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Cannabis legalization may increase the rates of emergency department presentations and hospitalizations from Cannabinoid Hyperemesis Syndrome (CHS). This syndrome was first described nearly 20 years ago and has become increasingly common. Yet, for a variety of reasons, CHS is still an underrecognized cause of recurrent abdominal pain, nausea, and vomiting. All physicians must be prepared to diagnose, manage, and counsel patients on this condition, regardless of their state’s current or future cannabis legislation.

Supplemental Digital Content is available in the text., The landscape of health care delivery and medical education is evolving. Institutions must continually reassess priorities, strategies, and partnerships to align the knowledge and skills of the health care workforce with the delivery of quality, socially accountable, collaborative health care that meets the needs of diverse populations in communities. This article describes the development, implementation, and early outcomes of the University of Missouri–Kansas City’s Health Care Quality and Patient Safety Consortium. Inspired by an actual patient safety event, the consortium aimed to improve patient outcomes by establishing quality improvement and patient safety (QIPS) education and scholarship as foundational within its unique, horizontal-matrix academic health center, which comprises 6 affiliated hospitals and 4 university-based health sciences schools. The consortium established a governance structure with leaders who, collectively, represent the diverse members and stakeholders of the consortium. The members share a common agenda and mutual goals. The consortium measures success by applying published conceptual frameworks for evaluating the outcomes of educational programs on learners (Kirkpatrick) and patients (Bzowyckyj and colleagues). Consortium learner and patient outcomes span all levels of these frameworks. Undergraduate and graduate QIPS-based projects with meaningful health system or improved individual health outcomes signify a Level 4 outcome (the highest level) for learners and patients alike. Factors critical to success include a financial gift, leadership buy-in and support, a clear champion, shared goals and a united vision, a willingness to collaborate across health systems with varied strengths and priorities, and a stable communication platform. Aspirational goals of the consortium include increasing involvement across health professional schools, incorporating simulation into QIPS activities, and aligning the consortium’s projects with broader community needs.

Contexte Les troubles hypertensifs pendant la grossesse, en particulier la pré-éclampsie et l’éclampsie (PE/E), constituent la deuxième cause de mortalité maternelle dans le monde et est. la moins bien comprise et la plus difficile à gérer. Bien que de grands progrès aient été réalisés dans la réduction de la mortalité maternelle et néonatale entre 1990 et 2015, il est. clair que cela n’a pas suffi pour atteindre les objectifs mondiaux en matière de santé. Pour réduire la mortalité maternelle: 1) la détection précoce de la PE doit être améliorée, 2) la gestion efficace de la PE/E doit se faire à des niveaux inférieurs du système de santé et devrait encourager la recherche de soins en temps utile et 3) la priorité doit être donnée à l’élargissement d’un ensemble complet de services à proximité du lieu de résidence des femmes. Résultats Ce commentaire décrit une approche pragmatique visant à tester des stratégies évolutives et durables pour élargir l’accès à des produits, interventions et services de santé maternelle de qualité et sous-utilisés. Nous présentons un modèle PE/E de soins de santé primaires (SSP) basé sur la recherche de mise en œuvre des lacunes identifiées dans les soins dans plusieurs pays, sur les meilleures pratiques mondiales acceptées et sur le principe de base selon lequel les prestataires de SSP peuvent acquérir des compétences supplémentaires avec un renforcement des capacités, un encadrement et une supervision adéquats, et les membres de la communauté souhaitent contrôler leur propre santé. Le modèle PE/E de SSP présente les liens et les possibilités de prévenir et de traiter la PE/E de manière simplifiée. Cependant, il existe de nombreux facteurs, angles et points critiques liés entre eux à prendre en compte, notamment le leadership, les politiques et les protocoles, les médicaments et les produits pertinents, les stratégies de renforcement des capacités en cours aux niveaux inférieurs et la compréhension de ce que les femmes et leurs communautés souhaitent pour des grossesses sans risque. Conclusion Le modèle de SSP décrit ici utilise la PE comme entrée pour améliorer la qualité des soins prénataux et par extension le continuum de la grossesse. Il est. logique de rapprocher les services de prévention et de traitement du lieu de résidence des femmes enceintes.

Familial LCAT deficiency (FLD) is due to mutations in lecithin:cholesterol acyltransferase (LCAT), a plasma enzyme that esterifies cholesterol on lipoproteins. FLD is associated with markedly reduced levels of plasma high-density lipoprotein and cholesteryl ester and the formation of a nephrotoxic lipoprotein called LpX. We used a mouse model in which the LCAT gene is deleted and a truncated version of the SREBP1a gene is expressed in the liver under the control of a protein-rich/carbohydrate-low (PRCL) diet-regulated PEPCK promoter. This mouse was found to form abundant amounts of LpX in the plasma and was used to determine whether treatment with recombinant human LCAT (rhLCAT) could prevent LpX formation and renal injury. After 9 days on the PRCL diet, plasma total and free cholesterol, as well as phospholipids, increased 6.1 ± 0.6-, 9.6 ± 0.9-, and 6.7 ± 0.7-fold, respectively, and liver cholesterol and triglyceride concentrations increased 1.7 ± 0.4- and 2.8 ±0.9-fold, respectively, compared with chow-fed animals. Transmission electron microscopy revealed robust accumulation of lipid droplets in hepatocytes and the appearance of multilamellar LpX particles in liver sinusoids and bile canaliculi. In the kidney, LpX was found in glomerular endothelial cells, podocytes, the glomerular basement membrane, and the mesangium. The urine albumin/creatinine ratio increased 30-fold on the PRCL diet compared with chow-fed controls. Treatment of these mice with intravenous rhLCAT restored the normal lipoprotein profile, eliminated LpX in plasma and kidneys, and markedly decreased proteinuria. The combined results suggest that rhLCAT infusion could be an effective therapy for the prevention of renal disease in patients with FLD.

International Medical Graduate (IMG) physicians applying to residency training programs in a country different from where they completed medical school, bring beneficial diversity to a training program, but also face significant challenges matching into an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program. Despite the growing number of IMG applications in Emergency Medicine (EM), there is a paucity of targeted recommendations for IMG applicants. As a result, the Council of Residency Directors (CORD) Advising Students Committee in EM (ASC-EM) created a dedicated IMG Advising Team to create a set of evidence-based advising recommendations based on longitudinal data from the National Residency Match Program (NRMP) and information collected from EM program directors and clerkship directors. IMG applicants should obtain at least two EM standardized letters of evaluation (SLOEs), review IMG matched percentages for programs-of-interest, analyze their objective scores with the previous matched cohorts, and rank at least 12 programs to maximize their chances of matching into EM.

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students’ ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM’s emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.

Background The objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply. Methods A survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated. Results One hundred four surveys were completed. Of respondents involved in the interview process, 2 or more standardized letters of evaluation (SLOEs) were recommended for osteopathic (90.1% [95% CI 84–96]), IMG (82.5% [73–92]), dual-accreditation (46% [19–73]), and average applicants (48.5% [39–58]). Recommendations for numbers of residency applications to submit were 21–30 (50.5% [40.7–60.3]) for the average applicant, 31–40 (41.6% [31.3–51.8]) for osteopathic, and > 50 (50.9% [37.5–64.4]) for IMG. For below-average Step 1 performance, 56.0% [46.3–65.7] were more likely to interview with an average Step 2 score. 88.1% [81.8–94.4] will consider matching an EM-EM couple. The majority were more likely to interview a military applicant with similar competitiveness to a traditional applicant. Respondents felt the best option for re-applicants was to pursue the Supplemental Offer and Acceptance Program (SOAP) for a preliminary residency position. Conclusion Advising and residency selection practices for special population applicants differ from those of traditional EM applicants. These data serve as an important foundation for advising these distinct applicant groups in ways that were previously only speculative. While respondents agree on many advising recommendations, outliers exist.

Author(s): Stobart-Gallagher, Megan; Smith, Liza; Giordano, Jonathan; Jarou, Zach; Lufty-Clayton, Lucienne; Kellogg, Adam; Hillman, Emily | Abstract: The Council of Emergency Medicine Residency Directors (CORD) Advising Students Committee(ASC-EM) has previously published student advising recommendations for general emergencymedicine (EM) applicants in an effort to disseminate standardized information to students andpotential advisors. As the shift to a single graduate medical education system occurs by 2020,osteopathic students will continue to represent a larger portion of matched EM applicants, but datashows that their match rate lags that of their allopathic peers, with many citing a lack of access toknowledge EM advisors as a major barrier. Based on available data and experiential information, asub-group of ASC-EM committee sought to provide quality, evidence-based advising resources forstudents, their advisors, and medical leadership. The recommendations advise osteopathic studentsto seek early mentorship and get involved in EM-specific organizations. Students should take Step 1of the United States Medical Licensing Exam and complete two EM rotations at academic institutionsto secure two Standardized Letters of Evaluation and consider regional and program-specific data onpercentage of active osteopathic residents.

Background Grand Challenges for international health and development initiatives have received substantial funding to tackle unsolved problems; however, evidence of their effectiveness in achieving change is lacking. A theory of change may provide a useful tool to track progress towards desired outcomes. The Saving Lives at Birth partnership aims to address inequities in maternal-newborn survival through the provision of strategic investments for the development, testing and transition-to-scale of ground-breaking prevention and treatment approaches with the potential to leapfrog conventional healthcare approaches in low resource settings. We aimed to develop a theory of change and impact framework with prioritised metrics to map the initiative’s contribution towards overall goals, and to measure progress towards improved outcomes around the time of birth. Methods A theory of change and impact framework was developed retrospectively, drawing on expertise across the partnership and stakeholders. This included a document and literature review, and wide consultation, with feedback from stakeholders at all stages. Possible indicators were reviewed from global maternal-newborn health-related partner initiatives, priority indicator lists, and project indicators from current innovators. These indicators were scored across five domains to prioritise those most relevant and feasible for Saving Lives at Birth. These results informed the identification of the prioritised metrics for the initiative. Results The pathway to scale through Saving Lives at Birth is articulated through a theory of change and impact framework, which also highlight the roles of different actors involved in the programme. A prioritised metrics toolkit, including ten core impact indicators and five additional process indicators, complement the theory of change. The retrospective nature of this development enabled structured reflection of the program mechanics, allowing for inclusion of learning from the first four rounds of the program to inform implementation of subsequent rounds. Conclusions While theories of change are more traditionally developed before program implementation, retrospective development can still be a useful exercise for multi-round programs like Saving Lives at Birth, where outputs from the development can be used to strengthen subsequent rounds. However, identifying a uniform set of prioritised metrics for use across the portfolio proved more challenging. Lessons learnt from this exercise will be relevant to the development of pathways to change across other Grand Challenges and global health platforms. Electronic supplementary material The online version of this article (10.1186/s12992-018-0327-z) contains supplementary material, which is available to authorized users.