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Emergency Medicine Pitfalls

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1. Ustekinumab for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contrai

Ustekinumab for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contrai October 2019 EUnetHTA Joint Action 3 WP4 1 EUnetHTA Joint Action 3 WP4 Version 1.0, 22/10/2019 Relative effectiveness assessment of pharmaceutical technologies USTEKINUMAB FOR THE TREATMENT OF ADULT PATIENTS WITH MODERATELY TO SEVERELY ACTIVE (...) and Pharmaceutical Benefits Agency (TLV). Relative effectiveness assessment of pharmaceutical technologies. Ustekinumab for the treat- ment of adult patients with moderately to severely active ulcerative colitis (UC) who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contraindications to such therapies. EUnetHTA Project ID: PTJA07. 2019. PTJA07 - Ustekinumab for active ulcerative colitis October 2019 EUnetHTA Joint Action 3

2020 EUnetHTA

2. Emergency Department Out of Hours Discharge Medications

(commissioned by the Department of Health) identified that “Where patients’ clinical needs are such that treatment should start without delay, they will need to be able to access the medicines they need at the same time and the same place as their out-of-hours consultation.” 5 Emergency Department Out of Hours Discharge Medications, April 2019 Considerations TTO Cupboard space Space in EDs is at a premium, therefore careful selection of which drugs and what quantities are stocked, should be taken when (...) is negligible with more expensive drugs. Prescribers should prescribe medicines generically (to minimise cost) unless there is a clinical / efficacy / safety reason not to e.g. patients taking anti-epileptics such as carbamazepine should be maintained on the same brand. ED staff should have access to FP10s without overly burdensome bureaucratic steps. Treating them as per a controlled drug is a reasonable measure. 7 Emergency Department Out of Hours Discharge Medications, April 2019 FP10s should be stored

2019 Royal College of Emergency Medicine

3. Non-medical Prescription Stimulant Use among Post-secondary Students

of Use According to the 2015 Canadian Tobacco, Alcohol and Drug Survey (CTADS), 0.2% of the general population report the non-medical use of prescription stimulants (Statistics Canada, 2015). This statistic was not reportable among emerging adults, aged 18–25, in the 2015 CTADS due to high sampling variability, but other survey results suggest rates are highest among this subgroup. For example, the 2015 National Survey on Drug Use and Health in the United States showed that 2.2% of emerging adults (...) to the greater negative impacts of street drugs, a finding consistent with other qualitative studies (Judson & Langdon, 2009; Kerley, Copes, & Giffin, 2015). Moreover, none of the 175 participants recognized that using prescription stimulants non-medically posed a significant health risk, and felt that because a pharmaceutical company manufactured them they were relatively safe. Other justifications for use included students’ beliefs that they were doing it for the right reasons (i.e., academic enhancement

2018 Canadian Centre on Substance Abuse

4. Medical testing is fraught with pitfalls

Medical testing is fraught with pitfalls Medical testing is fraught with pitfalls Medical testing is fraught with pitfalls | | September 7, 2018 53 Shares I am frequently asked by patients to “run some tests to make sure nothing is wrong.” This makes a lot of sense on the surface but makes no sense as a physician. Why? Because testing without a context or a medical question is nonsensical. Let’s talk about why. How doctors think Studies show that doctors only let their patient speak (...) that has not been adequately studied so we have an indeterminate result. Many people with a BRCA1 or BRCA2 gene mutation associated with cancer will not actually develop cancer. This is when consultation with a geneticist is key. Knowing what to do with your results is key. Beware of . Allergy issues are complicated! If it were as simple as running an at-home test, an allergist would not need four years of medical school followed by three years of internal medicine or pediatrics training and another

2018 KevinMD blog

5. Drug-Induced Liver Injury

andpathologicalphenotypesandthecurrentabsenceofspeci?c biomarkers. This makes the diagnosis of drug-induced liver injury an uncertain process, requiring a high degree of aware- ness of the condition and the careful exclusion of alternative aetiologies of liver disease. Idiosyncratic hepatotoxicity can be severe, leading to a particularly serious variety of acute liver failure for which no effective therapy has yet been developed. These Clinical Practice Guidelines summarize the available evi- dence on risk factors, diagnosis, management and risk (...) of its relatively low incidence, the variety in its clinical phenotype, as well as the absence of speci?c biomarkers. The hepatotoxic potential of many drugs used in clinical practice can further jeopardize the correct assessment of DILI cases. New immunotherapeuticagentsincludingbiologics,andinparticular immune checkpoint inhibitors for advanced cancer, are associ- ated with immune-mediated adverse reactions including hep- atic damage. These treatments are leading to emerging forms of DILI that pose

2019 European Association for the Study of the Liver

6. Emergency Medicine Pitfalls

Emergency Medicine Pitfalls Aka: Emergency Medicine Pitfalls , Emergency Medicine Pearls , Emergency Department BounceBacks , BounceBacks From Related Chapters II. History Avoid labeling patients Drug seeking patients can also have life-threatening illnesses Considered differential diagnosis should be complete regardless of a patient's frequency of emergency department visits Document findings that contribute to medical decision making Do not use a stereotype or label (e.g. drug seeker or frequent flyer (...) Emergency Medicine Pitfalls Emergency Medicine Pitfalls Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Emergency Medicine Pitfalls

2018 FP Notebook

7. Real world data as a key element in precision medicine for lymphoid malignancies: potentials and pitfalls. (Abstract)

Real world data as a key element in precision medicine for lymphoid malignancies: potentials and pitfalls. Molecular genetic studies of lymphoma have led to refinements in disease classification in the most recent World Health Organization update. Nevertheless, a 'one-size-fits-most' treatment strategy based on morphology remains widely used for lymphoma despite significant molecular heterogeneity within histopathologically-defined subtypes. Precision medicine aims to improve patient outcomes (...) by leveraging disease- and patient-specific information to optimise treatment strategies, but implementation of precision medicine strategies is challenged by the biological diversity and rarity of lymphomas. In this review, we explore existing and emerging real-world data sources that can be used to facilitate the development of precision medicine strategies in lymphoma. We provide illustrative examples of the use of real-world analyses to refine treatment strategies, provide comparators for clinical

2019 British journal of haematology

8. Pitfalls in anaphylaxis diagnosis and management at a university emergency department. (Abstract)

Pitfalls in anaphylaxis diagnosis and management at a university emergency department. Some previous reports revealed suboptimal management of anaphylaxis (ANX) in the emergency department (ED).To evaluate the recorded diagnosis and management of patients who presented with ANX at our university hospital ED and to assess how the management correlated with the severity of the case and the training level of the ED staff.A descriptive study that involved reviewing the electronic medical records (...) autoinjector prescriptions. Of the 50 who were discharged home, 48% were given epinephrine autoinjector prescriptions and 16% were given a referral for allergy evaluation.The observed low rates of appropriate diagnostic coding of ANX, of epinephrine administration, epinephrine autoinjector prescribing at discharge, and referral for allergy evaluation call for more education on these issues. Some of these pitfalls can be partly attributed to the setting in a university ED where health providers are usually

2018 Allergy and Asthma Proceedings

9. Diagnosis and management of glycogen storage disease type I: a practice guideline of the American College of Medical Genetics and Genomics

storage disease type I (GSD I) after reviewing the autopsy reports of two children whose livers and kidneys contained excessive amounts of Submitted 12 August 2014; accepted 12 August 2014; advance online publication 6 November 2014. doi:10.1038/gim.2014.128 Genet Med 00 00 2014 Genetics in Medicine 10.1038/gim.2014.128 ACMG Standards and Guidelines 00 00 12August2014 12August2014 © American College of Medical Genetics and Genomics 6November2014 Purpose: Glycogen storage disease type I (GSD I (...) , Durham, North Carolina, USA; 2 Division of Metabolic Disorders, Children’ s Hospital of Orange County, Orange, California, USA; 3 Division of Genetics, Nemours Children’ s Clinic, Jacksonville, Florida, USA; 4 Departments of Pediatrics and Medicine, Columbia University Medical Center, New Y ork, New Y ork, USA; 5 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA; 6 Department of Medicine, University of W ashington, Seattle, W ashington, USA; 7 Division

2014 American College of Medical Genetics and Genomics

10. Finding Quality Addiction Care in Canada: Drug and Alcohol Treatment Guide

relationships, work, school, social activities)? Source: Diagnostic and Statistical Manual (DSM 5) If you are concerned about your own or someone else’s alcohol or other drug use, you can get a full assessment by an addiction or healthcare provider. It is best to be assessed by someone with specialized training in alcohol and other drug treatment. Who can help? Professionals with the following credentials can help if they are also trained in addiction treatment. • Medical doctors (M.D.) • Addiction Medicine (...) such as HIV and hepatitis C through using or sharing needles. Opioid substitution therapy replaces the illegal use of heroin and opioid prescription pain medications with methadone, buprenorphine/naloxone, or other substitutes. Heroin-assisted therapy, which involves supervised prescription of pharmaceutical heroin, can be an option for individuals with severe heroin dependence who have not benefited from opioid substitution therapy or other treatments. Supervised consumption services prevent overdoses

2017 Canadian Centre on Substance Abuse

11. Medicalization of aging and the testosterone deficiency syndrome

with important adverse effects. Long-term safety of the drug is still unknown. Propaganda regarding TDS in Spain has been focussed on its supposed (false) favourable action on cardiovascular problems. The hard experience resulting from hormone replacement therapy in women should serve as a warning to avoid committing the error of transforming a hormonal change to disease. The proposed diagnostic methods should not be employed and only serve to medicalize a natural processMedicalization of aging (...) Medicalization of aging and the testosterone deficiency syndrome Servicio Navarro de Salud / Osasunbidea Plaza de la Paz, s/n - 31002 Pamplona T 848429047 - F 848429010 farmacia.atprimaria@cfnavarra.es Drug and Therapeutics Bulletin of Navarre. Spain abstract n Objective: to carry out a critical appraisal of the Testosterone Deficit Syndrome (TDS), also known as low testosterone or T-low, its diagnosis and management. Materials and methods: a bibliographic search was carried out in the TRIP

2012 Drug and Therapeutics Bulletin of Navarre (Spain)

12. Ease and difficulty of pre-hospital airway management in 425 paediatric patients treated by a helicopter emergency medical service: a retrospective analysis. Full Text available with Trip Pro

Ease and difficulty of pre-hospital airway management in 425 paediatric patients treated by a helicopter emergency medical service: a retrospective analysis. Pre-hospital paediatric airway management is complex. A variety of pitfalls need prompt response to establish and maintain adequate ventilation and oxygenation. Anatomical disparity render laryngoscopy different compared to the adult. The correct choice of endotracheal tube size and depth of insertion is not trivial and often challenged (...) formulae.Difficult airway management, including cannot intubate and cannot ventilate situations during pre-hospital paediatric emergency treatment was rare. In contrast, the success rate of endotracheal intubation at the first attempt was very high. High numbers of inadequate endotracheal tube size and deep placement according to patient age require further analysis. Practical algorithms need to be found to prevent potentially harmful treatment.

2016 Scandinavian journal of trauma, resuscitation and emergency medicine

13. Ultrasound Guidelines: Emergency, Point-of-care, and Clinical Ultrasound Guidelines in Medicine

curricula through residency to postgraduate education of physicians, and extended to other providers such as nursing, advanced practice professionals, and prehospital providers. US curricula in undergraduate medical education is growing exponentially due to the leadership and advocacy of emergency physicians. US in emergency medicine (EM) residency training has now been codified in the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS). Emergency US specialists (...) sophisticated and digital over the last decade allowing emergency US examinations to have versatility, mobility and integration. US hardware for emergency care has become more modular, smaller, and powerful, ranging from smartphone size to slim, cart-based systems dedicated to the emergency medicine market. US hardware has evolved to allow on- machine reporting, wireless connectivity and electronic medical record (EMR) and picture archiving and communication system (PACS) integration. A new software entity

2016 American College of Emergency Physicians

14. Medical Cognitive Error

making is a combination of thin and Thick Slicing Thin Slicing (fast and intuitive) Formulate initial patient plan based on limited information, gestalt, pattern recognition and intuition Allows for rapid emergency decision making Often accurate, especially in more expert clinicians (but risky in medical trainees) Pitfalls Requires experience, training and practice, with constant exposure to cases, simulations, peer review Risk of anchor bias and Confirmation Bias Processing occurs in the prefrontal (...) Medical Cognitive Error Medical Cognitive Error Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Medical Cognitive Error Medical

2018 FP Notebook

15. Medical Interpreter

Medical Interpreter Medical Interpreter Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Medical Interpreter Medical Interpreter Aka (...) as Interpreters due to their lack of understanding of adult issues Patients may filter their responses when asked embarrassing questions with a family member or friend interpreting Family members and friends may have personal agendas May provide unsolicited advice May diverge down tangential paths or break confidentiality Non-professional Interpreters may misunderstand medical concepts Results in errors and in some cases more complicated medical care References Be aware of medical interpretation pitfalls

2018 FP Notebook

16. Hypofractionated Radiation Therapy for Localized Prostate Cancer

Hypofractionated Radiation Therapy for Localized Prostate Cancer Prostate Cancer: Hypofractionated Radiotherapy Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology (...) Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research Funding AUA Funding Research Education & Events Online Research Education Courses Research Resources Biorepositories and Other Resources Research Publications Research Career Opportunities Advocacy Scholar & Fellowship Programs Comment Letters & Resources International International Opportunities Annual Meeting Membership Collaborations Academic Exchanges Giving Back Practice Resources Coding and Reimbursement

2018 American Urological Association

17. Effectiveness and Harms of Spinal Manipulative Therapy for the Treatment of Acute Neck and Lower Back Pain

Research & Development Service Washington, DC 20420 Prepared by: Evidence-based Synthesis Program (ESP) West Los Angeles VA Medical Center Los Angeles, CA Paul G. Shekelle, MD, PhD, Director Investigators: Principal Investigator: Paul G. Shekelle, MD, PhD Co-investigators: Neil M. Paige, MD, MSHS Research Associates: Isomi M. Miake-Lye, BA Jessica M. Beroes, BS Marika Suttorp Booth, MS Roberta Shanman, MS Effectiveness and Harms of Spinal Manipulative Therapy Evidence-based Synthesis Program (...) reported on specific adverse events, none of which were judged to be related to the treatment except for “the treatment hurts” being statistically more common in the group of patients receiving SMT (as part of a package of therapies) compared to those receiving conventional medical care. SMT in General We identified 8 studies that prospectively assessed adverse events in patients receiving SMT, generally by asking consecutive patients receiving SMT from a sample of manual therapy clinicians to complete

2017 Veterans Affairs Evidence-based Synthesis Program Reports

18. A veteran journalist explains why it’s so tough to inform the public about medical devices — and what can be done about it

attention to this data gap. While critical news coverage of the pharmaceutical industry and its products has made the public more wary of drugmakers, Lenzer asserts that “the same skepticism is largely lacking about implantable devices.” “The public and doctors often perceive these devices as advanced products of cutting-edge technology that are inert and so, unlike drugs, don’t have serious side effects,” she writes. “Nothing could be further from the truth.” Unlike drug companies, device makers often (...) the solution” she said. Profits over patient welfare Lenzer spent years researching her book, which chronicles the device industry’s lack of accountability through the story of one epilepsy patient who nearly died when a vagus nerve stimulator implanted in his chest repeatedly stopped his heart. The book is worth reading for anyone who wants to understand how government, medicine and academia became enmeshed in a medical-industrial complex that puts profits over patient welfare, and what policy steps might

2017 HealthNewsReview

19. Occupational Therapy for people Undergoing total hip replacement

and successful interventions in the whole of medical practice. The success of hip replacement is entirely dependent upon a multidisciplinary team approach, with occupational therapy being a core part of its success. The updated guidance reflects changes in practice and in particular the requirement for reduction in length of stay. The trend for patients undergoing hip arthroplasty at younger ages continues, as does the increasing numbers of total hip replacements being performed year on year. National (...) Occupational Therapy for people Undergoing total hip replacement Occupational therapy for adults undergoing total hip replacement Practice guideline Second Edition Royal College of Occupational TherapistsCover photographs (inset, top right) ©Tessa Fincham 1/17 Mrs Jeffries, a service user, describes her experience of total hip replacement: Total hip replacements may be a common procedure but they are always life-changing and challenging for the individual concerned. As my osteoarthritis became

2018 Publication 1554

20. Perceptions among Alberta Healthcare Professionals of Prescription Drug Misuse

Characteristics of Suspected PDM Opioids, stimulants, and sedatives/tranquillizers were the three drug classes studied. The study found that healthcare professionals’ perceptions of PDM were dependent upon drug class and 1 Prescription drug misuse was defined for the purposes of this study as “the use of a medication for a medical purpose other than as directed or indicated, whether intentionally or unintentionally, and whether harm results or not.” Canadian Centre on Substance Abuse • Centre canadien de (...) to the other drug classes. There were no differences in suspected youth misuse of any of the prescription drug classes. Healthcare professionals reported that the following patient actions were strong indicators of PDM: • Altering the delivery method of a prescription drug; • Forging prescriptions; • Double doctoring; • Doctor shopping; and/or • Using medications differently than were prescribed. The expression by family members or caregivers of worry about prescription drug use was also a strong indicator

2015 Canadian Centre on Substance Abuse

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