Gold Coast diagnostic criteria: Implications for ALS diagnosis and clinical trial enrollment.

Diagnostic criteria for amyotrophic lateral sclerosis (ALS) are complex, incorporating multiple levels of certainty from possible through to definite, and are thereby prone to error. Specifically, interrater variability was previously established to be poor, thereby limiting utility as diagnostic enrollment criteria for clinical trials. In addition, the different levels of diagnostic certainty do not necessarily reflect disease progression, adding confusion to the diagnostic algorithm. Realizing these inherent limitations, the World Federation of Neurology, the International Federation of Clinical Neurophysiology, the International Alliance of ALS/MND Associations, the ALS Association (United States), and the Motor Neuron Disease Association convened a consensus meeting (Gold Coast, Australia, 2019) to consider the development of simpler criteria that better reflect clinical practice, and that could merge diagnostic categories into a single entity. The diagnostic accuracy of the novel Gold Coast criteria was subsequently interrogated through a large cross-sectional study, which established an increased sensitivity for ALS diagnosis when compared with previous criteria. Diagnostic accuracy was maintained irrespective of disease duration, functional status, or site of disease onset. Importantly, the Gold Coast criteria differentiated atypical phenotypes, such as primary lateral sclerosis, from the more typical ALS phenotype. It is proposed that the Gold Coast criteria should be incorporated into routine practice and clinical trial settings.

Ultrasound assessment of optic disc edema in patients with headache.

Point-of-care ocular ultrasonography is emerging as a powerful tool to evaluate emergency department (ED) patients at risk for ophthalmologic and intracranial pathology.We present cases of 3 patients in whom optic disc swelling was identified using ocular ultrasound. Causes for optic disc swelling in our patients included idiopathic intracranial hypertension, secondary syphilis, and malignant hypertension with associated hypertensive retinopathy. Because direct visualization of the optic disc may be challenging in an ED setting, ultrasound examination of the optic disc may represent an important adjunct to fundoscopy when assessing patients with headache or visual complaints.

Impact on the reduction of CO2 emissions due to the use of telemedicine.

Digital health can reduce CO2 emissions thanks to telemedicine and access to digital test results and medical reports. However, the environmental impact of digital health activity is not well known. Here, we show that telemedicine reduces CO2 emissions. We found a net total of 6,655 tons of CO2 emissions decrease through a reduction in patient travel to surgeries and medical clinics thanks to the alternatives of digital appointments and digital access to test results and medical reports, which avoid the need to travel to a clinic for a face-to-face visit or to pick up printed results or reports. During 2020, a total of 640,122 digital appointments were carried out by the health care company, which avoided 1,957 net tons of CO2 emissions, while patients downloaded 3,064,646 digital medical reports through the company portal, which avoided an additional 4,698 net tons of CO2 emissions. Our results demonstrate how digital appointments and digital reports, reduce CO2 emissions by reducing the need for patient travel.

Ghost Attack: The East Providence Carbon Monoxide Mass Casualty Incident.

A routine call for a common medical emergency was expeditiously identified by the responding emergency medical service as a multiple victim carbon monoxide exposure. The event circumstances, exemplary fire department emergency medical services response, and ensuing hos- pital emergency department response are described. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].