Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology.

MR imaging of high-altitude cerebral edema shows reversible WM edema, especially in the corpus callosum and subcortical WM. Recent studies have revealed hemosiderin deposition in WM long after high-altitude cerebral edema has resolved, providing a high-altitude cerebral edema "footprint." We wished to determine whether these microbleeds are present acutely and also describe the evolution of all MR imaging findings.

Community IntraVenous Antibiotic Study (CIVAS): protocol for an evaluation of patient preferences for and cost-effectiveness of community intravenous antibiotic services.

Introduction: Outpatient parenteral antimicrobial therapy (OPAT) is used to treat a wide range of infections, and is common practice in countries such as the USA and Australia. In the UK, national guidelines (standards of care) for OPAT services have been developed to act as a benchmark for clinical monitoring and quality. However, the availability of OPAT services in the UK is still patchy and until quite recently was available only in specialist centres.

A clinical analysis of the emergency medicine workforce crisis.

Workforce crises in medicine can be devastating for a specialty, patients and professionals. Emergency medicine and general practice are currently affected but other acute specialties are showing early signs and symptoms of the condition. While symptomatic treatments are helpful, recognition and treatment of the causes is critical.

Absolute bioavailability of intranasal fluticasone furoate in healthy subjects.

Background: Fluticasone furoate (drug code GW685698) is an enhanced-affinity glucocorticoid that has been developed for the treatment of allergic rhinitis.

Objectives: The objectives of this study were to estimate the absolute bioavailability of fluticasone furoate nasal spray and to describe the intranasal (IN) and IV pharmacokinetics of fluticasone furoate in healthy subjects.

Methods: This was a single-center, randomized, open label, 2-period crossover study.

Core-peripheral temperature gradient as a diagnostic test in dyspnoea.

Objectives: To evaluate whether the core-peripheral temperature gradient could be used to distinguish between cardiac and respiratory causes of dyspnoea.

Methods: In total, 50 patients were enrolled in the study, based on the following inclusion criteria: (a) a primary presenting complaint of dyspnoea; (b) age > 40 years; (c) respiratory rate > 20 breaths/min; (d) hypoxia. The tympanic temperature and the temperature of the nasal tip were recorded, and the patient's discharge data and chest x ray results checked.

High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology.

Context: Because of its onset in generally remote environments, high-altitude cerebral edema (HACE) has received little scientific attention. Understanding the pathophysiology might have implications for prevention and treatment of both this disorder and the much more common acute mountain sickness.

Objectives: To identify a clinical imaging correlate for HACE and determine whether the edema is primarily vasogenic or cytotoxic.

Assessment of an objective structured clinical examination (OSCE) for undergraduate students in accident and emergency medicine.

Conventional techniques for assessing the knowledge and clinical competence of undergraduate medical students are widely acknowledged as being unsatisfactory. We introduced an objective structured clinical examination (OSCE) for our fourth year medical students at the end of their accident and emergency (A&E) medicine attachment. This paper outlines the organisation of the examination and the results of a comparison of marks obtained from the OSCE, from a multiple choice type examination and from a subjective rating of the students performance by their teachers.