Evaluation of renal function tests by age and sex to determine emergency department patients' eligibility for cardiac computed tomography.

Background: Coronary computed tomography angiography (CCTA) can be used for low-risk chest pain patients, but presents a risk of contrast-induced nephropathy.

Objective: We compared, by age and sex, the percent of patients who would become ineligible for CCTA based on serum creatinine (SCr) and glomerular filtration rate (GFR) cutoff points.

Methods: All adult patients who presented to the Emergency Department (ED) with chest pain were screened using their first ED SCr as part of the ROMICAT (Rule Out Myocardial Infarction Using Computer Assisted Tomography) study.

The fate of manuscripts rejected by The Journal of Bone and Joint Surgery (American Volume).

Background: Of the many manuscripts that are submitted to The Journal of Bone and Joint Surgery (American Volume) (JBJS-A) for publication, the majority are not accepted. However, little is known about the outcome of these rejected submissions. To determine the fate of studies rejected by JBJS-A, we conducted a follow-up investigation of all clinical and basic science manuscripts that were submitted to The Journal between January 2004 and June 2005 but were not accepted.

An update on brain death criteria: a simple algorithm with complex questions.

Brain death criteria have been based on 3 cardinal features throughout history: coma, brainstem areflexia, and apnea, and thus have undergone little change. In 1995, the American Academy of Neurology (AAN) detailed these criteria in a step-by-step fashion that included meeting prerequisites, performing the clinical examination, performing ancillary testing, and documentation. Fifteen years later, many questions still remain regarding the diagnosis of brain death.

Are "normal" multidetector computed tomographic scans sufficient to allow collar removal in the trauma patient?

Background: Controversy continues as to the most safe and reliable method for clearing the cervical spine (C-spine) in a trauma patient who is rendered unable to participate in a clinical examination. Although magnetic resonance imaging (MRI) is the most sensitive test to detect soft-tissue injuries, it is impractical for routine use in every patient largely because of its cost and time of acquiescence. Recent studies have advocated the sole use of multidetector computed tomographic (MDCT) scans of the C-spine to decide if cervical collar immobilization can be discontinued.

Fentanyl in the out-of-hospital setting: variables associated with hypotension and hypoxemia.

Background: Previous out-of-hospital fentanyl analgesia studies are limited by retrospective nature or low numbers.

Study Objectives: This study sought to prospectively assess fentanyl safety in a large out-of-hospital group, to identify variables associated with post-fentanyl hypotension (HN; systolic blood pressure [SBP] < 90) or hypoxemia (HX; SpO(2) < 90%).

Methods: As part of a new protocol requiring documentation of peri-dose vital signs and adverse effects associated with fentanyl bolus doses, our Emergency Medical Services helicopter service assessed 500 consecutive patients receiving fentanyl from July through September 2006.

Recent advances in functional neuroimaging.

New functional imaging techniques, including positron emission tomography, transcranial magnetic stimulation and functional magnetic resonance imaging, promise to allow the noninvasive study of haemodynamic, metabolic and activation parameters during acute migraine attacks in humans. These techniques are currently being applied to the study of the transient neurologic symptoms of the aura, as well as the painful headache phase of migraine. This review summarizes the most recent of these studies and discusses how they relate to the prevailing theories of migraine pathophysiology.