No abstract

Most patients with globus pharyngeus had normal results at pH monitoring and radiographic examination of the pharynx.

Reduction in dose for CT angiography in the detection of pulmonary embolism has a significant adverse effect on readers' subjective assessment of diagnostic confidence and image quality. Detection of pulmonary embolism also decreases as the tube current dose is reduced.

The development of an cellular inflammatory response secondary to mechanical wounding has not been observed previously in the fetus. The effect of amniotic fluid exclusion on the inflammatory response in fetal rabbits subjected to full-thickness dorsal excisional wounds on day 25 of gestation (term = 31-32) was examined. The fetuses were either returned immediately to the uterus; a silicone cover was sutured over the wound; or a silicone cover with a centrally located hole was sutured over the wound. Seventy-two hours after wounding, uncovered wounds (19 live fetuses) exhibited only occasional inflammatory cells. Covered wounds (14 live fetuses) showed a pronounced cellular inflammatory response. Partially covered wounds (six live fetuses) showed a peripheral, intermediate response. The findings suggest that amniotic fluid contains factors inhibitory to inflammation, which the cover effectively excludes.

No abstract

Dedicated emergency department CT scanners can have significant daily periods of consistent lack of use. The idle time can be reduced by identifying patterns of referral time and correcting specific operational delays.

Clinical decision support (CDS) systems are prevalent in electronic health records and drive many safety advantages. However, CDS systems can also cause unintended consequences. Monitoring programs focused on alert firing rates are important to detect anomalies and ensure systems are working as intended. Monitoring efforts do not generally include system load and time to generate decision support, which is becoming increasingly important as more CDS systems rely on external, web-based content and algorithms. We report a case in which a web-based service caused significant increase in the time to generate decision support, in turn leading to marked delays in electronic health record system responsiveness, which could have led to patient safety events. Given this, it is critical to consider adding decision support-time generation to ongoing CDS system monitoring programs.

We report a case showing the classic features of a Hangman's cervical spine fracture following a motor vehicle collision. Because this injury was not diagnosed at ED presentation, this case also illustrates the select subset of trauma patients for whom the almost obsolete lateral cervical spine radiograph remains an important part of the radiographic trauma series.