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Research and Reviews in the Fastlane 167
This article summarizes several retrospective reviews, concluding that patients with heroin overdose typically do well after EMS treat-and-release naloxone administration, and that they can be safely discharged from the ED after a period of one-hour observation. Considerable limitations in the retrospective nature of such reviews and significant impact of new adulterants such as fentanyl and U-47700 on current “heroin” overdoses seriously limit interpretation and applicability of these studies to today’s clinical practice. Strong caution should be taken in making practice changes based on retrospective and potentiall...
Source: Life in the Fast Lane - January 5, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Toxicology and Toxinology recommendations research and reviews Resuscitation Source Type: blogs

68 minutes with chest compressions, full recovery. Plus recommendations from a 5-member panel on cardiac arrest.
The following is told with full permission of the patient, who is a paramedic who also started, owns and runs with his wife a company for teaching CPR.  He has taught CPR to over 100,000 people.  And he's a wonderful guy.   Here is his story:Near midnight in December, this 56 yo very healthy and vigorous paramedic was out on a run with a critical case when his partner found him unresponsive in the front seat of the ambulance.  The partner began manual chest compressions immediately and called for help.  He was found to be in ventricular fibrillation and was defibrillated 4 times, unsuccessfully.&nb...
Source: Dr. Smith's ECG Blog - April 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs

Efficacy, We Don ' t Need No Stinking Proof of Efficacy - Says Apparent Trump Candidate to Lead FDA
DiscussionWe could do our usualrant about the revolving door here.   Obviously, the revolving door pheonomenon is a serious conflict of interest, if not form of corruption, that should have no place in our government, particularly in its agencies that are concerned with health care.  But there is a bigger issue here.So add anyone who might have to receive any medical treatment to the long list of people who should be worried about a future Trump administration.  Maybe we would all be better off if Mr Tump finds something else to do for the next four years.  Maybe he should stick tobeing executive p...
Source: Health Care Renewal - December 9, 2016 Category: Health Management Tags: adverse effects Donald Trump evidence-based medicine FDA revolving doors Source Type: blogs

A cohort study of blunt cerebrovascular injury screening in children: Are they just little adults?
BACKGROUND Blunt cerebrovascular injuries (BCVIs) are rare with nonspecific predictors, making optimal screening critical. Radiation concerns magnify these issues in children. The Eastern Association for the Surgery of Trauma (EAST) criteria, the Utah score (US), and the Denver criteria (DC) have been advocated for pediatric BCVI screening, although direct comparison is lacking. We hypothesized that current screening guidelines inaccurately identify pediatric BCVI. METHODS This was a retrospective cohort study of pediatric trauma patients treated from 2005 to 2015 with radiographically confirmed BCVI. Our primary outc...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - December 26, 2017 Category: Orthopaedics Tags: WTA 2017 Plenary Paper Source Type: research

In Pursuit Of Hospital Quality: Creating Effective Performance Measures And Transparency In Health Care
When Garrison Keillor of “Prairie Home Companion” fame welcomes his radio audience to Lake Wobegon, his fictional Minnesota town, he describes it as a place where, “all the children are above average.” When one of us or our loved ones goes to a hospital for care, we expect that facility to be “above average” too. Sometimes we are able to choose the hospital where we seek care; sometimes, due to an emergency, we have no choice. Either way, we depend on the professionalism of the hospital and its clinicians to provide high quality care and keep us safe. Reports by the Institute of Medicine (IOM) and other researc...
Source: Health Affairs Blog - August 4, 2015 Category: Health Management Authors: Charles Kahn Tags: Featured Health Professionals Hospitals Medicare Organization and Delivery Payment Policy Population Health Quality big data Charles Kahn Hospital Care Hospital Quality Alliance IOM Metrics Patient Safety Source Type: blogs

Health Care: What Should a Populist Do Now?
Conclusion The most common response to the suggestion that private contracts could be useful in reforming the health-care system for the benefit of ordinary Americans is the observation that people—ordinary Americans in particular—cannot reasonably be expected to read, let alone understand and compare, the multiple contracts they would confront. This point, however, while valid, is beside the real one, which is to give adequately subsidized consumers meaningful choices with respect to the cost and content of their future health care and enough reliable help in making them that they can be reasonably content with their ...
Source: The Health Care Blog - April 1, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Tropical Travel Trouble 008 Total TB Extravaganza
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 008 Peer Reviewer Dr McBride ID physician, Wisconsin TB affects 1/3rd of the population and one patient dies every 20 seconds from TB. Without treatment 50% of pulmonary TB patients will be dead in 5 years. In low to middle income countries both TB and HIV can be ubiquitous, poor compliance can lead to drug resistance and malnourished infants are highly susceptible. TB can be very complex and this post will hopefully give you the backbone to TB m...
Source: Life in the Fast Lane - June 16, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine Genexpert meningitis TB TB meningitis Tuberculosis Source Type: blogs

Variation in Pediatric Post-Ablation Care: A  Survey of the Pediatric and Congenital Electrophysiology Society (PACES)
This study describes the variation in post-ablation practices identified through a survey of the pediatric and congenital electrophysiology society (PACES). Pediatric and congenital electrophysiology society members were invited to participate in an online survey of post-ablation practices in September 2014. Survey questions targeted routine post-ablation practices for three common arrhythmia substrates: atrioventricular nodal reentry tachycardia, concealed accessory pathways (AP), and manifest APs. Significant practice variation was defined as  <90% concordance among respondents. There were 70 respondents from 67 cent...
Source: Pediatric Cardiology - June 15, 2017 Category: Cardiology Source Type: research

Antithrombotic Therapy Management of Adult and Pediatric Cardiac Surgery Patients.
This article is protected by copyright. All rights reserved. PMID: 30153372 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - August 28, 2018 Category: Hematology Authors: Baumann Kreuziger L, Karkouti K, Tweddell J, Massicotte MP Tags: J Thromb Haemost Source Type: research

Multisystem Inflammatory Syndrome in Children: Follow-Up of a Cohort from North India
This study was conducted to describe the long-term outcome of MIS-C from a tertiary care center in North India. Children admitted with MIS-C from September 2020 to January 2021 were followed up after discharge until June 2021. The details during the acute phase (clinical features, investigations, treatment, and outcome) and follow-up (symptoms, echocardiographic findings, ongoing treatment, and outcome) were collected retrospectively. During the acute phase, 40 children presented at median (interquartile range [IQR]) age of 7 (5-10) years with fever, mucocutaneous, gastrointestinal, and respiratory symptoms. The majority (...
Source: The American Journal of Tropical Medicine and Hygiene - February 16, 2022 Category: Tropical Medicine Authors: Puspraj Awasthi Vijay Kumar Sanjeev Naganur Karthi Nallasamy Suresh Kumar Angurana Arun Bansal Rohit Kumar Manoj Muralidharan Jayashree Source Type: research

Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia
ConclusionTreatment of CLI patient with SCS improved patient's walking ability, pain severity, and sleep quality. SCS should be considered as an effective treatment toward limb salvage in CLI.
Source: Neuromodulation - January 1, 2018 Category: Neurology Authors: Jung ‐Tung Liu, Chen‐Hsing Su, Se‐Yi Chen, Sang‐Jek Liew, Cheng‐Siu Chang Tags: Clinical Research Source Type: research

Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management.
Authors: Brummel A, Lustig A, Westrich K, Evans MA, Plank GS, Penso J, Dubois RW Abstract BACKGROUND: One of the most important and often overlooked challenges for accountable care organizations (ACOs) is ensuring the optimal use of pharmaceuticals, which can be accomplished by utilizing pharmacists' skillsets and leveraging their full clinical expertise. Developing capabilities that support, monitor, and ensure appropriate medication use, efficacy, and safety is critical to achieving optimal patient outcomes and, ultimately, to an ACO's success. The program described in this article highlights the best practices o...
Source: Journal of Managed Care Pharmacy - December 12, 2014 Category: Drugs & Pharmacology Tags: J Manag Care Pharm Source Type: research