Acute Migraine Management in Children.

Migraines are common, incapacitating, and often stress inducing for pediatric patients and parents alike. According to the Agency for Healthcare Research and Quality, more than 1 million Americans seek emergency care every year due to migraines, with increasing frequency among adolescents. The disease can vary in severity and character, often mimicking life-threatening conditions, requiring prompt nuanced recognition by emergency personnel and implementation of an effective treatment strategy.

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.

Methods: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).

Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).

Background: Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes.

Methods And Results: Using data from 10 087 AF patients in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF), symptom severity was evaluated using the European Heart Rhythm Association (EHRA) classification system, and quality of life was assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire. The association between AF-related symptoms, quality of life, and outcomes was assessed using Cox regression.

Sleep disorders and fatigue: special issues in the older adult with cancer.

Older adults with cancer reporting fatigue and sleep disorders often have coexisting geriatric syndromes and are at high risk of further functional decline. This review summarizes special considerations in the diagnosis and treatment of sleep disorders and fatigue when older persons with cancer present with multiple comorbidities, polypharmacy, dementia, delirium, and/or falls. Physicians caring for these older adults need to be aware of the unique diagnostic and treatment concerns in this population so that these patients can receive optimal care.

The feasibility and acceptability of groups for pain management in methadone maintenance treatment.

Objectives: Effective and safe pain management interventions in methadone maintenance treatment are needed.

Methods: We examined the feasibility (ie, single-session attendance) and acceptability (ie, patient satisfaction and booster session attendance) of cognitive-behavioral therapy-informed groups for pain management-Coping With Pain, Relaxation Training, Group Singing, and Mindful Walking. Pre- and postsession measures were collected.

Sex differences in long-term mortality after myocardial infarction: a systematic review.

Background: Studies of sex differences in long-term mortality after acute myocardial infarction have reported mixed results. A systematic review is needed to characterize what is known about sex differences in long-term outcomes and to define gaps in knowledge.

Methods And Results: We searched the Medline database from 1966 to December 2012 to identify all studies that provided sex-based comparisons of mortality after acute myocardial infarction.

Advanced, neglected basal cell carcinoma.

Although basal cell carcinoma (BCC) rarely metastasizes and has a cure rate >95% when diagnosed early in its course, BCC causes significant morbidity and presents an enormous burden to the healthcare system worldwide. Patients who present late in the course of their disease are particularly challenging in that their treatment can be more complicated and less likely to be effective than had they presented earlier. Given the high prevalence of this malignancy and the morbidity associated with a late presentation, healthcare professionals should be familiar with the consequences of neglected BCCs, as well as their management after presentation.

Hospital variation in noninvasive positive pressure ventilation for acute decompensated heart failure.

Background: Although noninvasive positive pressure ventilation (NIPPV) for patients with acute decompensated heart failure was introduced almost 20 years ago, the variation in its use among hospitals remains unknown. We sought to define hospital practice patterns of NIPPV use for acute decompensated heart failure and their relationship with intubation and mortality.

Methods And Results: We conducted a cross-sectional study using a database maintained by Premier, Inc.

Variability in recommendations for total knee arthroplasty among rheumatologists and orthopedic surgeons.

Objective: The most rapidly growing population of patients undergoing total knee arthroplasty (TKA) is under the age of 65. The objective of our study was to gain insight into the factors influencing physicians' recommendations for persons in this age group with moderate osteoarthritis (OA).

Methods: Rheumatologists and orthopedic surgeons attending national meetings were asked to complete a survey including a standardized scenario of a 62-year-old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management.

Variability in experts' opinions regarding risks and treatment choices in patients with antineutrophil cytoplasmic antibody-associated vasculitis.

Objective: There are insufficient toxicity data available to guide treatment decisions in patients with ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis. The objective of this study was to obtain expert input related to available treatment options.

Methods: We performed a Web-based survey of experts (defined as physicians whose practices focus on vasculitis and physicians engaged in research in vasculitis) regarding adverse events (AEs) associated with cyclophosphamide and/or rituximab, the 2 treatment options for remission induction of severe ANCA-associated vasculitis (AAV).

A tool to determine financial impact of adverse events in health care: healthcare quality calculator.

Objectives: Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin.

Methods: Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement.

New utility for an old tool: can a simple gait speed test predict ambulatory surgical discharge outcomes?

Objective: The primary aims of this study were to design prediction models based on a functional marker (preoperative gait speed) to predict readiness for home discharge time of 90 mins or less and to identify those at risk for unplanned admissions after elective ambulatory surgery.

Design: This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes.

The use of propofol to prevent fetal deceleration during electroconvulsive therapy treatment.

Electroconvulsive therapy has been demonstrated to be relatively safe during pregnancy for both the mother and the fetus. One risk to the fetus is cardiac deceleration during the grand mal seizure. We present a case of a young woman in her second trimester of pregnancy with bipolar depression.

The creation of the international thymic malignancies interest group as a model for rare diseases.

Similar to other orphan diseases, little progress has been made in the past decades in thymic malignancies. A determination to make a difference, despite the challenges facing a rare disease, led to the formation of the International Thymic Malignancies Interest Group (ITMIG) in 2010. This organization has brought together the majority of those focused on the management of thymic malignancies and has built a foundation for scientific collaboration, including consistent use of terms, an international database, and multidisciplinary engagement of clinicians and researchers from around the world.

Uterine dehiscence in early second trimester.

Background: The diagnosis of uterine dehiscence in the early second trimester by ultrasonography is rare and its effect on pregnancy outcome is unclear.

Case: An asymptomatic woman presented for anatomy survey in the 19th week of pregnancy. Uterine dehiscence at the site of previous hysterotomy was diagnosed by ultrasound scan.

Do anesthesiologists die at a younger age than other physicians? Age-adjusted death rates.

Unlabelled: I designed this study to determine whether anesthesiologists are susceptible to premature death. Three specialty groups were studied: anesthesiologists, internists, and all other physicians. Records were examined of all American physicians who died in the years 1989, 1990, 1995, 2000, and 2001, and those who were alive at the end of 1989, 1995, 2000, and 2001.