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Emergency Medicin

Shahriar Zehtabchi, Daniel Michael Fatovich
In this issue of the Academic Emergency Medicine, Viau et al.1 assess the yield of computed tomography (CT) of the head among patients presenting with syncope. The systematic review included a total of 17 studies (15 retrospective chart reviews and 2 prospective) that included adult ED patients presenting with the chief complaint of syncope or those admitted to the hospital for syncope. Approximately half of these ED patients underwent head CT with a 1.2% and 3.8% yield of serious intracranial conditions identified in admitted patients and emergency department patients, respectively...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Christopher R Carpenter, Jay Banerjee, Daniel Keyes, Debra Eagles, Linda Schnitker, David Barbic, Susan Fowler, Michael A LaMantia
Cognitive dysfunction in older adults includes mild cognitive impairment, dementia, and delirium in addition to traumatic brain injury, intoxication, and central nervous system infections also encountered in younger populations. Delirium is an acute and reversible disturbance in attention with multiple potential precipitants, while mild cognitive impairment is an early form of Alzheimer's disease with memory and language problems only manifest with formal testing.1,2 On the other hand, dementia represents a chronic neurodegenerative disease that impairs executive functioning, memory, orientation, and judgment...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Andreia B Alexander, Mary A Ott
As emergency physicians, we have all experienced the moment when we look at the patient board and the chief complaint "pregnancy test" pops up. The first thing we think to ourselves is, "Would have been cheaper to pick one up at the store." Upon chart review we see that this 19-year-old female, Jenny, has been in our ED 3 times in the past 2 years with the same request. Twice she was diagnosed with a sexually transmitted infection (STI), and this time her pregnancy test is positive. You personally saw her during one of the visits and referred her to OB/GYN (she was not able to make the visit)...
September 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jenna E Gallegos, Christopher Boyer, Eleanore Pauwels, Warren A Kaplan, Jean Peccoud
New innovation ecosystems are emerging that challenge the complex intellectual property and regulatory landscape surrounding drug development in the United States (US). A prime example is an initiative known as the Open Insulin Project. The goal of the project is to sidestep patents and enable generic manufacturers to produce cheaper insulin. However, the US regulatory environment, not patent exclusivity, is the main barrier to insulin affordability. If the Open Insulin Project succeeds in releasing an open protocol for insulin manufacturing, follow-on work could enable a number of new insulin production ecosystems, including 'home-brewed' insulin...
August 9, 2018: Trends in Biotechnology
Federica Depetri, Alberto Tedeschi, Massimo Cugno
Angioedema is a self-limiting edema of the subcutaneous or submucosal tissues due to localised increase of microvascular permeability whose mediator may be histamine or bradykinin. Patients present to emergency department when angioedema involves oral cavity and larynx (life-threatening conditions) or gut (mimicking an acute abdomen). After initial evaluation of consciousness and vital signs to manage breathing and to support circulation if necessary, a simple approach can be applied for a correct diagnosis and treatment...
September 13, 2018: European Journal of Internal Medicine
Muritala A Asafa, Rahman A Bolarinwa, Omotayo A Eluwole, Bolanle O Ibitoye, Adesoji M Adegoke, Oluwadare Ogunlade
BACKGROUND: The use of electrocardiogram for sex verification in adults is an emerging concept in medicine. It is feasible through the utilization of Ogunlade Sex Determination Electrocardiographic Score. The aim of this study was to use an electrocardiogram to verify the sex of a woman with primary amenorrhea. CASE PRESENTATION: We report a case of a 36-year-old woman of Yoruba ethnicity who presented with primary amenorrhea. A physical examination revealed a woman with a feminine appearance characterized by long plaited hair and well-developed breasts...
September 17, 2018: Journal of Medical Case Reports
Z Carr, M Maeda, D Oughton, W Weiss
Available experience from Chernobyl and Fukushima clearly demonstrate that nuclear emergencies may result in low and very low exposure levels, at which psychological and social effects among the affected population will dominate over the actual biological effects of ionising radiation. International protection standards and guidelines request, that both radiological and non-radiological health consequences have to be considered in preparedness and response to an actual emergency and there is a need to broaden the radiation protection system's philosophy beyond the metrics of radioactivity and radiation dose...
September 14, 2018: Radiation Protection Dosimetry
Renee Meyer, Paul G Werthmann, Gunver S Kienle
BACKGROUND: Colonic diverticula develop in at least 60% of elderly patients. Less than 25% of these develop diverticulitis. Recurrent episodes are experienced by about 13% of the symptomatic patients. The effect on prevention of recurrent diverticulitis of currently used therapies is controversial. Surgical colon resection is used in some patients in emergency or to prevent future episodes and complications. Carpellum Mali comp. (Juglans regia, Testa; Pirus malus, Carpellum) and Kalium aceticum comp...
October 2018: Complementary Therapies in Medicine
Valesca P Retèl, Lotte M G Steuten, Marnix H Geukes Foppen, Janne C Mewes, Melanie A Lindenberg, John B A G Haanen, Wim H van Harten
BACKGROUND: An emerging immunotherapy is infusion of tumor infiltrating Lymphocytes (TIL), with objective response rates of around 50% versus 19% for ipilimumab. As an Advanced Therapeutic Medicinal Products (ATMP), TIL is highly personalized and complex therapy. It requests substantial upfront investments from the hospital in: expensive lab-equipment, staff expertise and training, as well as extremely tight hospital logistics. Therefore, an early health economic modelling study, as part of a Coverage with Evidence Development (CED) program, was performed...
September 15, 2018: BMC Cancer
Yavuz Yigit, Dilek Helvacioglu-Yigit, Bahadir Kan, Cansu Ilgen, Serkan Yilmaz
BACKGROUND/AIM: Emergency department (ED) visits for dental issues are mostly related to traumatic injuries. The knowledge of ED physicians about diagnosis and treatment of dentofacial injuries is crucial for prognosis. The aim of this study was to evaluate the attitude and knowledge as well as education and self-confidence levels of emergency medicine physicians in ED regarding the diagnosis and treatment of dentofacial traumatic injuries. MATERIAL AND METHODS: A total of 109 emergency medicine physicians participated in the study...
September 15, 2018: Dental Traumatology: Official Publication of International Association for Dental Traumatology
Rani Polak, Amir Tirosh, Barbara Livingston, David Pober, James E Eubanks, Julie K Silver, Kaya Minezaki, Roni Loten, Edward M Phillips
PURPOSE OF REVIEW: Various dietary regimes have proven effective in preventing diabetes, yet its prevalence is growing. This review's goals are to examine the relationship between home cooking and diabetes and to present the literature on home cooking education programs as a novel strategy to improve adherence to healthy nutrition, thus decreasing the risk of diabetes. RECENT FINDINGS: Consumption of home-cooked food is linked to healthier nutrition and decreased risk of diabetes...
September 14, 2018: Current Diabetes Reports
Song Zhang, Hong-Yu Xue
Eyelid shape is one key distinctive feature of the Asian eye. The presence of epicanthal folds is a common eyelid defect of Asians. Different surgical techniques have been developed to correct epicanthal folds. However, potential problems with these techniques are emerging, such as difficulty in design, recurrence and/or prominent scarring after surgery, and restricted application together with double eyelidplasty. An improved epicanthoplasty technique with high simplicity and flexibility is imperative. From October 2000 to March 2017, we performed V-flap epicanthoplasty procedures on 423 Asian patients...
September 14, 2018: Aesthetic Plastic Surgery
Laurent Karila, Maude Marillier, Boris Chaumette, Joel Billieux, Franchitto Nicolas, Benyamina Amine
Synthetic opioids (SO) are a major risk for public health across the world. These drugs can be divided into 2 categories, pharmaceutical and non-pharmaceutical fentanyls. A new generation of SO has emerged on the drug market since 2010. North America is currently facing an opioid epidemic of morbi-mortality, caused by over-prescription of opioids, illegally diverted prescribed medicines, the increasing use of heroin, is and the emergence of SO. Furthermore, this opioid crisis is also seen in Europe. SO are new psychoactive substances characterized by different feature such as easy availability on the Internet, low price, purity, legality, and lack of detection in laboratory tests...
September 11, 2018: Neuroscience and Biobehavioral Reviews
Tim Montrief, Alex Koyfman, Brit Long
INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION: While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications...
September 8, 2018: American Journal of Emergency Medicine
Beatrice Bassetti, Corrado Carbucicchio, Valentina Catto, Elisa Gambini, Erica Rurali, Alberto Bestetti, Giuseppe Gaipa, Daniela Belotti, Fabrizio Celeste, Matteo Parma, Stefano Righetti, Lorenza Biava, Maurizio Arosio, Alice Bonomi, Piergiuseppe Agostoni, Paolo Scacciatella, Felice Achilli, Giulio Pompilio
BACKGROUND: Cell therapy with bone marrow (BM)-derived progenitors has emerged as a promising therapeutic for refractory angina (RA) patients. In the present study, we evaluated the safety and preliminary efficacy of transcatheter delivery of autologous BM-derived advanced therapy medicinal product CD133+ cells (ATMP-CD133) in RA patients, correlating perfusion outcome with cell function. METHODS: In the phase I "Endocavitary Injection of Bone Marrow Derived CD133+ Cells in Ischemic Refractory Cardiomyopathy" (RECARDIO) trial, a total of 10 patients with left ventricular (LV) dysfunction (ejection fraction ≤ 45%) and evidence of reversible ischemia, as assessed by single-photon emission computed tomography (SPECT), underwent BM aspiration and fluoroscopy-based percutaneous endomyocardial delivery of ATMP-CD133...
September 14, 2018: Stem Cell Research & Therapy
Edda Spiekerkoetter, Steven M Kawut, Vinicio A de Jesus Perez
Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy that causes right ventricular dysfunction and exercise limitation and progresses to death. New findings from translational studies have suggested alternative pathways for treatment. These avenues include sex hormones, genetic abnormalities and DNA damage, elastase inhibition, metabolic dysfunction, cellular therapies, and anti-inflammatory approaches. Both novel and repurposed compounds with rationale from preclinical experimental models and human cells are now in clinical trials in patients with PAH...
September 14, 2018: Annual Review of Medicine
John R Boulet, Steven J Durning
CONTEXT: As the practice of medicine evolves, the knowledge, skills and attitudes required to provide patient care will continue to change. These competency-based changes will necessitate the restructuring of assessment systems. High-quality assessment programmes are needed to fulfil health professions education's contract with society. OBJECTIVES: We discuss several issues that are important to consider when developing assessments in health professions education...
September 14, 2018: Medical Education
Rebecca J Chancey, Esther M Sampayo, Daniel S Lemke, Cara B Doughty
INTRODUCTION: Rapid Cycle Deliberate Practice (RCDP) is a team-based simulation method, emphasizing repetitive practice over reflective debriefing, with progressively more challenging rounds, frequent starts and stops, and direct coaching. Although some studies have shown improved performance, no study has evaluated learners' perceptions. We aimed to explore learners' experiences during RCDP. METHODS: This was a qualitative study of participants' perceptions regarding RCDP during their pediatric emergency medicine rotation...
September 13, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Marissa S Heirich, Lanja S Sinjary, Maisa S Ziadni, Sandra Sacks, Alexandra S Buchanan, Sean C Mackey, Jordan L Newmark
Introduction: Unsafe opioid prescribing practices to treat acute and chronic pain continue to contribute to the opioid overdose crisis in the United States, a growing public health emergency that harms patients and their communities. Poor opioid prescribing practices stem in part from a lack of education and skills training surrounding pain and opioid management. Methods: As part of the Clinical Pain Medicine Fellowship at Stanford University, physicians were given the opportunity to participate in a pilot program to practice opioid management in a live, simulated interaction...
September 12, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Judith L Flanagan, Neilsen De Souza
Vision impairment and blindness arise both as a cause, and a consequence, of poverty. Achievement of the United Nations Sustainable Development Goals in providing universal access and equity in eye care, both within and between among countries, remains challenging. A severe shortage of eye care providers is creating unnecessary blindness and vision impairment in developing communities worldwide. Education and training develops and strengthens the capacity of emerging nations to contribute to global eye health and the World Health Organization Development Goals in an effective and sustainable way...
September 14, 2018: Asia-Pacific Journal of Ophthalmology
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