Acta Clin Belg
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Objective: In this systematic review we explored the different aspects of burnout in emergency medicine physicians and residents. We also investigated the possible solutions for this frequent burden. Design: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. ⋯ Conclusions: A wide variety in the burnout prevalence was found in emergency physicians and emergency medicine residents. A non-patient-related problem (such as large administrative tasks) as well as human relations issues were reported as a trigger factor for burnout. Tackling these issues could lead to a breakthrough in the prevention and treatment for burnout.
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Review Case Reports
Behçet's disease; A rare refractory patient with vena cava superior syndrome treated with infliximab: a case report and review of the literature.
Objectives: Behçet's disease (BD) is a multi-systemic inflammatory disorder which can affect all types and sizes of vessels. The usage of TNF-α antagonists is increasing in different involvements of BD that is inadequately controlled by standard immunosuppressive regimens. Methods: Here we reported a rare BD case that is controlled by only infliximab (IFX) treatment. ⋯ Conclusions: Vascular involvement of BD are generally treated with immunosuppressive agents such as steroids and immunomodulators. IFX was found effective and well tolerated in the treatment of intestinal,neurological and vascular involvement of BD especially in patients with poor response or intolerance to conventional therapy. This case report supports IFX as a new therapeutic option for patients with vascular BD.
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Case Reports
Allergic myocardial infarction: Type I Kounis syndrome following blue crab consumption.
Objectives: Allergic myocardial infarction, known as Kounis syndrome, is an acute myocardial infarction after an allergic reaction to food, drugs, or insect stings, etc. Kounis syndrome can also be caused by all kinds of seafood, such as finned fish, molluscan shellfish, cephalopods, and crustacean shellfish. Methods: Herein, we report a case of a 67-year-old man, with hypertension, referred for itchiness, facial rash, chest pain, and palpitations developed after consumption of blue crab. Results: Electrocardiogram showed ST elevations in leads II,III,aVF. Transthoracic echocardiography revealed inferior wall hypokinezia with a left ventricular ejection fraction of 55%. ⋯ The patient was diagnosed to have Kounis Syndrome type I variant, secondary to blue crab ingestion. He was treated with oral antihistamines and prednisolone. The repeated cardiac markers were within normal limits, with resolution of electrocardiographic abnormalities and inferior wall motion echocardiographic changes. Conclusion: All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults.
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Observational Study
A shared medication scheme for community dwelling older patients with polypharmacy receiving home health care: role of the community pharmacist.
Background and objective: An accurate medication scheme may be a useful tool to improve medication safety in primary care. This study aimed to identify (1) pharmacists' alterations to nurse medication schemes and (2) potential improvements to the contribution of the community pharmacist to a shared medication scheme within a multidisciplinary collaboration. Dosing frequency, potentially incorrect moments of intake, drug-drug interactions and medication complexity (quantified by the Medication Regimen Complexity Index, MRCI) were investigated. ⋯ Pharmacists did not reduce dosing frequency. MRCI scores (median [IQR]) significantly differed between pharmacist (38 [15]) and nurse medication schemes (32 [11]) (p < 0.001) and between nurse (32 [11]) and researcher medication schemes (40 [15]) (p < 0.001). Conclusion: Alterations made by the community pharmacists enable more complete and accurate medication schemes; however, there is room for improvement in optimizing the patient's medication scheme in a multidisciplinary collaboration.
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Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR. ⋯ Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.