Cost Savings Analysis for a Diabetic Retinopathy Teleretinal Screening Program Using an Activity-Based Costing Approach.

Purpose: To examine the costs and cost savings associated with a large, urban teleretinal screening program for diabetic retinopathy (DR).

Design: Retrospective analysis.

Participants: Eighteen thousand twenty-five patients (36 050 eyes) screened via the Harris Health System (HHS) DR teleretinal screening program between June 2013 and April 2014.

Accuracy of Detection and Grading of Diabetic Retinopathy and Diabetic Macular Edema Using Teleretinal Screening.

Purpose: To determine the accuracy of a county teleretinal screening program of detecting referable diabetic retinopathy (DR) and treatable diabetic macular edema (DME), as well as to evaluate patient compliance with clinic follow-up after referral from teleretinal screening.

Design: Retrospective observational study.

Participants: Patients in the Harris Health System (HHS, Houston, TX) older than 18 years of age who underwent teleretinal screening between July 2014 and July 2016.

Acute Management of Hyperkalemia.

Purpose Of The Review: Hyperkalemia is a common electrolyte abnormality that can lead to life-threatening cardiac arrhythmia. Medical management of acute hyperkalemia revolves around three strategies-stabilizing the myocardium, intracellular shifting of serum potassium, and enhancing elimination of total body potassium via urinary or fecal excretion. In this review, we outline the current evidence behind the acute medical management of hyperkalemia.

Effectiveness of a Transesophageal Echocardiography Course.

Background: Transesophageal echocardiography has important applications for the management of the critically ill patient. There is a need to develop effective training programs for the critical care community in acquiring skill at critical care transesophageal echocardiography.

Objective: We studied the effectiveness of a 1-day simulation-based course that focused on the acquisition of skill in the performance of critical care transesophageal echocardiography.

Current treatment and unmet needs of hyperkalaemia in the emergency department.

Hyperkalaemia is a common electrolyte abnormality and can cause life-threatening cardiac arrhythmia. Even though it is common in patients with diabetes, heart failure, and kidney disease, there is poor consensus over its definition and wide variability in its treatment. Medications used to treat hyperkalaemia in the emergent setting do not have robust efficacy and safety data to guide treatment leading to mismanagement due to poor choice of some agents or inappropriate dosing of others.

High grade squamous intraepithelial lesion on high-risk HPV negative patients: Why we still need the Pap test.

Background: Cervical cancer is caused by high-risk human papillomavirus (hrHPV). Though screening Pap test (PT) has reduced cancer mortality by detecting precursor lesions, there is now a move toward replacing screening PT with hrHPV testing. The aims of this study were to determine hrHPV negative rate in high grade squamous intraepithelial lesion (HSIL) PT in high-risk patients and correlate with histopathology; and to review the hrHPV negative HSIL PT.

Touch imprint (TI) cytology of needle core biopsies (NCB) in pathology laboratories: A practice survey of participants in the College of American Pathologists (CAP) Non Gynecologic Cytopathology (NGC) Education Program.

Background: Intra-procedural assessment of touch imprint (TI) cytology from needle core biopsies (NCB) is used to ensure sample adequacy and to provide immediate diagnosis in various settings. We aimed to survey laboratories for current practices on the use of cytology with NCB.

Methods: A voluntary supplemental questionnaire including questions on demographics, personnel involved, sites, accessioning, and reporting was sent with the College of American Pathologists (CAP) 2015 Non gynecologic Cytopathology Education Program to survey practices of cytologic assessment of NCB.

Diagnostic Decision-Making in the Emergency Department.

Emergency medicine requires diagnosing unfamiliar patients with undifferentiated acute presentations. This requires hypothesis generation and questioning, examination, and testing. Balancing patient load, care across the severity spectrum, and frequent interruptions create time pressures that predispose humans to fast thinking or cognitive shortcuts, including cognitive biases.

Scleritis, keratitis, and orbital cellulitis: isolated ocular manifestation of systemic lupus erythematosus.

Systemic autoimmune diseases are associated with ocular inflammatory conditions such as episcleritis, scleritis, keratitis, and uveitis. However, ocular manifestations have been reported to correlate with the extent of systemic disease. We present a patient with scleritis, keratitis, and orbital cellulitis, as the isolated manifestation of systemic lupus erythematosus (SLE).

True Costs of Medical Clearance: Accuracy and Disagreement between Psychiatry and Emergency Medicine Providers.

Introduction: Medical clearance is required to label patients with mental illness as free of acute medical concerns. However, tests may extend emergency department lengths of stay and increase costs to patients and hospitals. The objective of this study was to determine how knowledgeable emergency and psychiatric providers are about the costs of tests used for medical clearance.

For diagnosis of liver masses, fine-needle aspiration versus needle core biopsy: which is better?

Introduction: Both fine needle aspiration (FNA) and needle core biopsy (NCB) are widely accepted methods for obtaining diagnostic material. There is variability in how different institutions use these techniques in assessing liver masses. The aim of this study is to compare the diagnostic accuracy and tissue quality between FNA and NCB, and create a cost-effective algorithm for evaluating liver masses.

Sufentanil sublingual tablet 30mcg for moderate-to-severe acute pain in the ED.

Background: Pharmacological properties of the sufentanil sublingual tablet 30mcg (SST 30mcg) could offer potential analgesic advantages in settings requiring noninvasive, acute pain management. The feasibility of using SST 30mcg for moderate-to-severe pain management in the emergency department (ED) was evaluated.

Methods: This open-label, multicenter feasibility study included patients aged ≥18years who presented to the ED with moderate-to-severe pain (≥4 on the numeric rating scale of pain intensity (NRS); opioid-tolerant patients were excluded.

HIV-1 viral protein R (Vpr) induces fatty liver in mice via LXRα and PPARα dysregulation: implications for HIV-specific pathogenesis of NAFLD.

HIV patients develop hepatic steatosis. We investigated hepatic steatosis in transgenic mice expressing the HIV-1 accessory protein Vpr (Vpr-Tg) in liver and adipose tissues, and WT mice infused with synthetic Vpr. Vpr-Tg mice developed increased liver triglyceride content and elevated ALT, bilirubin and alkaline phosphatase due to three hepatic defects: 1.

Study design of Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL-ED): a multicenter, prospective, observational study.

Objective: Hyperkalemia affects up to 10% of hospitalized patients and, if left untreated, can lead to serious cardiac arrhythmias or death. Although hyperkalemia is frequently encountered in the emergency department (ED), and is potentially life-threatening, standard of care for the treatment is poorly defined, with little supporting evidence. The main objectives of this observational study are to define the overall burden of hyperkalemia in the ED setting, describe its causes, the variability in treatment patterns and characterize the effectiveness and safety of ED standard of care therapies used in the United States.

Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income.

Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits.

Toxicologic Emergencies in Patients with Mental Illness: When Medications Are No Longer Your Friends.

Patients with psychiatric disorders are at risk for toxicologic emergencies. Psychotropic medications have numerous effects on the neurologic, cardiac, and other organ systems and interact with other medications, potentially leading to further side effects. It is important to become familiar with accepted psychiatric practice guidelines, common toxidromes, medical sequelae associated with prescribed medications, and the specific workup and treatment of overdoses of frequently prescribed psychotropics.

A post-marketing assessment of major bleeding in total hip and total knee replacement surgery patients receiving rivaroxaban.

Background: Rivaroxaban is a novel oral anticoagulant indicated for prophylaxis against deep vein thrombosis and pulmonary embolism in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery.

Objective: To evaluate major bleeding (MB) in THR/TKR patients receiving post-operative rivaroxaban.

Methods: Electronic medical records of nearly 10 million US Department of Defense (DoD) beneficiaries were queried from 1 January 2013 through 30 June 2015.