Precision emergency medicine.

Background: Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop personalized health solutions. To date, emergency medicine has not deeply engaged in the precision health movement. However, rapid advances in health technology, data science, and medical informatics offer new opportunities for emergency medicine to realize the promises of precision health.

Pneumothorax associated with accidental 4-nitrophenyl chlonoformate inhalation in an academic chemistry lab.

An otherwise healthy 16-year-old male presented to the pediatric emergency department 12 hours after accidental inhalation of 4-nitrophenyl chloroformate in a chemistry lab. His only pertinent findings were a complaint of chest tightness and decreased breath sounds on a pulmonary exam. He was found on chest radiograph to have a large right-sided pneumothorax with slight mediastinal shift and mild interstitial prominence.

Computed tomography rates in pediatric trauma patients among emergency medicine and pediatric emergency medicine physicians.

Background: Pediatric trauma patients undergo fewer computed tomography (CT) scans when evaluated at pediatric trauma centers (PTC) versus adult trauma centers (ATC) with no change in clinical outcome. Factors contributing to this difference are unclear. We sought to identify whether the training background of physicians, specifically emergency medicine (EM) versus pediatric emergency medicine (PEM), affected the CT rate of pediatric trauma patients within one institution.

Emergency department implementation of abbreviated magnetic resonance imaging for pediatric traumatic brain injury.

Pediatric head injury is a common presenting complaint in the emergency department (ED), often requiring neuroimaging or ED observation for diagnosis. However, the traditional diagnostic neuroimaging modality, head computed tomography (CT), is associated with radiation exposure while prolonged ED observation impacts patient flow and resource utilization. Recent scientific literature supports abbreviated, or focused and shorter, brain magnetic resonance imaging (MRI) as a feasible and accurate diagnostic alternative to CT for traumatic brain injury.

Magnetic Resonance Imaging Versus Ultrasound as the Initial Imaging Modality for Pediatric and Young Adult Patients With Suspected Appendicitis.

Background: While ultrasound (US), given its lack of ionizing radiation, is currently the recommended initial imaging study of choice for the diagnosis of appendicitis in pediatric and young adult patients, it does have significant shortcomings. US is time-intensive and operator dependent and results in frequent inconclusive studies, thus necessitating further imaging and admission for observation or repeat clinical visits. A rapid focused magnetic resonance imaging (MRI) for appendicitis has been shown to have definitive sensitivity and specificity, similar to computed tomography but without radiation and offers a potential alternative to US.

Predictors of Nondiagnostic Ultrasound for Appendicitis.

Background: Ionizing radiation and cost make ultrasound (US), when available, the first imaging study for the diagnosis of suspected pediatric appendicitis. US is less sensitive and specific than computed tomography (CT) or magnetic resonance imaging (MRI) scans, which are often performed after nondiagnostic US.

Objectives: We sought to determine predictors of nondiagnostic US in order to guide efficient ordering of imaging studies.

Development of DASH Mobile: a mHealth lifestyle change intervention for the management of hypertension.

Several landmark studies based on the DASH diet have established the effectiveness of a lifestyle approach to blood pressure control that emphasizes a diet rich in fruits and vegetables with moderate portions of low-fat dairy and lean protein along with increased physical activity and reduced sodium intake. However, this evidence base remains underused due feasibility limitations of implementing these intense in-person interventions and poor engagement with desktop computer based versions. Mobile technologies such as smartphones and wireless sensors have the ability to deliver behavioral interventions in-the-moment and with reduced user burden.

Improved physician work flow after integrating sign-out notes into the electronic medical record.

Background: In recent years, electronic sign-out notes have been identified as a means of enhancing the effective transfer of patient care between providers. Such a tool was developed and implemented within the electronic medical record (EMR) system, and its impact on physician work flow was assessed.

Methods: A printable sign-out report was implemented within the EMR system at a tertiary academic children's hospital.

[First epileptic seizure in the elderly: electroclinical and etiological data in 341 patients].

This study included 341 subjects aged over 60 years, 174 females and 167 males, (mean age 72-years), who experienced their first epileptic seizure and fulfilled all inclusion criteria over an 8-year period. Data were available from the physical examination, EEG, laboratory tests and CT scan or MRI for all patients. The international classification of epileptic seizures was applied, 41 p.

[Diogenes syndrome in the elderly: clinical form of frontal dysfunction? Report of 4 cases].

Purpose: Diogenes syndrome is characterised by self-neglect and domestic squalor which leads to unhealthy living conditions. It seems that no single model satisfactorily explains the development of Diogenes syndrome.

Methods: We report four cases of Diogenes syndrome discovered during a short-stay geriatric hospitalization.

[Hypernatremia in the aged: clinical characteristics].

Objective: Hypernatremia in young adults is a rare condition, sometimes occurring after gastrointestinal diseases, osmotic diuresis or diabetes insipidus. The clinical characteristics and prognosis of hypernatremia in geriatric patients would be different. Each case must be examined separately.

Subacute bacterial endocarditis masquerading as type III essential mixed cryoglobulinemia.

An adult man presented severely ill with vasculitis of his lower extremities and with impaired kidney function. After detailed evaluation at a local hospital, a diagnosis of essential type III cryoglobulinemia was made. High-dose steroid and cyclophosphamide therapy was begun.