Medicine recognizes burnout as a threat to quality patient care and physician quality of life. This issue exists throughout medicine but is notably prevalent in emergency medicine (EM). Because the concept of "wellness" lacks a clear definition, attempts at ameliorating burnout that focus on achieving wellness make success difficult to achieve and measure. Recent work within the wellness literature suggests that the end goal should be to achieve a culture of wellness by addressing all aspects of the physician's environment. A review of the available literature on burnout and wellness interventions in all medical specialties reveals that interventions focusing on individual physicians have varying levels of success. Efforts to compare these interventions are hampered by a lack of consistent endpoints. Studies with consistent endpoints do not demonstrate clear benefits of achieving them because improving scores on various scales may not equate to improvement in quality of care or physician quality of life. Successful interventions have uncertain, long-term effects. Outside of EM, the most successful interventions focus on changes to systems rather than to individual physicians. Within EM, the number of well-structured interventions that have been studied is limited. Future work to achieve the desired culture of wellness within EM requires establishment of a consistent endpoint that serves as a surrogate for clinical significance, addressing contributors to burnout at all levels, and integrating successful interventions into the fabric of EM.
We report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.
Background: Dementia is a leading cause of death and disability worldwide. Anticholinergic drugs have been frequently associated with a negative effect on cognition and increased risk of dementia. Previous studies have been restrained by comorbid medical problems in associating the diagnosis of dementia with anticholinergic drugs. Research Questions: What is the association between chronic anticholinergic drug use and future dementia? Are the effects specific to a particular drug class? Is there a dose response? Methods: This was a nested case-control study using the United Kingdom's Clinical Practice Research Datalink (CPRD). The CPRD includes demographics, clinical data, life style information, and prescribing records for 11.3 million patients in 674 primary care practices in the UK. Eligible cases were patients aged 65-99 with a diagnosis of dementia made between April 2006 and July 2015. Incidence density sampling was used to select matched controls (typically seven) for each subject from the CPRD database. A drug exposure period (DEP) of at least 1 year was required and the DEPs were between 4 and 20 years prior to the diagnosis of dementia. The diagnosis of dementia was made using medical coding, symptoms, referral, or prescription of a 'cognitive enhancer.' Cases were excluded if the onset of dementia was unknown or the patient was diagnosed with motor neuron disease, HIV/AIDs, MS, Down's syndrome or pre-existing alcohol abuse. Anticholinergic potency was assigned using
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.