Venous Thromboembolism: Are NOACs the Right Initial Drug of Choice for Unprovoked Venous Thromboembolism?

To the Editor: Venous thromboembolism (VTE) is a common vascular disorder affecting approximately 500,000 people each year in the United States.1 With the advent of novel oral anticoagulants (NOACs), the treatment of VTE has been revolutionized, especially of provoked deep vein thrombosis.2 There remains a concern when VTE is...

Sports-Injury Encephalopathy

Sports-related encephalopathies are a growing concern among athletes who have experienced head trauma. Anxiety is heightened for the public and especially among parents of children playing contact sports. The most common neuropsychological conditions are concussions and traumatic encephalopathies. Concussions result from brain traumas that can be asymptomatic, but more...

Intravascular Iodinated Contrast Is an Independent Cause of Acute Kidney Injury Following Coronary Angiography

Objectives: Recent studies have questioned whether intravascular iodinated contrast remains an independent cause of acute kidney injury (AKI). We sought to assess whether iodinated contrast administered during coronary angiography is an independent cause of AKI.Methods: We identified all of the patients who underwent coronary angiography between July 1, 2015...

Commentary on “Use of Rheumatologic Testing in Patients Who Eventually Receive a Diagnosis of Rheumatoid Arthritis”

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder of unknown etiology, for which delay in diagnosis and treatment may cause irreversible structural joint damage in affected individuals. A large body of evidence supports that early diagnosis and aggressive treatment of RA have a fundamental role in the...

Use of Rheumatologic Testing in Patients Who Eventually Receive a Diagnosis of Rheumatoid Arthritis

Objectives: Anti-cyclic citrullinated peptide antibody (ACPA) has excellent specificity and prognostic value in patients with early rheumatoid arthritis (RA). The American College of Rheumatology included ACPA in their 2010 classification criteria for RA, but we hypothesize that primary care physicians (PCPs) underuse ACPA, even when clinical suspicion for RA...

CME Article: A More Directive Living Will for Older Adult Patients with End-Stage Medical Conditions?

Objectives: Many older adult patients want to be treated aggressively for reversible conditions, even when their current quality of life is limited; however, most standard living wills focus on the very end of life and provide little guidance to acute care providers (ACPs) should their older adult patient be...

Teaching Medical Students in the Rural Setting Long Term: Physicians’ Attitudes and Perceptions

Objectives: The University of Alabama School of Medicine Tuscaloosa Regional Campus conducted a 2-month block in rural family practice, but committed to expanding to an 8-month longitudinal rural curriculum. We wanted to explore how rural physicians feel about teaching students in a prolonged rural preceptorship.Methods: We brainstormed with colleagues,...

Implementation of Case Conferences to Improve Interprofessional Collaboration in Resident Continuity Clinic

Objectives: Residents must be trained in skills for interprofessional collaboration and team-based care in the outpatient setting, and successful models are needed to achieve this aim. A longitudinal curriculum was developed to enhance residents’ knowledge of interprofessional team members’ roles, residents’ attitudes toward team-based care, and patient referrals to...

Enhanced vs Standard Parents as Teacher Curriculum on Factors Related to Infant Feeding among African American Women

Objectives: To determine the comparative impact of the standard Parents as Teachers (PAT) to the nutrition and physical activity enhanced version (PATE) of the perinatal educational curriculum on compliance with infant feeding recommendations and changes in maternal infant feeding knowledge and beliefs.Methods: Women at least 18 years of age,...

Improving Transitions of Care for Healthy Adolescents and Young Adults

Objectives: To explore the gaps in care within the transition process from pediatric to adult medicine for healthy and noncomplex adolescents and young adults and to highlight the importance of identifying and adapting interventions to improve transitions for this population.Methods: Three researchers independently completed searches in PubMed, PsychINFO, and...

Kala Blakely, DNP, CRNP, NP-C

Dr. Reza Sadeghian is a mid-career Pediatrician/healthcare executive who has gone back for additional training in clinical informatics as a fellow at the University of...

Transitions of Care for Healthy Young Adults: Promoting Primary Care and Preventive Health

The transition of care between pediatric and adult medicine is a challenging time for patients and physicians. This longitudinal process encompasses much more than the physical transfer of a patient between providers. Established transition of care processes and literature exist for many chronic disease populations, but little focus has...

Anesthetic Errors During Procedures in the United States

Objectives: The purpose of this study was to identify the incidence of anesthetic errors per discharges in the United States within these errors, the incidence of death. A secondary aim was to identify any association between the mortality and patient comorbidities.Methods: A retrospective analysis of the hospitals in the...

A Simulation Course Focusing on Forensic Evidence Collection Improves Pediatric Knowledge and Standardizes Curriculum for Child Abuse

Objectives: Our hypothesis was that pediatric residents and medical students who participated in a structured forensic evidence collection course would have improved knowledge of prepubertal evidence collection practices and pubertal genital anatomy.Methods: The course curriculum included a forensic evidence collection video created by the sexual assault nurse examiner directors....

Comment on “Propofol Versus Dexmedetomidine for Procedural Sedation in a Pediatric Population”

The utilization and standards of practice for pediatric deep sedation have undergone multiple changes during the last 20 to 30 years. The key drivers of change include growth inimaging and surgical procedures along with desires to better alleviate patient stress related to anxiety or pain, improve procedural performance of...

Moral Injury or Burnout?

Burnout among healthcare providers is a growing problem, leading to the early retirement of otherwise qualified professionals and suboptimal medical care. Rates of physician burnout in the United States are estimated to exceed 50%, increasing the cost of medical care through high turnover and decreased quality of patient...

Homelessness Among Patients in a Southeastern Safety Net Emergency Department

Objectives: Emergency departments (EDs) are important providers for homeless individuals, providing vital health care and meeting the subsistence needs of many homeless patients (eg, food, water, shelter). Studies that have examined the proportion of patients in the ED setting who experience homelessness have been conducted primarily in the northeastern...

Commentary on “Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study”

Today’s modern medical world is an array of technology and protocolized care. Evidence-based care is driving uniform practice and avoiding variability. This, unfortunately, is alsodriving disenchantment, burnout, moral outrage, or whatever one wishes to call it, in doctors, nurses, and medical personnel. Electronic medical records, check boxes, rule-driven pharmacologic...

CME Article: Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study

Objective: The Pause is a short-term, microbreak created by an emergency nurse in 2009. It provides care team members a few seconds of silence to honor a patient who has died while also honoring the efforts of the team. It is used now on four continents as a standard...

Patients Threatening Harm to Others Evaluated in the Emergency Department under the Florida Involuntary Hold Act (Baker Act)

Objectives: This study describes the specific threats of harm to others that led to the use of the Baker Act, the Florida involuntary hold act for emergency department (ED) evaluations. The study also summarizes patient demographics, concomitant psychiatric diagnoses, and emergent medical problems.Methods: This is a retrospective review of...