SonoGames: an innovative approach to emergency medicine resident ultrasound education.

SonoGames was created by the Academy of Emergency Ultrasound for the 2012 annual meeting of the Society for Academic Emergency Medicine. The assessment of resident knowledge and of the performance of point-of-care ultrasound examinations is an integral component of ultrasound education and is required in emergency medicine residency training. With that in mind, game organizers sought to assess and improve emergency medicine residents' point-of-care ultrasound knowledge, hands-on skills, and integration of knowledge into clinical decision making.

Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction.

Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction≥55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction<55%).

Surgical debridement alone does not adequately reduce planktonic bioburden in chronic lower extremity wounds.

Objective: It is commonly believed that sharp surgical debridement provides adequate bacteria control for local wound beds, despite limited supporting scientific evidence. We undertook a prospective study to evaluate the reduction in planktonic bacteria pre- and post-operative debridement in critically colonised wounds.

Method: Twelve patients, corresponding to 14 wounds, underwent debridement with either hydrodebridement or sharp steel debridement with pulse irrigation.

Moderately elevated intracranial pressure produces greater cross-filling of the anterior communicating artery.

This study aimed to investigate whether moderately elevated intracranial pressure is associated with greater cross-filling of the anterior communicating artery on diagnostic cerebral angiography. A retrospective study of 12 patients with subarachnoid hemorrhage was performed. Data on sequential cerebral angiograms and clinical data were used to indirectly estimate intracranial pressure (ICP).

Potential diagnostic significance of HSP90, ACS/TMS1, and L-plastin in the identification of melanoma.

Melanoma is one of the deadliest cancers, yet it remains a diagnostic and prognostic challenge. The lack of effective treatment modalities compounds this challenge. Characterizing the molecular mechanisms leading to the development of melanoma is the first step to understanding the pathophysiology of melanoma.

Inferior vena cava filters and their varying compliance with the ACCP and the SIR guidelines.

Objectives: We examined our experience with inferior vena cava filters to assess whether we conformed to the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR) guidelines and to evaluate the reasons for any discrepancy.

Methods: This was a retrospective medical record review of patients having inferior vena cava filters placed in two New York City hospitals during a 34-month period. The indications for filter placement, the type of filter used, and the conformity with the two guidelines were noted.

Point-of-care ultrasound in a patient with perforated appendicitis.

We present the case of an 8-year-old girl with two emergency department visits for constipation and abdominal pain. Her medical history and physical examination noted by the emergency physician did not reveal a clear etiology of her symptoms until the second visit, when a point-of-care ultrasound was performed. The sonographic findings were consistent with a fecalith surrounded by fluid concerning for appendiceal rupture.

HIV-Infected Individuals Who Delay, Decline, or Discontinue Antiretroviral Therapy: Comparing Clinic- and Peer-Recruited Cohorts.

A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or discontinue antiretroviral therapy (ART) when it is medically indicated (40-45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012-2013.

Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne.

Objective: Limited data are available on racial differences in clinical characteristics and burden in adult female acne. The objective was to describe racial differences in clinical characteristics, psychosocial impact, perceptions, behaviors, and treatment satisfaction in facial adult female acne.

Design: Cross-sectional, web-based survey.

A clinical pathway for total shoulder arthroplasty-a pilot study.

Background: Appropriate pain management after total shoulder arthroplasty (TSA) facilitates rehabilitation and may improve clinical outcomes.

Questions/purposes: This prospective, observational study evaluated a multimodal analgesia clinical pathway for TSA.

Methods: Ten TSA patients received an interscalene nerve block (25 cm(3) 0.

Leiomyomas beyond the uterus; benign metastasizing leiomyomatosis with paraaortic metastasizing endometriosis and intravenous leiomyomatosis: a case series and review of the literature.

Uterine leiomyomas affect 20-30 % of women 35 years and older. Extrauterine leiomyomas are rare and present a greater diagnostic challenge. Those unusual growth patterns occur more often in women of reproductive age with a history of hysterectomy or surgery for uterine leiomyomas.

Recent advances in childhood vitiligo.

Vitiligo is an autoimmune depigmentation disorder that is estimated to affect about .5% of the worldwide population. Half of all cases begin in childhood.

Internal medicine residents' perspectives on effects of 2011 ACGME work hour regulations on patient care.

Background: The Accreditation Council for Graduate Medical Education (ACGME) introduced new work hour limitations in July 2011.

Purposes: The aim is to assess internal medicine residents' perspectives on the impact of these limitations on their ability to discharge patient care duties.

Methods: An anonymous survey was administered to 158 medicine residents in an urban university-affiliated internal medicine residency program.

Association between obesity and eczema prevalence, severity and poorer health in US adolescents.

Background: Identification of modifiable risk factors for the development of eczema is of major public health significance.

Objective: This study aimed to determine the effects of obesity in adolescence on the prevalence, severity, and quality of life of patients with eczema.

Methods: We used the 2007-2008 National Survey of Children's Health, including a nationally representative sample of 45,897 adolescents aged 10 to 17 years.

Treatment discontinuations with new oral agents for long-term anticoagulation: insights from a meta-analysis of 18 randomized trials including 101,801 patients.

Objective: To systematically examine discontinuation rates with new US Food and Drug Administration-approved oral anticoagulants (NOACs) in patients with various indications for long-term anticoagulation.

Patients And Methods: Poor adherence to medications is considered a potential and frequent cause of treatment failure. We searched the PubMed, Cochrane Central Register of Controlled Trials, EMBASE, EBSCO, Web of Science, and CINAHL databases for articles published from January 1, 2001, through September 15, 2013.

Robotic-assisted fertility-sparing surgery for early ovarian cancer.

Objective: To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for earlystage ovarian cancer in women of reproductive age.

Methods And Design: The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma.

The endomyometrial thickness measurement for abnormal implantation evaluation by pelvic sonography.

Emergency physicians, obstetrician-gynecologists, and other medical specialists use pelvic sonography when caring for patients presenting with early pregnancy-related symptoms. A thin endomyometrial mantle and eccentric placement of a gestational sac should raise the suspicion for an abnormally implanted pregnancy. In such cases, an interstitial ectopic pregnancy or a cornual pregnancy, two clinically distinct entities, must be considered.

The importance of fasting blood glucose in screening for gestational diabetes.

Objective: To determine how well an isolated abnormal fasting blood glucose (FBG) value on the 1-step, 75-g, 2-hour glucose tolerance test (GTT) indicates significant gestational diabetes (GDM).

Methods: Retrospective cohort study, January 2011 to May 2012. Patients diagnosed by the 1-step method were assigned by their abnormal results to the isolated fasting (FBG), isolated 1-hour (1HBG), isolated 2-hour (2HBG), or multiple-value (≥2BG) group.

Minimally invasive colorectal resection is associated with significantly elevated levels of plasma matrix metalloproteinase 3 (MMP-3) during the first month after surgery which may promote the growth of residual metastases.

Introduction: MMP-3, a member of the matrix metalloproteinase (MMP) family, is involved in the breakdown of the extracellular matrix in tissue remodeling and may also play a role in cancer progression and metastasis. Minimally invasive colorectal resection (MICR) may increase plasma MMP-3 levels directly via surgical trauma or indirectly due to surgery-associated elevations in TNF-α and IL1 which are regulators of MMP-3. This study's purpose was to evaluate plasma MMP-3 levels during the first month after MICR for colorectal cancer.

Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis.

Importance: Thrombolytic therapy may be beneficial in the treatment of some patients with pulmonary embolism. To date, no analysis has had adequate statistical power to determine whether thrombolytic therapy is associated with improved survival, compared with conventional anticoagulation.

Objective: To determine mortality benefits and bleeding risks associated with thrombolytic therapy compared with anticoagulation in acute pulmonary embolism, including the subset of hemodynamically stable patients with right ventricular dysfunction (intermediate-risk pulmonary embolism).

Meta-analysis of randomized clinical trials comparing bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention and in patients with ST-segment elevation myocardial infarction.

This study sought to investigate the relative safety and efficacy of bivalirudin versus heparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI) and in those with ST-segment elevation myocardial infarction (STEMI). The safety of bivalirudin in PCI, particularly in patients with STEMI, continues to be debated. We searched the on-line databases for randomized controlled trials of bivalirudin versus heparin plus GP IIb/IIIa inhibitors.

Optimal conduit for diabetic patients: propensity analysis of radial and right internal thoracic arteries.

Background: Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revascularization of diabetic patients, we compared the outcomes for RA and RITA grafts to the circumflex coronary.

Methods: From January 1, 1995, to December 31, 2011, 908 consecutive diabetic patients underwent first-time, isolated CABG (99% on-pump), 659 with the RA and 502 with the RITA, respectively, in two affiliated hospitals.

Surgical management of medically refractory epilepsy due to early childhood stroke.

Unlabelled: OBJECT.: The risk of developing epilepsy after perinatal stroke, hypoxic/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve.

Efficacy of a checklist-style structured radiology reporting template in reducing resident misses on cervical spine computed tomography examinations.

The increasing use of medical checklists to promote patient safety raises the question of their utility in diagnostic radiology. This study evaluates the efficacy of a checklist-style reporting template in reducing resident misses on cervical spine CT examinations. A checklist-style reporting template for cervical spine CTs was created at our institution and mandated for resident preliminary reports.