Survey of Anesthesia, Sedation, and Non-sedation Practices for Children Undergoing Repetitive Cranial or Craniospinal Radiotherapy.

Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy.

Malignant mitral valve prolapse: an uncommon variation of a common condition.

Mitral valve prolapse affects up to 3% of the population, with an annual risk of death of up to 2% a year. Presentation is often in the third to fourth decade of life. This report details an adolescent with mitral valve prolapse with non-specific symptoms but investigative findings of ventricular ectopy at higher heart rates.

Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study.

Objectives: Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.

Design: Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.

Desmoplastic fibroblastoma of the left upper arm.

An elderly female patient presented to the clinic with a several-week history of a mass in her left upper arm that was tender to the touch. The mass was initially thought to be a schwannoma of the left radial nerve based on imaging and was surgically removed. The pathology report revealed an uncommon diagnosis of desmoplastic fibroblastoma.

Resilience skills as emergent phenomena: A study of emergency departments in Brazil and the United States.

Although the use of resilience skills (RSs) by emergency department (ED) front-line staff is ubiquitous, the nature and origin of these skills tend to be taken for granted. This study investigates the research question "where do RSs come from"? Case studies in two EDs were undertaken in order to answer the research question: one in Brazil and the other in the United States. The case studies adopted the same data collection and analysis procedures, involving interviews, questionnaires, observations, and analysis of documents.

Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam or Cefepime: A Retrospective Cohort Study.

Study Objective: The combination of vancomycin and piperacillin-tazobactam has been associated with an increased risk of acute kidney injury (AKI) in non-critically ill patient populations, but it is still unknown if this association exists in critically ill patients. The objective of this study was to compare the incidence of AKI development during therapy or within 72 hours after completion of therapy in adult critically ill patients who received vancomycin with concomitant piperacillin-tazobactam or cefepime.

Design: Retrospective cohort study.

Impact of prescription drug-monitoring program on controlled substance prescribing in the ED.

Objective: In 2009, Florida initiated a statewide prescription drug-monitoring program (PDMP) to encourage safer prescribing of controlled substances and reduce drug abuse and diversion. Data supporting the utility of such programs in the emergency department (ED) is scarce. This study sought to determine the effect of PDMP data on controlled substance prescribing from the ED.

Short-course of ranolazine prevents postoperative atrial fibrillation following coronary artery bypass grafting and valve surgeries.

Background: Postoperative atrial fibrillation (POAF) is a common complication arising after coronary artery bypass grafting (CABG) and valve replacement or repair surgeries. POAF has been associated with increased mortality, morbidity and cost.

Methods: The study was conducted to evaluate the incidence of POAF following CABG, valve or combination surgeries when perioperative ranolazine (1,000 mg preoperatively, then 1,000 mg twice daily for 7 days or until discharge) was or was not added to standard therapy.

Hemispherectomy: historical review and recent technical advances.

The surgical options available for intractable hemispheric epilepsy have evolved since their initial description in the early 20th century. Surgical techniques have advanced, as has the ability to predict good surgical outcomes with noninvasive diagnostics. The authors review the history of hemispherectomy and detail the novel imaging and surgical strategies used to confer seizure freedom.

Acute ethanol poisoning in a 6-year-old girl following ingestion of alcohol-based hand sanitizer at school.

Background: Alcohol-based hand sanitizers (ABHSs) have been widely used in homes, workplaces and schools to prevent the spread of infectious diseases. We report a young child unintentionally ingested ABHS at a school, resulting in intoxication.

Methods: The child was a 6-year-old girl who had been brought to the emergency department (ED) for hypothermia, altered mental status (AMS), periods of hypoventilation, hypothermia and vomiting.

Titanium screws as fiducial markers for image-guided stereotactic proton irradiation in pediatric central nervous system tumors: a technical report.

Objectives: Fiducial markers (FM) have been used to enhance the accuracy of radiation therapy in central nervous system (CNS) tumors. Recently, image-guided radiotherapy utilizing FM has been used in proton therapy of CNS tumors. We describe our surgical technique of placement of titanium screws as cranial FM in children undergoing proton therapy for CNS tumors.

Florida's trauma surgeons: a vanishing breed.

The delivery of trauma and emergency surgical care is in a state of crisis. We hypothesized that this looming crisis was already manifested in Florida. The trauma medical directors of the 20 state designated trauma centers were surveyed for information pertaining to number of available surgeons for trauma call, number of night calls/month, age of the current trauma surgeons, and the estimated number of years each surgeon planned to continue taking call.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

Study Objective: The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure.

Methods: This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition.

Changing pattern of esophageal cancer incidence in New Mexico: a 30-year evaluation.

Background And Aim: The incidence of esophageal adenocarcinoma has increased over the last 30 years, especially in non-Hispanic whites (nHw). Recent work indicates an increase in Hispanic Americans (HA). It is important to understand the effect of ethnicity on cancer occurrence over a prolonged interval.

Seizures and EEG findings in an adult patient with DiGeorge syndrome: a case report and review of the literature.

This is the first case report to describe the EEG findings in a patient with DiGeorge syndrome who survived into adulthood. The patient developed generalized tonic-clonic seizures when she was 9 years old and these were associated with hypocalcemia. Despite treatment with calcium, seizures persisted and the patient required antiepileptic medications.

Modified technique to extract malpositioned or migrated self-expanding stents from the esophagus and stomach.

Background And Aim: Various methods have been used to remove self expandable stents (SES) because of either malposition or migration. The main difficulties encountered in such situations are the anatomic obstacle of the lower and upper esophageal sphincters as well as risk of mucosal injury during removal.

Methods: We describe a modified approach using an esophagogastroduodenoscope (EGD) in combination with a foreign body hood protector, rat tooth forceps and snare allowing for successful SES removal from the upper gastrointestinal tract in four cases.

The impact of graduate medical education on teaching hospital efficiency.

This quantitative research study assesses the efficiency of university teaching hospitals in providing hospital services and graduate medical education, identifying areas in which inefficient teaching hospitals differed from their efficient counterparts. The study analyzed American Hospital Association (AHA) data from 2002 in order to examine the efficiency of Council of Teaching Hospital (COTH) hospitals. An efficiency frontier was determined using Data Envelopment Analysis, an effective method of measuring efficiency widely accepted within the health care management literature.

Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank.

Background: To examine the efficacy of early versus late spinal fracture fixation, we reviewed National Trauma Data Bank (NTDB) records to identify the breakpoint in reported timing of operative fixation. Using this breakpoint we then analyzed outcome for those treated early versus late, hypothesizing that the early group would experience better outcome as reflected by resource utilization and complications.

Methods: The NTDB was queried for patients with any level spinal fracture that required surgical stabilization.

Ethnic variation in lower oesophageal sphincter pressure and length.

Background: Oesophageal manometry (OM) is used to diagnose oesophageal motor disorders. Normal values of OM among United States ethnic groups are only available for Hispanic Americans (HA).

Aim: To obtain normal values of OM in adult African American (AA) volunteers, compare these with those obtained in HA and non-Hispanic white (nHw) volunteers to determine if ethnic variation in normal oesophageal motor function exists.

Retrograde jejunoduodenogastric intussusception due to a replacement percutaneous gastrostomy tube presenting as upper gastrointestinal bleeding.

Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding.