Pleural fluid cell-free DNA integrity index to identify cytologically negative malignant pleural effusions including mesotheliomas.

Background: The diagnosis of malignant pleural effusions (MPE) is often clinically challenging, especially if the cytology is negative for malignancy. DNA integrity index has been reported to be a marker of malignancy. The aim of this study was to evaluate the utility of pleural fluid DNA integrity index in the diagnosis of MPE.

Effects of hyperbaric oxygen therapy on quality of life in maxillofacial patients with type III osteoradionecrosis.

Purpose: Over a 4-year period, 18 patients with type III osteoradionecrosis that developed an average of 55 months after radiotherapy treatment for head and neck cancers were referred for hyperbaric oxygen therapy (HBO(2)).

Materials And Methods: Participants completed a questionnaire battery before and after HBO(2), including the European Organization for Research and Treatment of Cancer (EORTC) Core 30, the EORTC Head and Neck 35, and the Medical Outcomes Short Form 36.

Results: The EORTC Core 30 questionnaire indicated significant improvements in "emotional functioning" and "insomnia" (P ≤ .

Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement.

Background: The National Quality Forum (NQF) has endorsed a performance measure designed to increase imaging efficiency for the evaluation of pulmonary embolism (PE) in the emergency department (ED). To our knowledge, no published data have examined the effect of patient-level predictors on performance.

Methods: To quantify the prevalence of avoidable imaging in ED patients with suspected PE, we performed a prospective, multicenter observational study of ED patients evaluated for PE from 2004 through 2007 at 11 US EDs.

Self-reported use of communication techniques in the emergency department.

Background: Communication is considered a core competency for physicians. However, the Emergency Department setting poses significant and unique communication challenges.

Objective: The objective of this study was to explore self-reported use and perceptions of effectiveness and feasibility of communication techniques used by Emergency Physicians for communication with patients.

Pacific sleeper shark Somniosus pacificus trophic ecology in the eastern North Pacific Ocean inferred from nitrogen and carbon stable-isotope ratios and diet.

Stable-isotope ratios of nitrogen (δ¹⁵N) and lipid-normalized carbon (δ¹³C') were used to examine geographic and ontogenetic variability in the trophic ecology of a high latitude benthopelagic elasmobranch, the Pacific sleeper shark Somniosus pacificus. Mean muscle tissue δ¹³C' values of S. pacificus differed significantly among geographic regions of the eastern North Pacific Ocean.

Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: The POMPE-C tool.

Background: Clinical guidelines recommend risk stratification of patients with acute pulmonary embolism (PE). Active cancer increases risk of PE and worsens prognosis, but also causes incidental PE that may be discovered during cancer staging. No quantitative decision instrument has been derived specifically for patients with active cancer and PE.

Queensland Lung Cancer Screening Study: rationale, design and methods.

Background: Lung cancer is the leading cause of cancer-related mortality in Australia. Screening using low-dose computed tomography (LDCT) can reduce lung cancer mortality. The feasibility of screening in Australia is unknown.

Prospective study of the frequency and outcomes of patients with suspected pulmonary embolism administered heparin prior to confirmatory imaging.

Objectives: The administration of empiric systemic anticoagulation (ESA) before confirmatory radiographic testing in patients with suspected pulmonary embolism (PE) may improve outcomes, but no data have been published regarding current practice. We describe the use of ESA in a large prospective cohort of emergency department (ED) patients and report the outcomes of those treated with ESA compared with patients not receiving ESA.

Methods: 12-center, noninterventional study of ED patients who presented with symptoms concerning for PE.

D-dimer threshold increase with pretest probability unlikely for pulmonary embolism to decrease unnecessary computerized tomographic pulmonary angiography.

Background: Increasing the threshold to define a positive D-dimer could reduce unnecessary computed tomographic pulmonary angiography (CTPA) for a suspected pulmonary embolism (PE) but might increase rates of a missed PE and missed pneumonia, the most common non-thromboembolic diagnosis seen on CTPA.

Objective: Measure the effect of doubling the standard D-dimer threshold for 'PE unlikely' Revised Geneva (RGS) or Wells' scores on the exclusion rate, frequency and size of a missed PE and missed pneumonia.

Methods: Patients evaluated for a suspected PE with 64-channel CTPA were prospectively enrolled from emergency departments (EDs) and inpatient units of four hospitals.

European and American suspected and confirmed pulmonary embolism populations: comparison and analysis.

Background: If the prevalence of pulmonary embolism (PE) differs significantly between the US and Europe, this observation could reduce the generalizability of diagnostic protocols for PE derived in either location.

Objective: To determine possible causes and potential clinical consequences of these PE prevalence differences.

Methods: Secondary analysis of three prospectively collected multicenter samples (two French and one from the US) including 3174 European and 7940 American PE-suspected patients in Emergency departments (ED) (117 for Europe and 12 for US).

Induction of therapeutic hypothermia via the esophagus: a proof of concept study.

Background: Induction of hypothermia (a 4 °C decrease from baseline) improves outcomes in adult cardiac arrest and neonatal hypoxic ischemic encephalopathy, and may benefit other conditions as well. Methods used to implement or prevent hypothermia typically require skin contact with blankets or pads or intravascular access with catheter devices. The study was to evaluate the potential to induce mild therapeutic hypothermia via an esophageal route in a porcine model.

Prior altitude experience of climbers attempting to summit Aconcagua.

Aconcagua (6962 m) is one of the seven summits and the highest mountain outside of Asia. Climbers of varying experience are drawn to its nontechnical route. Our objective was to detail the prior altitude experience of climbers attempting to summit Aconcagua.

Cost-effectiveness of influenza vaccination of older adults in the ED setting.

Objectives: Adults older than 50 years are at greater risk for death and severe disability from influenza. Persons in this age group, however, are frequently not vaccinated, despite extensive efforts by physicians to provide this preventive measure in primary care settings. We performed this study to determine if influenza vaccination of older adults in the emergency department (ED) may be cost-effective.

Age, cumulative trauma and stressful life events, and post-traumatic stress symptoms among older adults in prison: do subjective impressions matter?

Background: The aging prison population in the United States presents a significant public health challenge with high rates of trauma and mental health issues that the correctional system alone is ill-prepared to address. The purpose of this study was to examine the relationship of age, objective, and subjective measures of trauma and stressful life events and post-traumatic stress symptoms among older adults in prison.

Methods: Data were gathered from 334 prisoners (aged 55+) housed in the New Jersey Department of Corrections, as of September 2010.

[η-(Phenyl-ethyn-yl)cyclo-penta-dien-yl](η-tetra-phenyl-cyclo-butadiene)cobalt(I).

In the title compound, [Co(C(13)H(9))(C(28)H(20))], the Co atom is sandwiched between cyclo-penta-dienyl and cyclo-butadienyl rings that are inclined at a dihedral angle of 2.6 (3)°. The four phenyl rings are tilted with respect to the cyclo-butadienyl plane so that the C(4)Ph(4) unit constitutes a four-bladed propeller.

Palliative care symptom assessment for patients with cancer in the emergency department: validation of the Screen for Palliative and End-of-life care needs in the Emergency Department instrument.

Objective: We sought to develop and validate a novel palliative medicine needs assessment tool for patients with cancer in the emergency department.

Methods: An expert panel trained in palliative medicine and emergency medicine reviewed and adapted a general palliative medicine symptom assessment tool, the Needs at the End-of-Life Screening Tool. From this adaptation a new 13-question instrument was derived, collectively referred to as the Screen for Palliative and End-of-life care needs in the Emergency Department (SPEED).

Visual analog scale (VAS) for assessment of acute mountain sickness (AMS) on Aconcagua.

Objective: The Lake Louise AMS Self-Report Score (LLSelf) is a commonly used, validated assessment of acute mountain sickness (AMS). We compared LLSelf and visual analog scales (VAS) to quantify AMS on Aconcagua (6962 m).

Methods: Prospective observational cohort study at Plaza de Mulas base camp (4365 m), Aconcagua Provincial Park, Argentina.

Lower mortality in sepsis patients admitted through the ED vs direct admission.

Purpose: Early aggressive resuscitation in patients with severe sepsis decreases mortality but requires extensive time and resources. This study analyzes if patients with sepsis admitted through the emergency department (ED) have lower inpatient mortality than do patients admitted directly to the hospital.

Procedures: We performed a cross-sectional analysis of hospitalizations with a principal diagnosis of sepsis in institutions with an annual minimum of 25 ED and 25 direct admissions for sepsis, using data from the 2008 Nationwide Inpatient Sample.

Targeting ovarian tumor cell adhesion mediated by tissue transglutaminase.

Tissue transglutaminase (TG2) is a transpeptidase involved in protein cross-linking through generation of ε-(γ-glutamyl)lysine isopeptide bonds. It also promotes cell adhesion through interaction with fibronectin and facilitates formation of fibronectin-integrin complexes. This interaction is involved in tumor cell adhesion to the matrix and in the process of tumor dissemination.

Fibrinolysis and thrombectomy for massive pulmonary embolus.

Treatment options for massive and submassive pulmonary embolus may include hemodynamic support, fibrinolysis, anticoagulation, and thrombectomy. Selection of the appropriate therapy requires scrutiny of the patient's hemodynamic status, preexisting conditions, risk of complications, and availability of services at the treatment center. This article illustrates a case of successful fibrinolysis and thrombectomy in a woman with massive pulmonary embolus.

Adaptation of EPEC-EM Curriculum in a Residency with Asynchronous Learning.

Objective: The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.

Methods: Curriculum adaptation followed Kern's standardized six-step curriculum design process.

An unusual presentation of metastatic colon adenocarcinoma in the oral cavity.

Background. A case report of a nonhealing ulcer of the tongue histologically proven to be adenocarcinoma. Method.

A novel online didactic curriculum helps improve knowledge acquisition among non-emergency medicine rotating residents.

Objectives: Rotating residents represent a significant proportion of housestaff in academic emergency departments (EDs), yet they rarely receive targeted didactic education during their emergency medicine (EM) rotations. The goals of this study were: 1) to determine the effectiveness of an online didactic curriculum in improving EM knowledge among rotating residents and 2) to assess rotating resident satisfaction with this curriculum.

Methods: The authors created an online lecture series of six EM subject areas targeted to rotating residents called the Northwestern University Rotating Resident Curriculum (NURRC).

Postexercise peripheral oxygen saturation after completion of the 6-minute walk test predicts successfully reaching the summit of Aconcagua.

Objective: The 6-minute walk test (6MWT) is a single measurement of functional status in patients with cardiovascular disease. It has not been studied at high altitude. We investigate the screening value of 6-minute walk distance (6MWD) and postexercise vital sign (VS) measurements as predictors of successfully reaching the summit or development of acute mountain sickness (AMS) on Aconcagua (6962 m).