Electrocardiographic spiked-helmet sign in critical non-cardiac illness.

The spiked-helmet sign (SHS) is an electrocardiographic finding characterised by a distinctive pattern associated with critical illness, resolving once the clinical condition improves. While the underlying mechanism remains uncertain, different mechanisms have been proposed to account for these findings including changes in intrathoracic or intra-abdominal pressures, transient compression of the coronary arteries, repolarisation abnormalities and electromechanical artefacts. We describe the development of the SHS in a patient with underlying left bundle branch pacing following the development of respiratory failure due to haemoptysis and review proposed mechanisms for its pathophysiology.

Effects of coaching on medical student well-being and distress: a systematic review protocol.

Introduction: Medical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms.

Use of statins, amiodarone, direct oral anticoagulants and NSAIDs in chronic liver disease: a guide for general clinicians.

Patients with chronic liver disease have associated comorbidities that require treatment, including cardiovascular disease, arrhythmias, cerebrovascular accidents and pain. These medications may affect the liver disease. Due to the complexity of medical problems in patients with chronic liver disease, treating clinicians benefit from targeted guidance for their care.

The association between pressure ulcers and endothelial dysfunction in a cohort of community elderly.

Vascular disease is a known risk factor for pressure ulcer development, but the underlying mechanisms of this association are less established. The authors evaluated the relationship between endothelial function (EF) and history of pressure ulcers in a nested case-control study of community-dwelling elderly, 60 years and older. Endothelial function was measured using peripheral arterial tonometry, and persons with a history of pressure ulcers in the past 5 years (n = 7) were matched 2:1 by age and gender to controls with no history of pressure ulcers (n = 14).

Early clinical experiences from students' perspectives: a qualitative study of narratives.

Purpose: To gain insight into how early clinical experiences contribute to medical students' professional development.

Method: Qualitative content analysis of second-year Mayo Medical School students' reflective journal essays pertaining to their first experiences with inpatients (from 2002 to 2004) was done using a grounded theory approach. The apprenticeship model of professional learning (knowledge and cognitive abilities, technical skills, and ethical standards) and perspectives from learning theory provided the conceptual framework.

Medical education research and IRB review: an analysis and comparison of the IRB review process at six institutions.

Purpose: To compare how different institutional review boards (IRBs) process and evaluate the same multiinstitutional educational research proposal of medical students' quality of life.

Method: Prospective collection in 2005 of key variables regarding the IRB submission and review process of the same educational research proposal involving medical students, which was submitted to six IRBs, each associated with a different medical school.

Results: Four IRBs determined the protocol was appropriate for expedited review, and the remaining two required full review.