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American College of Rheumatology Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 2.

Arthritis Rheumatol 2021 Jun 15. Epub 2021 Jun 15.

University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha.

Objective: To provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID-19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs).

Methods: A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Read More

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A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses.

Adv Skin Wound Care 2021 Jul;34(7):348-354

General Purpose: To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19.

Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

Learning Objectives/outcomes: After participating in this educational activity, the participant will:1. Read More

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MacEmerg Podcast: A Novel Initiative to Connect a Distributed Community of Practice.

AEM Educ Train 2021 Jul 25;5(3):e10550. Epub 2020 Nov 25.

and the Royal College of Physicians and Surgeons of Canada Emergency Medicine Training Program McMaster University Burlington Ontario Canada.

Background: Regional knowledge dissemination and information sharing is a challenge among physically divided groups of physicians. Many staff and resident physicians do not have easy access to share clinical and medical education and research information with each other in an academic setting. Our divisions of emergency medicine could benefit from a novel approach aimed at improving overall connection and collaborative engagement. Read More

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Esophagogastric junction outflow obstruction.

Neurogastroenterol Motil 2021 Jun 12:e14193. Epub 2021 Jun 12.

Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Metrohealth Medical System, Case Western Reserve University, Cleveland, OH, USA.

In the Chicago Classification version 4.0 (CCv4), esophagogastric junction outflow obstruction (EGJOO) is manometrically defined as an elevated median integrated relaxation pressure (IRP) and elevated intrabolus pressure (IBP) during supine wet swallows, and persistently elevated median IRP in the upright position. A clinically relevant conclusive diagnosis of EGJOO requires a manometric diagnosis of EGJOO and associated symptoms such as dysphagia and/or chest pain with at least one of the following supportive investigations (pharmacologic provocation, timed barium esophagogram, and/or endoflip). Read More

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Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation.

BMC Pregnancy Childbirth 2021 Jun 11;21(1):425. Epub 2021 Jun 11.

Wuqu' Kawoq | Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala.

Background: Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Read More

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Hands-On Workshops Improve Emergency Department Physicians' Self-Reported Understanding of Pediatric Hand Injuries.

Pediatr Emerg Care 2021 May 18. Epub 2021 May 18.

From the University of Ottawa Divisions of Plastic Surgery Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Objectives: The aims of this study were to assess emergency department (ED) physician perception of hand injuries and improve their understanding and confidence in treating these injuries.

Methods: Combined didactic and hands-on workshops for ED physicians were developed and run by a team of medical students, plastic surgeons, and ED physicians. The workshops consisted of a short review by a hand surgeon followed by hands-on sessions involving radiograph assessment, administration of local anesthetic, closed reduction, and splinting. Read More

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Viscosupplementation for the treatment of osteoarthritis. The contribution of EUROVISCO group.

Ther Adv Musculoskelet Dis 2021 28;13:1759720X211018605. Epub 2021 May 28.

U.O.S. of Rheumatology, Ospedale San Pietro Fatebenefratelli, Rome, Italy.

Viscosupplementation (VS) is a symptomatic treatment for knee and other joint osteoarthritis (OA). Despite a long history of use, conflicting opinions remain on the best clinical indications and the most appropriate patients to be treated with intra-articular hyaluronic acid (IA-HA), the optimal dosing regimen and the modalities of retreatment. A multidisciplinary committee of European experts on OA (EUROVISCO) was constituted to formulate recommendations, aimed at helping physicians in the decision-making and the optimal achievement of VS. Read More

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Electrocardiogram in Pediatric Syncope: Practice Variation Among Pediatric Emergency Physicians.

Pediatr Emerg Care 2021 Jun 7. Epub 2021 Jun 7.

From the Division of Emergency Medicine Children's Heart Centre, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.

Objectives: We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population.

Methods: We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. Read More

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2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Arthritis Care Res (Hoboken) 2021 Jun 8. Epub 2021 Jun 8.

Weill Cornell Medicine, New York, New York.

Objective: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. Read More

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2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.

Arthritis Rheumatol 2021 Jun 8. Epub 2021 Jun 8.

Weill Cornell Medicine, New York, New York, United States.

Objective: To develop updated guidelines for the pharmacologic management of rheumatoid arthritis.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes (PICO) questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the certainty of evidence. Read More

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Development of a simple screening tool based on the 5-question geriatric locomotive function scale for locomotive syndrome.

J Orthop Sci 2021 Jun 2. Epub 2021 Jun 2.

Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan.

Background: The optimal cut-off values of the 5-question Geriatric Locomotive Function Scale (GLFS-5) as a screening tool to identify Locomotive Syndrome (LS) diagnosed with the 25-question Geriatric Locomotive Function Scale (GLFS-25) has yet to be fully investigated. This study aimed to construct a simple screening tool, based on the GLFS-5, for the detection of LS-1, LS-2, and LS-3 diagnosed with the GLFS-25.

Methods: This research was approved by the institutional review board of Fukushima Medical University School of Medicine (No. Read More

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Impact of Pharmacist-led Educational Intervention on Predictors of Diabetic Foot at Two Different Hospitals of Malaysia.

J Pharm Bioallied Sci 2021 Jan-Mar;13(1):108-115. Epub 2020 Dec 21.

Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia.

Objective: Diabetes mellitus (DM) is a chronic metabolic disorder that can initiate organ damage inside the body if not treated appropriately. Apart from tight glycemic control, a suitable educational intervention is also needed from health-care providers to stop or decrease the progression of organ damage in diabetic patients. This study intended to measure the impact of pharmacist-led educational intervention on improvement in predictors of diabetic foot in two different hospitals in Malaysia. Read More

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December 2020

Changes in Schedule II oral opioid volume dispensed in a private health plan following Florida's Acute Pain Opioid Restriction Law.

J Manag Care Spec Pharm 2021 Jun;27(6):779-784

Department of Pharmaceutical Outcomes & Policy; Center for Drug Evaluation and Safety; and Pain Research and Intervention Center of Excellence, University of Florida, Gainesville.

Florida's House Bill 21 (HB21), implemented into law on July 1, 2018, limited opioid prescriptions for acute pain to a 3-day supply. While the law has been associated with a decrease in opioid prescribing for acute pain, its effect on opioid volume dispensed at the plan level remains unknown. To assess the impact of HB21 on the total volume dispensed of oral Schedule II opioids. Read More

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Tazarotene 0.045% Lotion for Moderate-to-Severe Acne in Male and Female Participants: A Phase II Analysis.

J Clin Aesthet Dermatol 2021 Apr 1;14(4):E53-E60. Epub 2021 Apr 1.

Dr. Baldwin is with the Acne Treatment and Research Center in Brooklyn, New York, and Rutgers Robert Wood Johnson Medical Center in New Brunswick, New Jersey.

NCT02938494 In a Phase II study, tazarotene 0.045% lotion was statistically superior to vehicle and comparable to tazarotene 0.1% cream in reducing acne lesions, with fewer treatment-related adverse events (TEAEs) than the cream. Read More

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Intention to receive a COVID-19 vaccine: results from a population-based survey in Canada.

BMC Public Health 2021 05 29;21(1):1017. Epub 2021 May 29.

Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.

Background: The success of any COVID-19 vaccine program ultimately depends on high vaccine uptake. This study determined overall intention to receive a COVID-19 vaccine and identified factors that predict intentions to be vaccinated against COVID-19 in Canada, specifically in key priority groups identified by the American Committee on Immunization Practice (ACIP) and the National Advisory Committee on Immunization (NACI) for early immunization.

Methods: Individuals from research cohorts from the general population of British Columbia aged 25-69 were invited complete an online survey based on validated scales and theoretical frameworks to explore intention to receive a COVID-19 vaccine. Read More

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Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses.

PLoS One 2021 27;16(5):e0251982. Epub 2021 May 27.

Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Objectives: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC).

Design: Qualitative study conducted through semi-structured in-depth interviews.

Setting: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. Read More

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Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review.

J Foot Ankle Surg 2021 Apr 20. Epub 2021 Apr 20.

Director Evidence Synthesis Program and Core Investigator, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN; Staff Physician, Minneapolis VA Medical Center, Minneapolis, MN; Professor of Medicine, University of Minnesota School of Medicine, Minneapolis, MN.

Orthobiologics are biologically-derived materials intended to promote bone formation and union. We review evidence on effectiveness and harms of orthobiologics compared to no orthobiologics for foot and ankle arthrodesis. We searched multiple databases (1995-2019) and included clinical trials and other studies with concurrent controls, English language, and reporting patient-centered outcomes, union/time to union, costs/resource utilization, or harms. Read More

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"Better than having no evaluation done": a pilot project to conduct remote asylum evaluations for clients in a migrant encampment in Mexico.

BMC Health Serv Res 2021 May 26;21(1):508. Epub 2021 May 26.

Medical Initiatives, Project Lifeline, Houston, TX, USA.

Background: Asylum evaluations are highly specialized medico-legal encounters to collect physical or mental health evidence for use in immigration proceedings. Although the field of asylum medicine is growing, access to these evaluations is still inadequate, particularly for those in United States immigration detention or other forms of custody, such as under the U.S. Read More

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Authors' response to AAEM on the impact of advanced practice provider staffing in emergency departments.

Acad Emerg Med 2021 May 26. Epub 2021 May 26.

US Acute Care Solutions, Canton, OH, USA.

We appreciate the opportunity to respond to questions raised by the American Academy of Emergency Medicine (AAEM). We realize staffing models for emergency departments (EDs) with or without advanced practice providers (APPs) are of increasing interest. Our study was intended to fill a gap in the literature, not to advocate for a particular position on this issue. Read More

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Azithromycin in the Successful Management of COVID-19: A Family Physician's Perspective.

Cureus 2021 Apr 20;13(4):e14574. Epub 2021 Apr 20.

Family Medicine, Touro College of Osteopathic Medicine, New York, USA.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), causing coronavirus disease-19 (COVID-19), has been responsible for approximately 75 million cases and 1.6 million deaths globally as of December 22, 2020. Currently, no treatment modalities or management options have been recommended by the National Institutes of Health (NIH) prior to patient hospitalization and supplemental oxygen requirement. Read More

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POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care.

J Am Med Dir Assoc 2021 May 21. Epub 2021 May 21.

VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form used to document preferences about cardiopulmonary resuscitation (CPR), medical interventions such as hospitalization, care in the intensive care unit, and/or ventilation, as well as artificial nutrition. Programs based on the POLST paradigm are used in virtually every state under names that include POST (Physician Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and MOST (Medical Orders for Scope of Treatment), and these forms are used in the care of hundreds of thousands of geriatric patients every year. Although POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limiting medical condition, some nursing homes and residential care settings use POLST to document CPR preferences for all residents, resulting in potentially inappropriate use with patients who are ineligible because they are too healthy. Read More

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Clinical profile of children with West syndrome: A retrospective chart review.

J Family Med Prim Care 2021 Jan 30;10(1):350-353. Epub 2021 Jan 30.

Department of Pediatrics, Pt. BD Sharma PGIMS, Rohtak, Haryana, India.

Background: This study was intended to document the clinical profile and treatment outcome of West syndrome in children attending a tertiary care centre in Northern India.

Methods: Data were collected by a retrospective chart review of children diagnosed with West syndrome between January 2017 to January 2018. Information was recorded pertaining to the age at onset and presentation, etiology, and associated co-morbidities; results of electroencephalography (EEG) and neuroimaging; treatment given; and final outcome. Read More

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January 2021

The B Reader Program, Silicosis, and Physician Workload Management: A Niche for AI Technologies.

J Occup Environ Med 2021 May 19. Epub 2021 May 19.

Harvard Law School, Cambridge, Massachusetts Harvard T. H. Chan School of Public Health, Boston, Massachusetts MedLaw LLC, Chief Medical and Science Officer Dartmouth College Geisel School of Medicine, Clinical Assistant Professor University of New England, Clinical Assistant Professor.

The National Institute for Occupational Safety and Health (NIOSH) has operated its B Reader Program for over fifty years. Originally intended as a screening program for black lung disease, it has since received a broadened mandate to cover other occupational pneumoconioses, such as silicosis. At the same time, the B Reader Program itself has witnessed a consistently declining pool of participating physicians, alongside high levels of subjectivity and possible financial conflicts of interest. Read More

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Toward a New Model of Training in Canadian Forensic Psychiatry.

J Am Acad Psychiatry Law 2021 May 20. Epub 2021 May 20.

Department of Psychiatry, University of Ottawa, Ottawa, Ontario. Department of Psychiatry, University of Toronto, Toronto, Ontario. Forensic Psychiatry, University of Toronto, Toronto, Ontario.

The Royal College of Physicians and Surgeons of Canada has recently introduced a new model of training for residents and fellows in all specialties and subspecialties, including forensic psychiatry.This model, Competence by Design, is intended to improve the training of residents with the goal of increasing the competence of practicing specialists. In the Competence by Design model, training is broken down into four distinct phases. Read More

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Committee Opinion No. 418: The Complete 11-14 Week Prenatal Sonographic Examination.

J Obstet Gynaecol Can 2021 May 17. Epub 2021 May 17.

Toronto, ON. Electronic address:

Objective: Sonography during the first trimester provides an opportunity to assess a pregnancy in its early stage. This document provides an opinion about the implementation and content of prenatal sonographic examinations at 11-14 weeks gestation in Canada.

Target Population: Pregnant women at 11-14 weeks gestation. Read More

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First preliminary Clinical Experiences using Hyperspectral Imaging for Burn Depth Assessment of Hand Burns.

J Burn Care Res 2021 May 20. Epub 2021 May 20.

Department of Plastic, Reconstructive and Hand surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University.

The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment often subjective depending on the experience of the physician. Hyperspectral Imaging is intended to counteract this subjective diagnosis by an accurate and objective analysis of perfusion parameters. Read More

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The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap.

J Gen Intern Med 2021 May 19. Epub 2021 May 19.

Division of Hospital Medicine, University of Colorado, Aurora, CO, USA.

Introduction: Hospitalizations related to the consequences of substance use are rising yet most hospitalized patients with substance use disorder do not receive evidence-based addiction treatment. Opportunities to leverage the hospitalist workforce could close this treatment gap.

Aim: To describe the development, implementation, and evaluation of a hospitalist-directed addiction consultation service (ACS) to provide in-hospital addiction treatment. Read More

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The Role of Apology Laws in Medical Malpractice.

J Am Acad Psychiatry Law 2021 May 19. Epub 2021 May 19.

Department of Psychiatry, Case Western Reserve University, Cleveland, OH. Department of Psychiatry, Saint Louis University School of Medicine, Saint Louis, MO.

Apologies are an integral part of human communication and can repair damaged relationships. Within the medical system, apologies remain controversial. Physicians often wish to apologize to patients harmed by medical errors, but they may not disclose errors to patients and their families because of the concern that disclosing errors could increase the likelihood of a malpractice claim. Read More

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Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool.

Simul Healthc 2021 Mar 13. Epub 2021 Mar 13.

From the Neil and Elise Wallace STRATUS Center for Medical Simulation (D.A.M., C.N.P., A.E., S.Y.), and Department of Emergency Medicine (D.A.M., N.H., C.N.P., A.E., J.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI (J.S.); Department of Surgery (S.Y.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Department of Clinical Surgery (S.Y.), The University of Edinburgh, Edinburgh, United Kingdom.

Introduction: Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice.

Methods: This was a mixed methods study conducted in 2 phases, following Kane's validity framework. Read More

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