to placebo. The primary outcome of the study will be infection. Other outcomes studied will be wound-healing patient satisfaction and cost.
| Quinn, James V; McDermott, Daniel; Rossi, Jennifer et al. (2010) Randomized controlled trial of prophylactic antibiotics for dog bites with refined cost model. West J Emerg Med 11:435-41 |
| Quinn, James; McDermott, Daniel; Stiell, Ian et al. (2006) Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 47:448-54 |
| Quinn, James V; Stiell, Ian G; McDermott, Daniel A et al. (2005) The San Francisco Syncope Rule vs physician judgment and decision making. Am J Emerg Med 23:782-6 |
| Quinn, James; Cummings, Steven; Callaham, Michael et al. (2002) Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 325:299 |
