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Evidence of questionable research practices in clinical prediction models. ROC curves help clinicians determine how well a test or model can differentiate between patients with and without a condition. Their widespread use introduces a strong temptation for researchers to achieve better AUC values.
Now let’s compare the two documents. Here is what the USPSTF says: They call for more research. That is my conclusion as well, and I favor large, pragmatic randomized trials in adults and kids with staggered starting times (adults first — to protect kids from harms we may not yet know). From their document.
Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. Studies supporting antibiotic treatment of documented mycoplasma pneumoniae in children are limited. Pediatr Emerg Care. 2025 Feb 17. doi: 10.1097/PEC.0000000000003338.
We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be welldocumented in the medical record, but more accurately identify the child’s injuries.” Cervical spine injuries in children associated with sports and recreational activities.
13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors.
Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. But the key fact is that every compression device manufacturer includes existing DVT as a contraindication in their product documentation.
In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR). Why is this study needed?
A 2015 Nature (Pediatric Research) paper by Nils J. Bergman summarizes a body of research that confirms the benefits of sleeping on the belly. Research by Collett et al (2018) shows that, despite some improvement in PP by 18 months, the deformations persist beyond 36 months. This may not be true for infants.
Introduction Pain is the most common presenting feature within the ED, yet undertreatment of pain in the ED is a well-documented problem worldwide. Despite the development of interventions to address this problem, there is still limited understanding of how pain management can be improved within the ED.
A recent study in Nature Medicine , entitled “ An automated histological classification system for precision diagnostics of kidney allografts ,” has showcased the efforts of a group of researchers who have developed an automated system that can diagnose kidney transplant rejection.
Currently, the infusion of IV calcium before diltiazem is not well understood, and more studies have focused on administering IV calcium prior to verapamil than diltiazem. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments.
Whereas previous versions of GPT were unable to pass the medical examinations, GPT-4 demonstrated scores of approximately 85 percent correct on each Step of USMLE, well above the passing threshold. Future versions are likely to have greater accuracy and error-checking abilities, as well as improved domain-specific generative abilities.
Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. This study aimed to assess discharge practices for children presenting with acute wheeze in emergency departments in the Paediatric Emergency Research in the UK and Ireland (PERUKI) network. Why does it matter?
She is the cofounder of FOAMcast and is a pulmonary embolism and implementation science researcher. It is not welldocumented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches. The headache is similar to prior migraine headaches.
If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. Additionally, a higher HR reduction at 30 and 60 minutes, as well as ED discharge/transfer. There was no difference in safety outcomes.
1] It is worth mentioning this formula was designed for well, euvolaemic children, which does not represent the popluation of children who require IV fluids. saline), however more research is needed in this area. [4] Our population and their demographics has also changed significantly since this study in 1957.
Nurse notes: the silent scream of the heart The emergency nursing notes document the patient complaining of chest pain refractory to nitro, with a rising trop: 2200: ECG shown to ED MD 0020: repeat ECG shown to ED MD, patient complain of midsternal chest pain 0520: nitro x 3. . _
Unequal distribution of domestic responsibility has been documented as a factor in the underrepresentation in female physicians in leadership roles in academic medicine as well as contributing to career satisfaction. How does this apply to us? Similar Articles Hitti E, Hadid D, Khoury SJ, Tamim H, Makki M, Karam CM.
Why does it work so well? When I found it, I felt the documentation (if done at all) largely tended to be the bare minimum, and certainly not reflective of the beautiful learning conversations happening in the room. – The re-design of C+C documentation process was launched. It also dovetails with our governance process.
We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.
Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. 2018 Jun;54(6):633-7.
Emergency physicians have become leaders in achieving cost efficiency in health care, predominantly through implementation of new processes and research findings, enabling us to achieve significant financial savings. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice.
1 Other, non-transformer-based ML methods can be used on clean, well-structured data sets, but LLMs are frequently capable of feats of unanticipated competence right out of the box. The evolving capabilities of LLMs far outpace the ability of researchers to test and report their performance.
It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. If you think your patient is the perpetrator, he may well be an innocent, or even an off-duty or undercover officer.
Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Am J Cardiol.
Paediatric social admissions, unlike social determinants of health (SDOH) and adverse childhood experiences (ACEs) is under-researched. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. More ACEs can lead to increased rates of common childhood illnesses.
weeks was seen for well-care. No specific documentation regarding the duration of the car seat testing could be identified in the medical records. Patient Presentation A former 35 week, appropriate for gestational age male, now 37.5 The pertinent physical exam showed the patient was now 3.34
Should also document presence of shunt, size and direction. Your histogram allows you to visualise how well your patient is oxygenating over a longer time period rather just a snapshot, and this gives you the opportunity to optimise oxygenation by altering ventilator settings if required. 2/3 systemic is normal.
This is based partly on the Western ethical principle of autonomy: our family members know us well and (it’s generally agreed) can best ascertain what care we would agree to, or not. This is a well-established principle. Yet it’s also important to acknowledge some correlated truths. But that is not your job.
Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in the UK and Ireland) to point out something that has caught their eye. These are the preferable contraceptive choice, so this point appears to have been well communicated in the video. Why does it matter? Children (Basel). 2023 Jan 15;10(1):171.
and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented.
The under-representation of women in clinical trials has been welldocumented but even less appreciated is the lack of attention to potential differences in outcomes according to sex and gender.
This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.
You can assess how well (or poorly) a practicing cardiologist did analyzing a paper in the Journal of Clinical Epidemiology. Specification curve analysis is similar to a multiverse analysis, meaning it’s a way of defining and implementing all plausible and valid analytic approaches to a research question. It’s the Methods
He had no previously documented medical problems except polysubstance use. The LCx and OM vessels are not as well visualized. Circulation Research , 56 (2), 184–194. That said, most of the time — AIVR is a short-lived and benign rhythm ( as well as an encouraging sign that at least some reperfusion is occurring).
The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” 0700 : The PA-C goes off-shift.
Peter Attia - From Surgeon to Longevity Guru I first encountered Peter Attia online while researching ketosis , the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched and helpful. To support his Medicine 3.0 2 Apparently, in Attia's practice, "this is my starting point with any patient.
She is the cofounder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and research methodology editor for Annals of Emergency Medicine […] The post SGEM#316: What A Difference An A.P.P. Diagnostic Testing Differences Between A.P.P.s Reference: Pines et al.
A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. The presence of these pathways is documented inutero and they usually regress by around 20 weeks gestation. Family history. What are the important investigations?
Corneal injury and defects have been documented from direct contact of milkweed sap to the eye and any exposure should be immediately treated with copious water irrigation. Dr. Hack is chief of the division of medical toxicology and vice chair for research at East Carolina University in Greenville, North Carolina.
4 The association between ackee ingestion and the illness was initially recognized in 1875 and officially documented in 1904. 5 Despite being endemic to Jamaica, cases of THS have been reported across the world, with the first case in the United States documented in 1993. Franco is an emergency medicine attending physician at St.
AEM Dec 2022 Guest Skeptic: Dr. Michelle Lin is an emergency physician and health services researcher whose goal is to transform acute care delivery to best meet the needs of those who experience the […] The post SGEM Xtra: You Don’t Own Me – Post Roe Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.
Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries.
Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Documents improvements in BVMs previously investigated and found deficient in FIO2.
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