Internal and emergency medicine
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Multicenter Study Observational Study
Utility of point-of-care biliary ultrasound in the evaluation of emergency patients with isolated acute non-traumatic epigastric pain.
To determine the utility of emergency physician-performed point-of-care biliary ultrasound in the evaluation of emergency department (ED) patients with isolated acute non-traumatic epigastric pain. This was a multi-center prospective observational study of adult patients presenting to the ED with isolated acute non-traumatic epigastric pain. Patients with abdominal tenderness at any site other than the epigastric region, or with a history of gall stones, cholecystectomy, gastrointestinal bleeding, chronic abdominal pain, trauma, or altered mental status were excluded. ⋯ Point-of-care biliary ultrasound detected gall stones in more than one-third of ED patients with isolated acute non-traumatic epigastric pain. All patients presenting to the ED with non-traumatic epigastric pain should be evaluated for biliary disease with an ultrasound imaging study. Bedside ultrasound can avoid misdiagnosis and expedite management in these patients.
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Transfers of care have been associated with adverse events. High quality sign-out may help mitigate this risk. The authors sought to characterize the clinical questions asked of physicians covering patients overnight and to determine the adequacy of current sign-out practice to anticipate inquiries. ⋯ The proportion of inquiries successfully anticipated (47% overall) significantly decreased as the academic year progressed (AOR = 0.4, 95% CI 0.2, 0.8). Trainees rely on sign-out to answer nearly half of overnight inquiries, but the quality of sign-out may decrease over the course of the academic year. The deterioration of sign-out quality from novice to experienced interns and the common use of sign-out as a reference by covering interns suggest continued education, support and oversight by supervising physicians may be beneficial.
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Randomized Controlled Trial Comparative Study
Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure.
In patients with chronic heart failure (CHF) blood pressure (BP) control, represents a relevant target of management. This study evaluated the effect of different intensities exercise training on 24-h ambulatory BP profile and insulin resistance in patients with CHF. Thirty-six CHF patients with left ventricular ejection fraction <40%, were randomized to high-intensity interval training (HIT) or moderate continuous training (MIT) for 12 weeks. ⋯ Both HIT and MIT induced a significant decrease in fasting glucose and insulin, whereas HOMA-IR decreased significantly only after HIT. In patients with CHF exercise training reduces BP throughout the day, without substantial differences between moderate and more vigorous exercise intensity, with a small exception for day-time diastolic BP. HIT was more effective in improving insulin resistance.