Originally described by Grey Turner in 1920 as a sign of haemorrhagic pancreatitis, flank ecchymoses are caused by blood tracking subcutaneously from a retroperitoneal or intraperitoneal source.
The Alliance for Academic Internal Medicine (AAIM) supports the need for a uniform subspecialty fellowship training and advanced residency training start date. At present, training programs and their ...sponsoring institutions vary widely in the timing of institutional orientation and fellowship/advanced residency training start dates. Some institutions conduct orientation programs before the scheduled completion of the initial training program, which leads to conflicts for the resident between current and future obligations. AAIM believes that requiring residents to report for fellowship before completion of residency training is disruptive to medical education, creates unnecessary stress for the residents, and risks, violating federal labor laws and Center for Medicare and Medicaid Services graduate medical education funding rules. Adoption of Jul 1, 2015 as the earliest start date for all training and orientation activities can be endorsed internally by AAIM institutions and would resolve these conflicts. Here, Barrett et al examine AAIM adoption of a uniform subspecialty fellowship and other advanced training.
Abstract Background Misclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce ...these errors. Objective The purpose of this study is to examine the effects of real-time cardiology ECG review in patients evaluated for acute coronary syndrome. Methods A prospective observational study was done on weekdays, 8 am to 11 pm, from April 28, 2006, to October 27, 2006, in an urban academic medical center. Eligible subjects were those aged 21 years with chest pain or the equivalent. Those with ECGs considered “normal” or “unchanged from baseline” were excluded. Emergency physicians completed a data sheet and faxed the ECG to a cardiology fellow for review. The primary outcome was the effect of the cardiology review on emergency department (ED) triage and treatment decisions. We excluded those who eloped or left against medical advice (AMA) or those cases wherein the cardiology fellow came to evaluate the patient. Data included demographics, clinical and ECG characteristics, and a 3-month outcome. We used descriptive statistics with 95% confidence intervals. Results One hundred forty-nine ECGs were faxed to a cardiology fellow. One hundred twenty cases were analyzed. Excluded were AMA/eloped/ineligible (n = 11) and those whose cardiology forms were unavailable (n = 18). Subjects were aged (median) 50.5 years (range, 24-93 years), 50% (n = 60) were female, and 87.5% (n = 105) had cardiac markers in ED. Cardiology ECG review triggered callback in 6 cases (5.0%; 95% confidence interval, 1.5%-10.9%) with documented discussion with a cardiology fellow about treatment. In 3 cases (2.5%; 95% confidence interval, 0.5%-7.1%), disposition was changed to coronary care unit and cardiac catheterization consulted, although none were emergently treated.
Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD: An evaluation of ...technologies for identifying acute cardiac ischemia in the emergency department: A report from a National Heart Attack Alert Program Working Group.
Ann Emerg Med January 1997;29:13-87.
Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD: An evaluation of ...technologies for identifying acute cardiac ischemia in the emergency department: Executive Summary of a National Heart Attack Alert Program Working Group report.
Ann Emerg Med January 1997;29:1-12.
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