Tenth year of Headache Medicine Journal, 25 years of Brazilian publications in the headache field

Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology – Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.

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Response to Letter to the editor: Acute Medicine Journal

Acute Medicine Journal ◽

10.52964/amja.0801 ◽

2020 ◽

Vol 19 (1) ◽

pp. 57-57

Author(s):

Ben Chadwick ◽

◽

Nick Murch ◽

Anika Wijewardane ◽

◽

...

Keyword(s):

Internal Medicine ◽

Acute Care ◽

Working Group ◽

Point Of Care ◽

Early Years ◽

Point Of Care Ultrasound ◽

Acute Medicine ◽

Front Door ◽

Medicine Journal ◽

Wide Range

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care. Contrary to the situation described in the correspondence, the new curriculum does not move away from each trainee being required to develop a specialist skill, such as medical education, management, stroke medicine or focused echocardiography. Trainees will still need to acquire competency in a specialist skill for their final 36 months of their training programme, usually after they have completed their Point of Care Ultrasound (POCUS) certification. The thinking behind introducing mandatory POCUS in the curriculum is that: POCUS is in the proposed curricula for intensive care medicine, respiratory medicine and emergency medicine, therefore we feel that in order to recruit the best trainees it is imperative POCUS training is offered as standard As evidenced by the trainee surveys, they often do not get allocated time to develop their specialist skill, especially in the early years of Higher Specialty Training before they often have decided on a particular skill. The introduction of mandatory POCUS training should legtimise time off the ward to obtain this skill early in training. POCUS is becoming more and more standardised in 21st Century acute care alongside the reducing costs of Ultrasound probe e.g. Philips Lumify and Butterfly iQ which are compatible with smart phones POCUS has been heralded as the fifth pillar of examination (observation, palpation, percussion, auscultation, insonation)1 The proposed curriculum therefore facilitates trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This will also enable trainees to have time away from the ‘front door’ high intensity acute care. Mandatory POCUS will continue to set AIM training apart from other physician training programmes and continue to attract high quality trainees to apply to the specialty. Formal feedback seen at the SAC meeting in October 2019 to the draft curriculum (personal correspondence from JRCPTB) showed a positive response from nine individuals, an ambivalent one from two people, and only two against the introduction of formal POCUS training in the curriculum. Point of Care Ultrasound will likely be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country. Concerns regarding supervision are being addressed by the POCUS working group, in anticipation of the lead in period of well over two years. It is anticipated that most trainees can achieve POCUS sign off (e.g. Focused Acute Medical Ultrasound) in 6 to 12 months (personal correspondence Nick Smallwood from POCUS working group). With ongoing concerns regarding recruitment and retention in Acute Internal Medicine we agree strongly that with POCUS inclusion, we have a further selling point for AIM training.

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‘Towards Embracing Clinical Uncertainty: Lessons from Social Work, Optometry and Medicine’, Journal of Social Work, 7, pp. 155–78

Social Work Ethics ◽

10.4324/9781315242842-59 ◽

2017 ◽

pp. 587-610

Keyword(s):

Social Work ◽

Clinical Uncertainty ◽

Medicine Journal

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Global Emergency Medicine Journal Club: A Social Media Discussion About the Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism Trial

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.02.024 ◽

2015 ◽

Vol 65 (5) ◽

pp. 604-613 ◽

Cited By ~ 5

Author(s):

Salim R. Rezaie ◽

Anand Swaminathan ◽

Teresa Chan ◽

Sam Shaikh ◽

Michelle Lin

Keyword(s):

Emergency Medicine ◽

Social Media ◽

Pulmonary Embolism ◽

Journal Club ◽

Medicine Journal ◽

Cutoff Levels ◽

D Dimer ◽

Rule Out

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P070: A systematic assessment of opioid-related advertisements aimed at emergency physicians in North America

CJEM ◽

10.1017/cem.2020.276 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S89-S89

Author(s):

A. Kirubarajan ◽

A. Dragoman ◽

J. Balakumaran ◽

T. Got ◽

N. Persaud ◽

...

Keyword(s):

Emergency Medicine ◽

North America ◽

Medical Association ◽

American Medical ◽

Family Physician ◽

North American ◽

Conflicts Of Interest ◽

Medical Journals ◽

Levels Of Evidence ◽

Medicine Journal

Introduction: The opioid epidemic has been influenced by immense marketing campaigns produced by pharmaceutical companies. These campaigns include advertisements aimed at emergency medicine (EM) physicians, which may have influenced overprescription. This study is a part of a larger effort to systematically assess opioid ads published in major medical journals in North America. To our knowledge, this is the first study to systematically assess the volume, claims, and levels of evidence for opioid ads aimed at EM physicians. Methods: Up to two issues per year from 1996 to 2016 of ten major North American medical journals were hand-searched for opioid advertisements. Specifically, we assessed random samples of issues from five major North American emergency medicine journals, including Annals of Emergency Medicine, Emergency Medicine, Canadian Journal of Emergency Medicine, Emergency Medicine Journal, and American Journal of Emergency Medicine. Five generalist medical journals were assessed including Journal of the American Medical Association, New England Journal of Medicine, Canadian Medical Association Journal, American Family Physician, and Canadian Family Physician. The volume of advertisements, nature of the claims, and cited evidence were collected by independent reviewers. The referenced evidence was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. Results: Of the 269 issues across the ten journals, opioid ads compromised 95 of the 3392 pharmaceutical advertisements with 79 opioid ads available for analysis. When analysis was completed with two reviewers, inter-rater agreement was rated as 99.87 (Cohen's kappa of 0.976). 37/79 ads did not mention the addictive potential of opioids, with 60/79 not mentioning the possibility of death. The tamper potential of medications was mentioned in 27/79 ads. Positive claims included efficacy (47/79), fast-acting ability (16/79), patient preference (5/79), convenience (26/79) and reduced side effects (22/79). 26/79 cited references directly in their text. Citations were provided for a total of 19 available original studies, of which a majority (16/19) were Level 2 evidence. Upon examination of conflicts of interest, 100% (19/19) of the referenced studies were funded by a pharmaceutical company. Conclusion: A variety of claims were published in medical journals through opioid advertisements, which cite industry studies. Many ads did not mention key negative information, which may have influenced EM physician prescribing.

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A retrospective study investigating requests for self-citation during open peer review in a general medicine journal

PLoS ONE ◽

10.1371/journal.pone.0237804 ◽

2020 ◽

Vol 15 (8) ◽

pp. e0237804

Author(s):

Erin Peebles ◽

Marissa Scandlyn ◽

Blair R. Hesp

Keyword(s):

Retrospective Study ◽

Peer Review ◽

General Medicine ◽

Medicine Journal

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