Rhode Island medical journal (2013)
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Takotsubo cardiomyopathy is a reversible cardiomyopathy which has increasingly been recognized in the differential diagnosis of patients presenting with acute coronary syndrome. It is characterized by transient systolic ventricular dysfunction with regional wall motion abnormalities beyond a single vascular territory and in the absence of significant epicardial coronary artery obstruction. Often, there is an acute emotional or physical stressor immediately preceding the presentation. ⋯ Catecholamine excess and cardiotoxicity is the most compelling putative mechanism. The long-term prognosis is excellent but serious complications including cardiogenic shock and arrhythmias may occur acutely. Supportive treatment is the mainstay of therapy.
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Despite the fact that up to half of all heart failure occurs in patients without evidence of systolic cardiac dysfunction, there are no universally accepted diagnostic markers and no approved therapies for heart failure with preserved ejection fraction (HFpEF). HFpEF, otherwise known as diastolic heart failure, has nearly the same grim prognosis as systolic heart failure, and diastolic heart failure is increasing in incidence and prevalence. ⋯ Even criteria for diagnosis of HFpEF are still debated, and there is still no gold standard marker to detect diastolic dysfunction. Here, we will review some promising new insights into the pathogenesis of diastolic dysfunction that may lead to new diagnostic and therapeutic tools.
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As Urgent Care Centers (UCCs) multiply, more children receive care in this setting. Little is known about UCC providers' perspectives on the management of common pediatric conditions. The objectives of this study are to describe the perceptions of UCC providers and identify challenges they face regarding common pediatric conditions. ⋯ Interviews identified three common pediatric scenarios that challenged UCC providers: acutely ill young infants, minor traumatic brain injury (mTBI), and uncooperative children requiring minor procedures. UCCs should focus quality initiatives to educate their providers on evidence-based management of common pediatric clinical scenarios. Efforts may include dissemination of validated guidelines, education targeted to non-pediatric trained providers, and the integration of minimal sedation protocols for minor procedures.
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The pediatric emergency department can be frightening for children. Visits are unplanned, and frequently accompanied by significant emotional and physical distress. ⋯ The pediatric emergency physician is now a primary advocate for treatment of children's pain and anxiety and for the safe and appropriate use of procedural sedation. This article focuses on the treatment spectrum available for providing safe and effective procedural sedation, analgesia and anxiolytic therapy.
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Multicenter clinical research studies are often needed to address issues of generalizability, conditions with low incidence, adequate statistical power, and potential study bias. While pediatric research networks began work in the 1950s, and Rhode Island physicians have contributed to many of these studies, pediatric emergency medicine (PEM) collaboratives are relative newcomers. ⋯ Its mission is to perform high quality, high impact PEM research. Since joining the network, Rhode Island Hospital has quickly become a productive and valued member of the network, portending a bright future for multicenter PEM research in the Ocean State.