Factors influencing implementation and adoption of direct oral penicillin challenge for allergy delabelling: a qualitative evaluation.

Background: Over 95% of penicillin allergy labels are inaccurate and may be addressed in low-risk patients using direct oral penicillin challenge (DPC). This study explored the behaviour, attitudes and acceptability of patients, healthcare professionals (HCPs) and managers of using DPC in low-risk patients.

Methods: Mixed-method, investigation involving patient interviews and staff focus groups at three NHS acute hospitals.

The reporting standards of randomised controlled trials in leading medical journals between 2019 and 2020: a systematic review.

Randomised controlled trials (RCTs) are the gold standard study design used to evaluate the safety and effectiveness of healthcare interventions. The reporting quality of RCTs is of fundamental importance for readers to appropriately analyse and understand the design and results of studies which are often labelled as practice changing papers. The aim of this article is to assess the reporting standards of a representative sample of randomised controlled trials (RCTs) published between 2019 and 2020 in four of the highest impact factor general medical journals.

An Exploration of Gender Bias Affecting Women in Medicine.

Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach.

Lemonade from Lemons-Using COVID Downtime to Teach Essential Telemedicine Skills.

As a result of the COVID-19 pandemic, the use of telemedicine has rapidly accelerated. Our orthopaedic department created a telemedicine educational program for residents using standardized patient scenarios. Training residents to use telemedicine will help them navigate through unforeseen issues that otherwise may have never been a consideration.

Identification and characterization of enzymes involved in the biosynthesis of pyrimidine nucleoside antibiotics.

Covering: up to September 2020 Hundreds of nucleoside-based natural products have been isolated from various microorganisms, several of which have been utilized in agriculture as pesticides and herbicides, in medicine as therapeutics for cancer and infectious disease, and as molecular probes to study biological processes. Natural products consisting of structural modifications of each of the canonical nucleosides have been discovered, ranging from simple modifications such as single-step alkylations or acylations to highly elaborate modifications that dramatically alter the nucleoside scaffold and require multiple enzyme-catalyzed reactions. A vast amount of genomic information has been uncovered the past two decades, which has subsequently allowed the first opportunity to interrogate the chemically intriguing enzymatic transformations for the latter type of modifications.

Blind nasogastric tube advancement following sleeve gastrectomy: an animal model.

Background: Sleeve gastrectomy is an effective surgical treatment for morbid obesity. The major technical risk of this procedure is staple line dehiscence. Some surgeons are reluctant to place a nasogastric tube (NGT) blindly due to the perceived risk of damage to the staple line.

Refining and expanding nonribosomal peptide synthetase function and mechanism.

Nonribosomal peptide synthetases (NRPSs) are involved in the biosynthesis of numerous peptide and peptide-like natural products that have been exploited in medicine, agriculture, and biotechnology, among other fields. As a consequence, there have been considerable efforts aimed at understanding how NRPSs orchestrate the assembly of these natural products. This review highlights several recent examples that continue to expand upon the fundamental knowledge of NRPS mechanism and includes (1) the discovery of new NRPS substrates and the mechanism by which these sometimes structurally complex substrates are made, (2) the characterization of new NRPS activities and domains that function during the process of peptide assembly, and (3) the various catalytic strategies that are utilized to release the NRPS product.

Antibacterial and Cytotoxic Actinomycins Y-Y and Zp from Streptomyces sp. Strain Gö-GS12.

Four new Y-type actinomycin analogues named Y-Y (1-4) were isolated and characterized from the scale-up fermentation of the Streptomyces sp. strain Gö-GS12, as well as actinomycin Zp (5), which was, for the first time, isolated as a natural product. Structures of the new compounds were elucidated by the cumulative analyses of NMR spectroscopy and HRMS.

Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 institute of medicine resident duty hours recommendations.

Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience.

Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 Institute of Medicine resident duty hours recommendations.

Background: Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated.

Discussion: The elements highlighted include patient safety, resident wellness, and the resident training experience.

Impact of outside regulatory investigation on opiate administration in the emergency department.

Unlabelled: This study was conducted to determine whether outside regulatory investigation related to opiate prescription diversion changes the prescribing frequency of opiates in an emergency department (ED). The presence of ED administration of opiates and prescriptions for opiates on discharge were compared across a baseline period 90 days before arrest of a physician for opiate diversion, a period immediately surrounding the arrest, and a follow-up period 90 days later. At no time was there investigation of excessive opiate prescribing for patients in the ED.

Keynote address: Toward a pragmatic model for community consultation in emergency research.

Under the Final Rule enacted in 1996 by the United States Food and Drug Administration and Office of Health and Human Services, community consultation and public notification are required when emergency research is to be conducted in the absence of prior informed consent by subjects. There is a dearth of published recommendations concerning the degree to which communities must be aware of the existence and parameters of a study for which informed consent might not be obtained prior to enrollment. It is argued that effective community consultation requires empirical measurement of the dynamics of community, and that ordinary notions of community may not capture the populations at greatest risk or those who might for other reasons figure most prominently in community consultation.

The effect of practitioner characteristics on patient pain and embarrassment during ED internal examinations.

Unlabelled: The objective was to determine if practitioner characteristics influence patients' pain and embarrassment during an emergency department (ED) internal pelvic examination (IPE). This prospective, comparative study was performed in an urban, university teaching hospital ED with an annual census of 64,000. The study population consisted of a convenience sample of patients who required an IPE as part of her ED evaluation.

Midazolam syrup as a premedication to reduce the discomfort associated with pediatric intravenous catheter insertion.

This randomized, double-blind, placebo-controlled study evaluated midazolam syrup for reducing discomfort from intravenous placement in children 9 months to 6 years. Parents and observers rated the child's discomfort by using visual analogue scales. Median parents' pain scores were significantly lower in the midazolam than the placebo group (P =.

Parental report of child restraint device use in an emergency department population.

To survey parents regarding use of child restraint devices (CRD) and knowledge of CRD recommendations, parents of children < or = 14 years of age presenting to an emergency department (ED) provided demographic data and answered questions regarding the family's restraint use and their understanding of CRD recommendations. Three hundred thirteen adults completed surveys, providing data on 541 children. Decreasing restraint use was reported with advancing child age.

Nebulized fentanyl for relief of abdominal pain.

Objective: To compare the efficacies of nebulized vs. intravenous fentanyl for the relief of abdominal pain.

Methods: This randomized, double-blind, double-placebo-controlled study compared nebulized and intravenous fentanyl (1.

Necessity of fire department response to the scene of motor vehicle crashes.

The purpose of this study was to identify how often fire department (FD) response to the scene of motor vehicle crashes (MVCs) is necessary for rescue and fire suppression. A retrospective review of MVCs between January 1, 1997 and December 13, 2000 occurring in a suburban municipality (population 79,000, 13 FDs) was conducted. Data abstracted included the total number of reported MVCs, MVCs with personal injury (PIAC), MVCs to which the FD responded, MVCs requiring any extrication, MVCs requiring extensive extrication, and MVCs requiring fire suppression.

The emergency department care of hemodialysis patients.

Aims: To describe the emergency department (ED) presentation, evaluation and disposition of maintenance hemodialysis (HD) patients.

Materials And Methods: A retrospective review of adult HD patients seen 1/1-12/31/97. The following was collected: demographics, mode of arrival, chief complaint, etiology of renal failure, evaluation, treatment, disposition, length of stay and facility charges.

Prevalence of traumatic brain injury in an ED population.

The objective of this study was to determine prevalence of traumatic brain injury (TBI) in an emergency department (ED) population. Questionnaires were administered to patients in an urban, university, trauma center ED. All respondents provided demographics; patients reporting TBI were asked age at injury, if they experienced loss of consciousness (LOC), mechanism, or if medical attention was sought.

Validation of a brief screening tool to detect depression in elderly ED patients.

Although depression is the most common psychiatric disorder in the elderly, it is often unrecognized by physicians. The objective of the study was to assess the utility of a 3-question screening instrument (ED-DSI) to detect depression among elderly emergency department (ED) patients. We used a prospective convenience sample of English-speaking ED patients >or=65yr.