Unusual bot fly larva removed from the scalp of a returning traveler.

An aberrant bot fly specimen was removed from the scalp of a patient 3 wk after returning from Belize. The specimen showed little resemblance to the typical human bot fly larva, Dermatobia hominis, prompting a molecular identification using cytochrome oxidase I and II (COI and COII, respectively) mitochondrial DNA sequence regions. A BLAST search was subsequently performed, and both our COI and COII amplicon sequences showed 99-100% match with Dermatobia hominis, despite the specimen's clearly aberrant morphology.

Fifteen-minute consultation: Management of raised intracranial pressure in children.

Raised intracranial pressure (ICP) in children can be very challenging to recognise and manage. In order to minimise secondary brain injury, measures to reduce intracranial pressure must be initiated as soon as possible. Initial management is often commenced in District General Hospitals prior to transfer for definitive treatment.

Digital supervision in the clinical learning environment: Characterizing teamwork in the electronic health record.

Background: Attending physicians in academic hospitals work in supervisory team structures with medical residents to provide patient care. How attendings utilize the electronic health record (EHR) to support learning through supervision is not well understood.

Objective: To compare EHR behavior on teaching versus direct care, including evidence of supervisory calibration to learners.

Physician EHR Time and Visit Volume Following Adoption of Team-Based Documentation Support.

Importance: Physicians spend the plurality of active electronic health record (EHR) time on documentation. Excessive documentation limits time spent with patients and is associated with burnout. Organizations need effective strategies to reduce physician documentation burden; however, evidence on team-based documentation (eg, medical scribes) has been limited to small, single-institution studies lacking rigorous estimates of how documentation support changes EHR time and visit volume.