Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality. However, the differential diagnosis can be broad with conditions that mimic this disease and ...require different evaluation and treatment. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. Fever is present in many patients, though most are low grade. Blood testing and imaging may assist with the diagnosis, but the gold standard is joint aspiration. Management includes intravenous antibiotics and orthopedic surgery consult for operative management vs. serial aspirations. Clinicians should consider mimics, such as abscess, avascular necrosis, cellulitis, crystal-induced arthropathies, Lyme disease, malignancy, osteomyelitis, reactive arthritis, rheumatoid arthritis, and transient synovitis. While monoarticular arthritis can be due to septic arthritis, other medical and surgical conditions present similarly and require different management. It is essential for the emergency clinician to be aware how to diagnose and treat these mimics.
The profession of psychology is regulated by the U.S. Constitution, federal laws, state statutes, professional regulatory boards, and, indirectly, the profession. These multiple sources of regulation ...have led to a patchwork quilt of rules that often conflict and can create obstacles for practitioners who are making their best efforts to provide competent and ethical service to their patients. However, a significant and ongoing concern revolves around interjurisdictional (state to state) practice. In this article, we briefly review the history of professional regulation nationally, the purpose and development of state regulation, the ethical principles at risk, and the lack of regulatory concordance across jurisdictions. In the next section, we discuss the efforts to address these problems and the unintended consequences they have created for interjurisdictional practice. We conclude with recommendations both for individual practitioners and the profession on how we may resolve some of the current, confusing, and overly complex jurisdictional problems.
Public Significance Statement
The profession of psychology is regulated to ensure that psychologists provide competent care to educate the public. The rapid development of electronic media and the increased mobility of both patients and psychologists have led to unintended barriers and potentially adverse consequences for both practitioners and consumers. In this article, we address the systemic barriers to providing interjurisdictional care, what might be done about them, and how individual practitioners can cope with the situation.
Acute compartment syndrome (ACS) is a time-sensitive surgical emergency caused by increased pressure within a closed compartment. ACS can lead to significant morbidity and mortality if it is not ...rapidly identified and treated.
This article provides an evidence-based review of the diagnosis and management of ACS, with focused updates for the emergency clinician.
ACS is the result of decreased perfusion within a compartment and is associated with a number of risk factors, but it occurs most commonly after fractures or trauma to the involved area. It can present with a variety of findings, including pain out of proportion to the injury, paresthesias, pain with passive stretch, tenseness or firmness of the compartment, focal motor or sensory deficits, or decreased pulse or capillary refill time. Pain is typically the earliest finding in patients with ACS. Unfortunately, history and physical examination are typically unreliable and cannot rule out the diagnosis. Measurement of intracompartmental pressures using a pressure monitor is the most reliable test, though noninvasive means of diagnosis are under study. Treatment involves surgical consultation for emergent fasciotomy, as well as resuscitation and management of complications, such as rhabdomyolysis.
ACS is a dangerous medical condition requiring rapid diagnosis and management that can result in significant complications if not appropriately diagnosed and treated. Emergency clinician awareness and knowledge of this condition is vital to appropriate management.
Enhancing Professionalism Through Self-Reflection Knapp, Samuel; Gottlieb, Michael C.; Handelsman, Mitchell M.
Professional psychology, research and practice,
06/2017, Letnik:
48, Številka:
3
Journal Article
Recenzirano
In this article we review the actions that psychologists can take to improve their ability to self-reflect. These activities include building professional networks, engaging in personal ...psychotherapy, taking part in continuing education, soliciting feedback from patients and colleagues, participating in Balint groups, engaging in expressive writing, and learning mindfulness skills. These activities may be most effective if they involve interactions with other people, expand the amount of information that psychologists receive, and are conducted in a spirit of openness to new experiences.
Public Significance Statement
The best psychologists have the ability to self-reflect and modify their behavior as needed. This article describes some activities that psychologists can engage in to increase their ability to self-reflect.
Gene drive technology offers the promise for a high-impact, cost-effective, and durable method to control malaria transmission that would make a significant contribution to elimination. Gene drive ...systems, such as those based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein, have the potential to spread beneficial traits through interbreeding populations of malaria mosquitoes. However, the characteristics of this technology have raised concerns that necessitate careful consideration of the product development pathway. A multidisciplinary working group considered the implications of low-threshold gene drive systems on the development pathway described in the World Health Organization
, focusing on reduction of malaria transmission by
s.l. mosquitoes in Africa as a case study. The group developed recommendations for the safe and ethical testing of gene drive mosquitoes, drawing on prior experience with other vector control tools, GM organisms, and biocontrol agents. These recommendations are organized according to a testing plan that seeks to maximize safety by incrementally increasing the degree of human and environmental exposure to the investigational product. As with biocontrol agents, emphasis is placed on safety evaluation at the end of physically confined laboratory testing as a major decision point for whether to enter field testing. Progression through the testing pathway is based on fulfillment of safety and efficacy criteria, and is subject to regulatory and ethical approvals, as well as social acceptance. The working group identified several resources that were considered important to support responsible field testing of gene drive mosquitoes.
Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This ...paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.
Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency ...physicians with a focused overview of the evaluation and management of angioedema. Two primary forms include histamine-mediated and bradykinin-mediated angioedema. Histamine-mediated forms present similarly to anaphylaxis, while bradykinin-mediated angioedema presents with greater face and oropharyngeal involvement and higher risk of progression. Initial evaluation and management should focus on evaluation of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes. Histamine-mediated angioedema should be treated with epinephrine intramuscularly, antihistaminergic medications, and steroids. These medications are not effective for bradykinin-mediated forms. Other medications include C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists. Evidence is controversial concerning the efficacy of these medications in an acute episode, and airway management is the most important intervention when indicated. Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy. Disposition is dependent on patient's airway and respiratory status, as well as the sites involved.
Clinicians are not trained to work within the legal system, and the thought of becoming professionally involved in it can cause much anxiety. In this article, we select common examples from civil, ...criminal, family, and immigration law where practitioners may find themselves unintentionally involved in legal proceedings, and how they may avoid or cope with them in a professional manner. We conclude with general recommendations.
Clinical Impact StatementClinical practitioners are generally not familiar with forensic work or the rules that govern it. When they find themselves involved in legal matters, they can become distressed and may be prone to errors. We discuss common scenarios where these situations may arise and offer concrete recommendations regarding their management.
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