Crisis in the Emergency Department: The Evaluation and Management of Acute Agitation in Children and Adolescents.

Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important.

Multimodality Imaging Review of Normal Appearance and Complications of the Postoperative Rotator Cuff.

Objective: The objective of this article is to provide a multimodality imaging review of the imaging features of the postoperative rotator cuff, including a discussion of the most common complications.

Conclusion: Both MRI and ultrasound can be used to evaluate the repaired rotator cuff and potential complications. The appearance of the rotator cuff within the first 6 months after repair is heterogeneous and may be difficult to interpret but normalizes over time.

A Nurse-Led Mobility Program on an Acute Rehabilitation Unit.

Rehabilitation assists patients with return to baseline activities of daily living after catastrophic events or long hospitalizations. In an effort to increase mobility episodes in the rehabilitation patient, a nurse-led mobility program was suggested. This allows the rehabilitation nurse to participate in the improvement of mobility for rehabilitation patients by mobilizing the patients safely during hours in which physical therapy is not available.

Incorporating Safe Patient-Handling Techniques to Mobilize Our Most Complex Patients on Extra Corporeal Membrane Oxygenation.

Historically, patients supported on extra corporeal membrane oxygenation were thought to be too unstable to engage in early mobility but are at increased risk for deconditioning from prolonged immobilization due to the nature of illness, numerous cannulas, equipment, and hemodynamic and respiratory instability along with heavy sedation/analgesia or paralysis. This article will discuss the specific considerations that should be employed to keep the patient and the staff safe while providing mobility to patients on extra corporeal membrane oxygenation.

Integrating a Standardized Mobility Program and Safe Patient Handling.

Early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, and improves muscle strength and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving while keeping them and our staff safe through the use of a standardized mobility protocol that incorporates the components of safe patient handling. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria.

Implications of Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle and Initial Lactate Measurement on the Management of Sepsis.

Background: Sepsis remains a significant cause of morbidity and mortality in the United States, leading to the implementation of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). SEP-1 identifies patients with "severe sepsis" via clinical and laboratory criteria and mandates interventions, including lactate draws and antibiotics, within a specific time window. We sought to characterize the patients affected and to study the implications of SEP-1 on patient care and outcomes.

Musculoskeletal ultrasound: athletic injuries of the lower extremity.

Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities.

Radiation-Induced Edema After Single-Fraction or Multifraction Stereotactic Radiosurgery for Meningioma: A Critical Review.

Purpose: Potential dosimetric and clinicopathologic predictors of radiation-induced brain edema after single-fraction or multifraction stereotactic radiosurgery (SRS) for non-base of skull (non-BOS) meningiomas are summarized based on a systematic review of the published literature.

Methods And Materials: Reviewed studies (PubMed indexed from 1998 through 2017) included all or some non-BOS meningioma patients, reported risks of edema after SRS, and correlated dosimetric and/or nondosimetric measures with the magnitude of risk.

Results: Twenty-six studies reporting risks of edema after SRS for meningioma are reviewed.

Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction.

Background: Two recent randomised trials studied the benefit of mineralocorticoid receptor antagonists (MRAs) in ST-segment elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both undersized to assess hard clinical endpoints. A pooled analysis was preplanned by the steering committees.

Early onset sporadic colorectal cancer: Worrisome trends and oncogenic features.

Early onset colorectal cancers, defined as arising before 50 years of age, are a growing health hazard in western and eastern countries alike. The incidence of colon and rectal cancers in young individuals is projected to increase by as much as 90% and 140%, respectively, by 2030. Although several known cancer risk factors (e.

Designing a Curriculum for Professionalism and Ethics Within Radiology: Identifying Challenges and Expectations.

Although professionalism and ethics represent required competencies, they are more challenging than other competencies to design a curriculum for and teach. Reasons include variability in agreed definitions of professionalism within medicine and radiology. This competency is also framed differently whether as roles, duties, actions, skills, behavior, beliefs, and attitudes.

Interrater Agreement and Diagnostic Accuracy of a Novel Computer-Aided Detection Process for the Detection and Prevention of Retained Surgical Instruments.

Objective: The purpose of this study is to evaluate the diagnostic accuracy of a process incorporating computer-aided detection (CAD) for the detection and prevention of retained surgical instruments using a novel nondeformable radiopaque μTag.

Materials And Methods: A high-specificity CAD system was developed iteratively from a training set (n = 540 radiographs) and a validation set (n = 560 radiographs). A novel test set composed of 700 thoracoabdominal radiographs (410 with a randomly placed μTag and 290 without a μTag) was obtained from 10 cadavers embedded with confounding iatrogenic objects.

Malignant Transformation of a Site of Prior Diabetic Foot Ulceration to Verrucous Carcinoma: A Case Report.

The case of a 62-year-old Caucasian man with type 1 diabetes who developed malignant transformation of an area of prior diabetic foot ulceration (DFU) is reported. He had significant hallux valgus deformity, multiple episodes of healing and breakdown, and eventual transformation to verrucous carcinoma (VC). This case report highlights the malignant transformation of a site of previous DFU to VC, which, to the best of the authors' knowledge, has not yet been described in the literature.

Acute pseudogout of the foot following Parathyroidectomy: a case report.

Background: The current case report is the first in the literature to report the association between parathyroidectomy and an episode of probable pseudogout in the foot in a patient with diabetes mellitus.

Case Presentation: The authors present a case of pseudogout of the left foot following a subtotal parathyroidectomy in an 80-year-old female with type 2 diabetes mellitus and primary hyperparathyroidism. Pseudogout, also known as calcium pyrophosphate dehydrate deposition disease, is an unusual metabolic sequela following parathyroidectomy.

Retrospective Cohort Analysis of Pedal Procedures in the Thrombocytopenic Patient.

Thrombocytopenia is an important medical condition to understand prior to performing procedures in the foot and ankle. We have set forth to highlight factors a physician should take into consideration before performing procedures in the thrombocytopenic patient. A retrospective cohort analysis at a large academic institution was undertaken utilizing a cohort discovery tool to discover incidence and management strategies for patients with foot-related conditions that require in-office procedures.

The Long-Term Oxygen Treatment Trial for Chronic Obstructive Pulmonary Disease: Rationale, Design, and Lessons Learned.

The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates.

Transfusion Strategies are Associated with Epigenetic Changes Following Blunt Trauma.

Introduction: Epigenetics has been identified in multiple diseases. The effect of transfusion strategy on epigenetics is unknown. We hypothesized that expression of epigenetic regulating genes would be associated with resuscitation strategy following blunt trauma.