Using the Novel Musculoskeletal Emergency Medicine Assessment Tool: A Feasibility Study.

Background and objective While musculoskeletal (MSK) disorders account for a significant number of primary care and emergency department (ED) visits, there are widely recognized shortcomings and gaps in MSK education throughout medical training. Undergraduate medical education (UME) frequently fails to impart clinically relevant MSK knowledge, while many emergency medicine (EM) residency graduates report feeling unprepared to manage MSK complaints. Existing MSK assessments are not tailored to EM and may inaccurately assess specialty-specific MSK knowledge. The novel validated Musculoskeletal Emergency Medicine Assessment Tool (MEAT) holds great promise in standardizing EM MSK knowledge assessment. This trial of feasibility was conducted to assess the viability and practicality of using MEAT to evaluate MSK knowledge among incoming resident physicians in EM programs. Methods This feasibility study involved 21 incoming EM resident physicians from two programs at a single institution. MEAT was administered online during orientation, and demographic data and survey metadata were collected. UME MSK education details were obtained, and MEAT scores were analyzed. Results Participants reported no difficulties in accessing or understanding the 50-question online MEAT, resulting in a 100% response rate. The average pretest score for all interns was 29.9, with a median of 30. Most participants had documented UME MSK education, but curricular content varied widely. The participants took an average of 32 minutes to complete the assessment. Conclusions MEAT demonstrated successful implementation and high response rates, suggesting a high level of feasibility. The tool can be used to assess baseline MSK knowledge and ultimately track progression during residency with the potential for evaluating educational interventions once further validation studies have been performed. Further adoption of MEAT across multiple EM residency programs will help to enhance the tool's generalizability.

Case Report: Depression × dementia with Lewy bodies in the elderly: The importance of differential diagnosis.

Background: Dementia is a clinical syndrome which is more common in elderly people. Dementia with Lewy bodies (LBD) is not so rare in elderly people, with cognitive impairment in about 30% over age 65. The clinical picture is characterized by fluctuation in cognitive functions, recurrent, well-formed, detailed visual hallucinations, and Parkinsonism, with rigidity, tremor, bradykinesia, and slurred speech. Case presentation: We present a case report of LBD in a 73-year-old retired teacher, which a initial wrong diagnosis of refractory depression for at least 3 years. We also conduct a review of recent works on theme. Conclusion: LBD diagnosis can be neglected for years, with a legal and clinical issues to patients and their families. Detailed medical research, including differential diagnosis, are very necessary on those cases, specially when they are called refractory. We encourage new research and adequate clinical training to prevent damage.

Reconstruction of asbestos exposure in workers suffering from pleural neoplasms and employed in sectors not generally associated with high exposure levels: the importance of an accurate standardized assessment of occupational medicine.

INTRODUCTION: Malignant pleural mesothelioma onset in workers exposed to asbestos is well known with reference to multiple working sectors. In some cases, occurring among workers of sectors characterized by a presumed lower relevance of asbestos exposure, the absence of a well-defined correlation can prevent their emergence and compensation. To improve definition of these cases, this article underlines the importance of a standardized approach to occupational anamnesis. METHODS: Thorough standardized occupational health assessment method application in a case of pleural malignant neoplasm occurred in a hauler, a job generally not associated with high levels of exposure to asbestos fibres. RESULTS: Assessment of malignant pleural mesothelioma diagnosis and dual mode relevant occupational exposure to asbestos during both truck driving and loading and unloading operations of asbestos-containing goods. CONCLUSIONS: Systematic occupational medicine assessment with accurate standardized approach is essential for reconstruction of asbestos exposure, in order to highlight every aspect useful to establish causal link between cases of pleural mesothelioma and possible occupational and non-occupational exposure to the mineral, even in cases where the first-level occupational history does not appear to be suggestive.

A complex intervention for multimorbidity in primary care: A feasibility study.

AIM: To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics. METHODS: Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients' care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups. RESULTS: Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52-89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48). CONCLUSIONS: Patients and health-care professionals found the CIM acceptable.

The wish 'not to be'. Survey of suicide cases arriving at the Prosecutor's Office of the Court in Bari in the years 2014-2016.

The issue of suicide has always been a very sensitive and important problem, that raises many questions in the society where it occurs, that is not always able to oppose an adequate response. Every scientist in the field agrees that this is an act provoked by multifaceted reasons, which include cultural, social and biographical motives. Therefore, this topic also poses ethical and civil problems, as well as epistemologic and research methodology issues, because of its complexity as a subject of study. The authors propose a case-by-case contribution, evaluating the judicial acts on 73 suicides made available by the Bari Public Prosecutor's Office for the years 2014-2016. The authors believe collected and systematized data, and the ensuing considerations, can offer a contribution to the debate in the field of legal and socio-healthcare actors, who are often the first to deal with and confront this complex and tragic phenomenon.