Why do we need quality measures in emergency medicine?

Quality measures increasingly influence the delivery and reimbursement of care provided in emergency departments. While emergency physicians are accustomed to using quality measures to improve care delivery, payors, including the Centers for Medicare and Medicaid Services (CMS), are increasingly adjusting reimbursement to measure performance as a means to bend the cost curve and improve the value of healthcare services. The American College of Emergency Physicians Quality and Patient Safety Committee presents this whitepaper to guide practicing emergency physicians through the policy context of implementing measures in emergency care and understanding its impact reimbursement.

Large language models outperform general practitioners in identifying complex cases of childhood anxiety.

Objective: Anxiety is prevalent in childhood but often remains undiagnosed due to its physical manifestations and significant comorbidity. Despite the availability of effective treatments, including medication and psychotherapy, research indicates that physicians struggle to identify childhood anxiety, particularly in complex and challenging cases. This study aims to explore the potential effectiveness of artificial intelligence (AI) language models in diagnosing childhood anxiety compared to general practitioners (GPs).

On the Operating Table: A Student's Experience in Surgery.

The role of medical students in patient care is complex. Students suggest plans but are not responsible for enacting them. We are anticipated to make mistakes but expected to perform tasks with excellence.

Clinical significance of culture-negative, PCR-positive bronchoalveolar lavage results in severe pneumonia.

https://bit.ly/3DWoFPo.

Alpha-T-catenin is expressed in peripheral nerves as a constituent of Schwann cell adherens junctions.

The adherens junction component, alpha-T-catenin (αTcat) is an established contributor to cardiomyocyte junction structure and function, but recent genomic studies link CTNNA3 polymorphisms to diseases with no clear cardiac underpinning, including asthma, autism and multiple sclerosis, suggesting causal contributions from a different cell-type. We show Ctnna3 mRNA is highly expressed in peripheral nerves (e.g.

A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer.

Background: Older adults ≥65 years of age represent the majority of new cancer diagnoses and are vulnerable to developing depression-like symptoms. Evaluation and management of depression in older cancer patients is underappreciated despite its high prevalence and impact on health-related quality of life. Although antidepressants are the primary pharmacologics used to treat depressive-like symptoms, the efficacy and overall benefit(s) are not well-characterized in older adult patients with cancer.

Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis.

Objective: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized.

Glioblastoma as an age-related neurological disorder in adults.

Background: Advanced age is a major risk factor for the development of many diseases including those affecting the central nervous system. Wild-type isocitrate dehydrogenase glioblastoma (IDH GBM) is the most common primary malignant brain cancer and accounts for ≥90% of all adult GBM diagnoses. Patients with IDH GBM have a median age of diagnosis at 68-70 years of age, and increasing age is associated with an increasingly worse prognosis for patients with this type of GBM.

Association between spirituality and quality of life of women with breast cancer undergoing radiotherapy.

Objective: To verify whether there is an association between spirituality/religiosity and quality of life of women with breast cancer undergoing radiotherapy.

Method: Cross-sectional, quantitative study performed between May and July 2019 in an Oncology Hospital of Porto Alegre state, Brazil. A sociodemographic questionnaire and the instruments EORTC-QLQ-C30 and WHOQOL-SRPB were applied.

Residency Leadership Lessons From the Epicenter of the COVID-19 Surge.

Emergency medicine residency program directors (PDs) in areas hit hardest by the initial U.S. COVID-19 pandemic surge faced novel and rapidly evolving organizational, educational, and resident wellness challenges.

Major Outcomes With Personalized Dialysate TEMPerature (MyTEMP): Rationale and Design of a Pragmatic, Registry-Based, Cluster Randomized Controlled Trial.

Background: Small randomized trials demonstrated that a lower compared with higher dialysate temperature reduced the average drop in intradialytic blood pressure. Some observational studies demonstrated that a lower compared with higher dialysate temperature was associated with a lower risk of all-cause mortality and cardiovascular mortality. There is now the need for a large randomized trial that compares the effect of a low vs high dialysate temperature on major cardiovascular outcomes.

Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018.

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis.

Application of the MISSCARE scale in an Oncology Service: a contribution to patient safety.

Objective: To investigate the prevalence of and reasons for missed nursing care in oncology units.

Method: A cross-sectional study was conducted at inpatient oncology units at a private hospital. Eighty-three professionals from the nursing team took part.

TP53 p.Arg337His germline mutation prevalence in Southern Brazil: Further evidence for mutation testing in young breast cancer patients.

Premenopausal breast cancer (BC) is a core tumor of Li-Fraumeni (LFS) and Li-Fraumeni-like (LFL) Syndromes, predisposition disorders caused by germline mutations in TP53 gene. In the Southern and Southeastern regions of Brazil, a specific TP53 germline mutation, c.1010G>A (p.

Gait Study of Parkinson's Disease Subjects Using Haptic Cues with A Motorized Walker.

Gait abnormalities are one of the distinguishing symptoms of patients with Parkinson's disease (PD) that contribute to fall risk. Our study compares the gait parameters of people with PD when they walk through a predefined course under different haptic speed cue conditions (1) without assistance, (2) pushing a conventional rolling walker, and (3) holding onto a self-navigating motorized walker under different speed cues. Six people with PD were recruited at the New York Institute of Technology College of Osteopathic Medicine to participate in this study.

Expanding Health Information Exchange Improves Identification of Frequent Emergency Department Users.

Study Objective: Frequent emergency department (ED) users are of interest to policymakers and hospitals. The objective of this study is to examine the effect of health information exchange size on the identification of frequent ED users.

Methods: We retrospectively analyzed data from Healthix, a health information exchange in New York that previously included 10 hospitals and then grew to 31 hospitals.

A Broader View of Quality: Choosing Wisely Recommendations From Other Specialties With High Relevance to Emergency Care.

Study Objective: The American College of Emergency Physicians (ACEP) joined the Choosing Wisely campaign in 2013 and has contributed 10 recommendations to reduce low-value care. Recommendations from other specialties may also identify opportunities to improve quality and patient safety in emergency care. The Choosing Wisely work group of the ACEP Quality and Patient Safety Committee seeks to identify and characterize the Choosing Wisely recommendations from other professional societies with the highest relevance to emergency care.

The scenario of scientific publication on palliative care in oncology over the last 5 years: a scoping review.

Objective: To identify the profile of studies published on palliative care in oncology and to analyze their levels of evidence.

Method: A scoping review. Inclusion criteria published in the last 5 years, in English, Portuguese or Spanish.

Assessment of the care process with orthotics, prosthetics and special materials.

Objective: to assess potential failures in the care process with orthotics, prosthetics and special materials in a high-complexity hospital.

Method: an intervention study conducted from March to October 2013. This process was assessed with the Failure Mode and Effects Analysis (FMEA) service tool.

αT-catenin: A developmentally dispensable, disease-linked member of the α-catenin family.

α-Catenins are actin-filament binding proteins and critical subunits of the cadherin-catenin cell-cell adhesive complex. They are found in nominally-defined epithelial (E), neural (N), and testis (T) forms transcribed from three distinct genes. While most of α-catenin research has focused on the developmentally essential founding member, αE-catenin, this review discusses recent studies on αT-catenin (CTNNA3), a developmentally dispensable isoform that is emerging as relevant to cardiac, allergic and neurological diseases.

Gait parameter control timing with dynamic manual contact or visual cues.

We investigated the timing of gait parameter changes (stride length, peak toe velocity, and double-, single-support, and complete step duration) to control gait speed. Eleven healthy participants adjusted their gait speed on a treadmill to maintain a constant distance between them and a fore-aft oscillating cue (a place on a conveyor belt surface). The experimental design balanced conditions of cue modality (vision: eyes-open; manual contact: eyes-closed while touching the cue); treadmill speed (0.