A Vision For the Future of Cardiovascular Medicine Practise in Ghana: Inspiration From the Yale-New Haven Health System.

The Ghana Physicians and Surgeons Foundation (GPSF) of North America sponsors Ghanaian clinical fellows to undertake an eight-weeklong clinical observation with the Yale University School of Medicine and Yale-New Haven Health (YNHH) annually, through the Residents in Training Educational Stipend (RITES) programme. This offers the opportunity to appreciate new perspectives in clinical care to improve Ghana's healthcare standard. The cardiovascular medicine workforce at the YNHH is heterogenous, with significant reliance on non-doctor cadres of health workers who demonstrate competence.

Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?

The conventional sequence of guideline-directed medical therapy (GDMT) initiation in heart failure with reduced ejection fraction (HFrEF) assumes that the effectiveness and tolerability of GDMT agents mirror their order of discovery, which is not true. In this review, the authors discuss flexible GDMT sequencing that should be permitted in special populations, such as patients with bradycardia, chronic kidney disease, or atrial fibrillation. Moreover, the initiation of certain GDMT medications may enable tolerance of other GDMT medications.

Perceived Gaps in Knowledge for the Advanced Heart Failure and Transplant Cardiology Fellow: the Results of a National Needs-Assessment Survey.

Background: The field of Advanced Heart Failure and Transplant Cardiology has evolved greatly since it was first established. We sought to elicit program directors' and fellows' viewpoints on potential curricular deficits so we can better meet the educational goals of current and future fellows.

Methods And Results: We surveyed advanced heart failure and transplant cardiology program directors and fellows concerning their perceptions of the current adequacy of training and their desire for additional training needed to achieve medical competency in advanced heart failure and transplant cardiology at their institutions, as defined by the 2017 ACC Advanced Training Statement.

Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?

The conventional sequence of guideline-directed medical therapy (GDMT) initiation in heart failure with reduced ejection fraction (HFrEF) assumes that the effectiveness and tolerability of GDMT agents mirror their order of discovery, which is not true. In this review, the authors discuss flexible GDMT sequencing that should be permitted in special populations, such as patients with bradycardia, chronic kidney disease, or atrial fibrillation. Moreover, the initiation of certain GDMT medications may enable tolerance of other GDMT medications.

Specialist medical toxicologist consultations provided by the New Zealand National Poisons Centre, 2018-2020.

Aims: The National Poisons Centre (NPC) provides 24/7 specialist medical toxicologist consultations to healthcare professionals regarding the clinical management of poisoning cases. The use of toxicologist services was investigated to characterise the extent and content of consults to inform further development of this service.

Methods: A retrospective analysis of 2018-2020 medical toxicologist consultations summarised contact numbers, professional backgrounds and district health boards (DHBs) of the people contacting the NPC, and the patient(s) and substance(s) involved.

Changes in training patterns and confidence to return to sport in United States collegiate athletes during the COVID-19 pandemic.

Objective: To describe the training patterns, return to sport (RTS) confidence, and perceived fitness during the COVID-19 pandemic summer 2020 and to compare training patterns and RTS readiness during COVID-19 versus during the 2019 summer in a cohort of Division III collegiate athletes.

Methods: An electronic survey of varsity athletes ≥18 years at three United States Division III colleges querying athlete demographics, Modified Athletic Identity Scale (mAIMS), changes in training regimen summer 2020 vs. 2019, RTS confidence, and perceived physical fitness.

Musculoskeletal and Sports Medicine Curriculum Guidelines for Pediatric Residents.

Musculoskeletal (MSK) and sports-related conditions are relatively common in the pediatric population. Pediatric residencies should provide residents with the knowledge and skills to assess and manage both acute and chronic MSK and sports injuries and complaints. Residents should develop the competencies and attitudes to safeguard and promote a healthy and active lifestyle for youth.

Factors influencing palliative care referral for hospitalised patients with heart failure: an exploratory, randomised, multi-institutional survey of hospitalists and cardiologists.

Objective: To identify factors influencing cardiologists' and hospitalists' decisions regarding palliative care referral among hospitalised patients with advanced heart failure.

Design: An exploratory, randomised vignette-based survey.

Setting: Cardiology and hospitalist divisions at three Michigan State institutions and the Society of Hospital Medicine's Michigan Chapter.

Heart failure documentation in outpatients with diabetes and volume overload: an observational cohort study from the Diabetes Collaborative Registry.

Background: Heart failure is a common and devastating complication of type 2 diabetes (T2D). Prompt recognition of heart failure may avert hospitalization, facilitate use of guideline-directed therapies, and impact choice of T2D medications. We sought to determine the rate and factors associated with heart failure documentation in T2D patients with evidence of volume overload requiring loop diuretics.

Poisoning due to tutin in honey-a report of an outbreak in New Zealand.

Aim: In autumn 2008, an outbreak of toxic honey poisoning was identified. The outbreak was not recognised initially until three cases from one family group presented to hospital, with a common factor of recent consumption of locally produced honey. The aim of this study was to investigate potential cases of this honey poisoning and determine which toxin was involved.

A single population of red globular clusters around the massive compact galaxy NGC 1277.

Massive galaxies are thought to form in two phases: an initial collapse of gas and giant burst of central star formation, followed by the later accretion of material that builds up their stellar and dark-matter haloes. The systems of globular clusters within such galaxies are believed to form in a similar manner. The initial central burst forms metal-rich (spectrally red) clusters, whereas more metal-poor (spectrally blue) clusters are brought in by the later accretion of less-massive satellites.

The Effect of Prior Concussion History on Dual-Task Gait following a Concussion.

Sustaining repeated concussions has been associated with worse outcomes after additional injuries. This effect has been identified using symptom inventories and neurocognitive tests; however, few investigations have examined how a prior concussion history affects gait soon after a subsequent concussion. We examined the gait characteristics of athletes with no documented concussion history (n = 31), athletes recovering from their first lifetime concussion (n = 15), and athletes recovering from their second or greater lifetime concussion (n = 22).

Initial somatic symptoms are associated with prolonged symptom duration following concussion in adolescents.

Aim: To determine which initial postinjury symptom domains are independently associated with symptoms lasting >28 days in youth athletes who sustained sport-related concussions.

Methods: Patients who presented for care at a sport concussion clinic completed the postconcussion symptom scale. They were classified into two groups: those who reported symptom resolution within 28 days of injury and those who did not.

Knee injury patterns in young irish dancers.

Objective: To characterize knee injury patterns in Irish dancers.

Methods: A retrospective chart review was performed for Irish dancers under age 19 who presented with knee injuries to the sports medicine or orthopedic clinic from January 1, 2000 to December 31, 2010. Data were collected on all knee injuries partially or directly related to Irish dance.

Anesthesia duration as a marker for surgical complications in office-based plastic surgery.

Background: Office-based plastic surgery has continued to rise in the past 2 decades with the increased demand for cosmetic surgery. Although several large studies have shown the safety of office-based surgery, current regulations place some restrictions on ambulatory office-based surgical facilities. To provide further evidence-based literature on the safety of office-based plastic surgery, we examine surgical complication rates as a function of anesthesia duration.

Pediatric neck masses.

The majority of neck masses in the pediatric population are congenital or inflammatory in origin requiring a thorough understanding of embryology and anatomy of the cervical region. However, malignancy must always be ruled out as they represent 11%-15% of all neck masses in the pediatric population. The initial history and physical are of utmost important to correctly work-up and eventually diagnose the lesion.

The clinical toxicology of the designer "party pills" benzylpiperazine and trifluoromethylphenylpiperazine.

Introduction: Benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) are synthetic phenylpiperazine analogues. BZP was investigated as a potential antidepressant in the early 1970s but was found unsuitable for this purpose. More recently, BZP and TFMPP have been used as substitutes for amfetamine-derived designer drugs.

The clinical toxicology of metamfetamine.

Introduction: Metamfetamine is a highly addictive amfetamine analog that acts primarily as a central nervous system (CNS) stimulant. The escalating abuse of this drug in recent years has lead to an increasing burden upon health care providers. An understanding of the drug's toxic effects and their medical treatment is therefore essential for the successful management of patients suffering this form of intoxication.