Hospital Admission Rates and Mortality Among Emergency Department Patients with COVID-19 Discharged with Remote Patient Monitoring with or without HOME - A Value-Based Approach.

Background: The pandemic caused by the novel Coronavirus 2019 (COVID-19) overwhelmed healthcare systems with emergency department (ED) and hospital overcrowding. Our hospital system was able to discharge a subset of COVID-19 patients home with remote patient monitoring (RPM) and home oxygen (HOME) if needed, which opened up beds for the more critical patients. The objective of this study was to review the all-cause 30-day mortality and admission rates for patients chosen for our program, and to additionally examine the financial impact.

Virtual Town Hall Meetings to Convey Emergency Medicine Residency Program Information to Students.

Background: Applying to emergency medicine (EM) residency programs as a medical student is challenging and complicated in a normal year, but the 2020/2021 application cycle was further complicated by the COVID-19 pandemic. Due to the decrease of in-person opportunities for students to connect with residency programs, virtual "town-hall" meetings were developed. In this study our primary objective was to determine whether attendance at a virtual residency program information session improved the perceived knowledge of curriculum information and program exposure to medical students applying to an EM residency.

Clinical utility of anti-cytosolic 5'-nucleotidase 1A antibody in idiopathic inflammatory myopathies.

Objective: To define the clinicopathologic features and diagnostic utility associated with anti-cytosolic 5'-nucleotidase 1A (NT5C1A) antibody seropositivity in idiopathic inflammatory myopathies (IIMs).

Methods: Anti-NT5C1A antibody status was clinically tested between 2014 and 2019 in the Washington University neuromuscular clinical laboratory. Using clinicopathologic information available for 593 patients, we classified them as inclusion body myositis (IBM), dermatomyositis, antisynthetase syndrome, immune-mediated necrotizing myopathy (IMNM), nonspecific myositis, or noninflammatory muscle diseases.

Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial.

Study Objective: The objective of this study is to show that patients with corneal abrasions would experience more pain relief with short-term topical tetracaine than placebo.

Methods: The study was a prospective, double-blind, randomized trial of tetracaine versus placebo set in the emergency department (ED). A total of 118 adults who presented with uncomplicated corneal abrasions were included and randomized.

A Functional Chopart's Amputation With Tendon Transfers.

Generally, forefoot osteomyelitis is treated with a reliable level of amputation such as at the transmetatarsal level. However, when osteomyelitis extends proximal to the midfoot and presents with significant peripheral arterial disease, it is generally thought that the next best functional level of amputation is a transtibial amputation. This is mostly in part due to the high failure rate of Chopart's amputations which can be attributed to poor biomechanical and tendon balancing.

A Case Report of a Severe, Unusually Delayed Anaphylactoid Reaction to Intravenous N-Acetylcysteine During Treatment of Acute Acetaminophen Toxicity in an Adolescent.

Introduction: Anaphylactoid reactions are well-documented adverse events associated with the intravenous administration of N-acetylcysteine (NAC) in patients with acetaminophen overdose. Most reactions are mild, occurring within the first 1-5 hours of initiation. This report presents the case of an adolescent with a delayed, life-threatening anaphylactoid reaction 24.

The Dangerous Life of a Storm Chaser: A Lightning Strike Injury Causing Serious Injury.

Lightning strikes to people are rare events that cause significant injuries and mortality when they do occur. We describe an uncommon case of a storm chaser in Oklahoma who was struck by lightning who suffered cutaneous burns, bilateral tympanic membrane ruptures, as well as pulmonary edema, which is an atypical finding in survivors. This case report highlights several injury patterns seen in lightning strike cases and provides evidence that these patients should be managed at a center with multidisciplinary services available.

A Case of Acute Coronary Occlusion in a Morbidly Obese Patient Masked on Electrocardiogram by Low QRS Voltage.

Timely diagnosis of acute coronary occlusion is essential to avoid chronic cardiac impairment and death. We describe an uncommon case of acute myocardial infarction masked by low QRS voltage secondary to morbid obesity. This case highlights the importance of considering the degree of ST-segment elevation proportionally to the QRS amplitude if there is clinical suspicion of acute coronary occlusion.

Clinical, genetic, and pathologic characterization of Mexican founder mutation c.1387A>G.

Objective: To characterize the clinical phenotype, genetic origin, and muscle pathology of patients with the c.1387A>G mutation.

Methods: Standardized clinical data were collected for all patients known to the authors with c.

Concussion management in combat sports: consensus statement from the Association of Ringside Physicians.

Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines. To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself.

High Prevalence of Sterile Pyuria in the Setting of Sexually Transmitted Infection in Women Presenting to an Emergency Department.

Introduction: The clinical presentations for sexually transmitted infections (STI) and urinary tract infections (UTI) often overlap, and symptoms of dysuria and urinary frequency/urgency occur with both STIs and UTIs. Abnormal urinalysis (UA) findings and pyuria are common in both UTIs and STIs, and confirmatory urine cultures are not available to emergency clinicians to aid in decision-making regarding prescribing antibiotics for UTIs. The objective of this study was to determine the frequency of sterile pyuria in women with confirmed STIs, as well as whether the absolute number of leukocytes on microscopy or nitrite on urine dipstick correlated with positive urine cultures in patients with confirmed STIs.

Increased Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in General Trauma Patients.

Objective: To review the evidence regarding increased enoxaparin dosing for venous thromboembolism (VTE) prophylaxis in the general trauma patient population.

Data Sources: A search of MEDLINE databases (1946 to October 2016) was conducted using the search terms enoxaparin, thromboembolism prophylaxis, venous thromboembolism, trauma, anti-factor Xa, and weight-based dosing. Additional references were identified from a review of literature citations.

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care.

Objective: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.

Endosonographic examination of thyroid gland among patients with nonthyroid cancers.

Objectives: There is limited endosonographic literature regarding thyroid gland pathology, which is frequently visualized during upper endoscopic ultrasound (EUS). Our objective was to assess the prevalence of benign and malignant thyroid lesions encountered during routine upper EUS within a cancer center setting.

Materials And Methods: The data were prospectively collected and retrospectively analyzed.

Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center.

Objective To provide a foundation to justify the presence of a full-time clinical pharmacist in the ambulatory cancer center in addition to an existing centralized pharmacist through cost avoidance calculation and patient and staff satisfaction surveys. Methods The prospective, pilot study took place in an ambulatory cancer center over four weeks in 2014. Cost avoidance values were assigned to interventions performed by a pharmacy resident, who was present in the ambulatory cancer center during clinic hours, along with a centralized oncology pharmacist routinely working with the cancer center.

Melatonin Receptor Agonists for Delirium Prevention.

Objective: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention.

Data Sources: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included.

Trends in the Use of Guideline-Directed Therapies Among Dialysis Patients Hospitalized With Systolic Heart Failure: Findings From the American Heart Association Get With The Guidelines-Heart Failure Program.

Objectives: The purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)-related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD).

Background: Previous studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time.

Simple infrared thermometry in fever detection: consideration in mass fever screening.

Objective: The need to rapidly screen patients during outbreaks has prompted Cutaneous Infrared Thermometry (CIT) use. Little is known of CIT performance in this context. What are the performance characteristics of simple CIT in detecting fever?

Design: Prospective cohort, sequential convenience sample.

Warm Autoimmune Hemolytic Anemia with a Direct Antiglobulin Test Positive for C3 and Negative for IgG: A Case Study and Analytical Literature Review of Incidence and Severity.

Polygenic IgG autoantibodies are implicated in majority of the cases of warm autoimmune hemolytic anemia (WAIHA). In some of these cases, complement (C3) proteins accompany the IgG antibodies. WAIHA mediated by C3 alone is relatively rare.

Comparison of two protocols for pulseless cardiopulmonary arrest: vasopressin combined with epinephrine versus epinephrine alone.

Introduction: Survival from pulseless cardiac arrest typically is dismal. Some suggest that adding vasopressin to epinephrine as a cardiovascular stimulant can improve outcomes.

Problem: This study compares survival outcomes using epinephrine verses vasopressin and epinephrine in persons with pulseless cardiac arrest.