Internal and emergency medicine
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Review
Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin.
The role of cardiac troponins as diagnostic biomarkers of myocardial injury in the context of acute coronary syndrome (ACS) is well established. Since the initial 1st-generation assays, 5th-generation high-sensitivity cardiac troponin (hs-cTn) assays have been developed, and are now widely used. ⋯ We aim to provide insights into using hs-cTn as a quantitative marker of cardiomyocyte injury to help in the differential diagnosis of coronary versus non-coronary cardiac diseases. We also review the recent evidence and guidelines of using hs-cTn in suspected ACS.
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To validate the proxy version of the Quality of Life after Brain Injury (QOLIBRI) questionnaire to utilize caregivers for comparison and to evaluate the correspondence between patients' self-perceived and caregivers' perception of patients' Health-Related Quality of Life (HRQoL). Ninety-two patients with severe TBI and their main caregivers were enrolled. Patients' and caregivers' HRQoL was assessed by the Patient-QOLIBRI (Pt-QOLIBRI) and the Proxy-QOLIBRI (Pro-QOLIBRI), respectively. ⋯ There was also positive correlation between the level of satisfaction measured by Pro-QOLIBRI but not by Pt-QOLIBRI, and the disability severity and social integration of the patients. The comparison between the Pt-QOLIBRI and Pro-QOLIBRI confirmed the usefulness of the Pro-QOLIBRI, especially the caregiver-centered version, to predict the social reintegration of survivors. To our knowledge this is the first study that correlates the HRQoL of survivors, as self-perceived and as perceived by the caregivers with social reintegration.
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There is a paucity of research on the quality and quantity of clinical teaching in the emergency department (ED) setting. While many factors impact residents' perceptions of attending physicians' educational skill, the authors hypothesized that the amount of time residents spend with attending in direct teaching is a determinant of residents' perception of their shift's educational value. Researchers shadowed emergency medicine (EM) attendings during ED shifts, and recorded teaching time with each resident. ⋯ No confounders had a significant effect. The study shows a moderate correlation between the total time attendings spend directly teaching residents and the residents' perception of educational value over a single ED shift. The authors suggest that mechanisms to increase the time attending physicians spend teaching during clinical shifts may result in improved resident education.
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Emergency medicine (EM) training mandates that residents be able to competently perform low-frequency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. ⋯ Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5 ± 13.3 for tube thoracostomy and 78.7 ± 14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver-based training provides superior landmark and tissue fidelity compared to simulation training and may be a valuable addition to EM residency training for certain low-frequency procedures.