Canadian family physician Médecin de famille canadien
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A 2-year-old child was recently brought into my office for repeated episodes of neck stiffening and shivering movements of the shoulders and arms. The episodes last 4 to 5 seconds and occur more than 10 times per day, with no apparent pattern except increased frequency at mealtime. Although there has never been loss of consciousness, the parent was worried that these were seizures. The child was diagnosed by a neurologist as having shuddering attacks. Should I start antiepileptic medications for this child? ⋯ Shuddering attacks are involuntary movements of the head and upper extremities that occur during normal activities and do not impair consciousness. Normal neurologic examination findings and normal electroencephalogram tracing will confirm that this child has shuddering attacks, a benign phenomenon that requires no further investigation or medical therapy. The condition is of unknown cause but is distinct from epilepsy and neither warrants nor responds to antiepileptic medications. Parents can be reassured that attacks will decrease in frequency and will spontaneously remit with age.
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To determine the effect of a physician assistant (PA) working in a secondary care hospital emergency department (ED) on the overall performance of the ED. ⋯ This study suggests that a PA has a statistically significant positive effect on the overall performance of an ED. Future studies should examine the effect of a PA on quality of care and hospital funding.
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To determine whether changes to the appearance of an emergency department (ED) waiting room influenced the number of patients who left without being seen (LWBS). ⋯ The number of patients registering is influenced by the apparent high or low occupancy of the waiting area at the time of registration.