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Introduction: Ankle injuries represent one of the most common sports and extremity related complaints presented in emergency departments (ED) with over five million ankle injuries annually arising in the United States. The 2007 US National Health Statistics Report stated that lower limb and ankle complaints accounted for 4.1% of all reported body sites undergoing injury in the ED. The purpose of this study was to examine how frequently a sample of ED patients’ perception of having a possible ankle fracture was predictively associated with results of their X-ray evaluation results. Methods: After 2017 IRB approval, a sample of consented adult patients receiving care at the authors’ two Ohio and Michigan ED were asked, “Do you think you broke your ankle?” Regardless of each patient’s answer, they received an X-ray to evaluate for an ankle fracture that was interpreted by a radiologist. Results: A total of 69 eligible patients received an ankle X-ray. The total number of ankle fractures confirmed by X-ray was 20 (29.4% of sample) while 48 (70.5%) of ankles that were X-rayed were not fractured. Six (28.5%) out of 21 males and 14 (30.4%) out of 46 females were found to have a confirmed ankle fracture. The sensitivity of the perceived ankle fracture question was at or below 50% in all sample subgroups except for smokers at 67%. Conclusion: These findings support the importance of an ED clinician’s intuition when considering a patient’s own self-assessment during their clinical decision-making processes

Last November, Nursing Management Congress2016 attendees experienced a one-of-a-kind keynote address when Zubin Damania, MD, took the stage. Through self-produced song and video, he explored the ethics of delivering compassionate care in our challenging healthcare system. Here, read about the Iora Health model that Dr. Damania celebrates as "having it right."

Purpose: To compare outcomes of early medical abortion with mifepristone and misoprostol in a family medicine setting and specialized reproductive health clinics. Methods: This study used data collected from a prospective, open-label, randomized trial of oral versus buccal misoprostol efficacy. A secondary analysis was performed, evaluating efficacy, acceptability, and interventions after medication at the family medicine site compared with the 6 specialized reproductive health sites. Results: Comparing data from patients in the family medicine setting (n = 116) to specialized reproductive health sites (n = 731) revealed no difference in overall efficacy (95.7% vs 93.4%; P = .351). The family medicine site used a second dose of misoprostol more frequently than the other sites (6.9% vs 2.5%; P = .018). In addition, uterine aspiration after medical abortion at the family medicine site was not used for “medically necessary” reasons whereas reproductive health clinics used it 2.6% of the time (marginally significant; P = .094). Patient satisfaction at family medicine sites was comparable to the other sites (91.2% vs 92.0%; P = .792). Conclusion: Medical abortion has similar efficacy and patient satisfaction when offered in a family medicine practice or at a reproductive health specialty clinic. These findings should reassure family physicians that medical abortion can be offered safely in their practices.

The objective of this study was to determine whether propofol and methohexital differ in their efficacy, acceptability, cost and side effects when used as the single anesthetic agent for inducing general anesthesia in first-trimester vacuum abortion. We randomized 400 unpremedicated American Society of Anesthesiologists grade I-II women to receive 1% propofol or 1% methohexital by intravenous bolus infusion during abortion. No ancillary anesthetic or adjunctive drugs were used. Visual analogue scale scores were used to grade preoperative patient anxiety and the quality of the anesthetic experience. All personnel outside the operating suites, except the data analyst, were blinded. Chi2, median, analysis of variance and Student's t-tests were used, as appropriate. There were no statistically significant differences in age, gravidity, parity, spontaneous and induced abortion, body mass index or gestational age. Mean total operating time and total drug dose were similar. Propofol use resulted in a significant reduction in the incidence of postoperative nausea (11.5% vs. 17.5%) or vomiting (3.5% vs. 7.0%) with a combined p (mean difference) = 0.002 (95% confidence interval of the mean difference 1.8%, 17.2%). Both the nursing and patient appraisals of the quality of the anesthetic experience favored propofol, but only the nursing scores reached statistical significance (p0.001). The cost differential was more than twofold greater for propofol patients, 9.51 dollars vs. 4.42 dollars. In our population of midwestern patients in a major urban area, propofol use had modest advantages over methohexital when used as single agents as judged by first recovery charge nurses, but patients found them equally acceptable.