Autism is an extensively studied disorder in which the gender disparity in prevalence has received much attention. In contrast, only a few studies examine gender differences in symptomatology. This systematic review and meta-analysis of 22 peer reviewed original publications examines gender differences in the core triad of impairments in autism. Gender differences were transformed and concatenated using standardized mean differences, and analyses were stratified in five age categories (toddlerhood, preschool children, childhood, adolescence, young adulthood). Boys showed more repetitive and stereotyped behavior as from the age of six, but not below the age of six. Males and females did not differ in the domain of social behavior and communication. There is an underrepresentation of females with ASD an average to high intelligence. Females could present another autistic phenotype than males. As ASD is now defined according to the male phenotype this could imply that there is an ascertainment bias. More research is needed into the female phenotype of ASD with development of appropriate instruments to detect and ascertain them.

BackgroundThe treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using “blind” or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments. We hypothesized that emergency physicians can be effectively trained to safely perform and implement ultrasound-guided femoral nerve blocks, resulting in effective pain relief in patients with proximal femoral fractures.MethodsIn this prospective observational study, emergency physicians were trained by expert anesthesiologists to perform ultrasound-guided femoral nerve blocks during a single-day course. Femoral nerve blocks were performed on patients with proximal femoral fractures. A system of direct supervision by skilled anesthesiologists and residents was put in place.ResultsA total of 64 femoral nerve blocks were performed. After 30 min, blocks were effective in 69% of patients, and after 60 min, in 83.3%. The mean reduction in pain scores after 30 and 60 min was 3.84 and 4.77, respectively (both p <  0.001).Patients reported a mean satisfaction of 8.42 (1 to 10 scale). No adverse events occurred.ConclusionsUltrasound-guided femoral nerve block is an effective, safe, and easy to learn (single-day course) procedure for emergency physicians to implement and perform in the emergency department. Patient satisfaction was high.

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Background: This is the first study to validate the National Emergency Department Overcrowding Study (NEDOCS) tool as a quantitative tool for assessing crowding at the Emergency Department (ED) of a Dutch level I trauma center at an academic hospital with a patient volume of 22.000 every year. Methods: This was a prospective observational study performed between April 20th, 2017 and June 19th, 2017 at the ED of the Radboud University Medical Center (Radboudumc), a level I academic hospital in the Netherlands. The NEDOCS score was generated every 30 minutes during the study period of 2 months. During this study period the charge nurse and emergency physician (EP) both filled in a questionnaire 5 time a day to register perceived crowding and work load. The correlation and agreement between the perceived crowding by the ED staff members and the NEDOCS score were calculated. Results: The NEDOCS score was measured 2,887 times, with a median score of 16.15. A positive correlation between the NEDOCS score and the perceived crowding was measured (Spearman’s correlation coefficient 0.715). There was low agreement between the NEDOCS score and the perceived crowding.Conclusion: The NEDOCS tool shows a positive correlation with the perceived crowding by the ED staff making it a potential tool for national crowding management. However, there is a low agreement in its current form. Future studies should be performed to optimize the NEDOCS tool and usage.