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BACKGROUND Prior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually. METHODS This retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks' and 24 weeks' gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models. RESULTS Charts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P  less then 0.001) and pregnancy termination (P  less then 0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P  less then 0.001). Rates of peri-operative transfusion and re-admission for bleeding were less then 4%. CONCLUSION While blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation. Non-invasive prenatal testing (NIPT) using cell-free DNA (cfDNA) offers numerous benefits to pregnant women and their families. It also raises ethical, legal and social concerns regarding, for instance, the possible effects of a routinization of prenatal genetic testing on free and informed decision-making by prospective parents, and the role of the state in governing its use. Technological advances are allowing cfDNA analyses to detect an increasing number of genetic risks and conditions in the fetus, potentially further exacerbating such concerns. selleck From May 2015 to December 2016, we conducted a three-round Policy Delphi study (NR1 = 61, NR2 = 58, NR3 = 47; overall retention rate = 77.0%) to explore the social acceptability (SA) of current and potential future uses of NIPT in Canada according to participants with relevant professional, research or advocacy expertise. Participants came from four groups healthcare professionals (NR3 = 14), social sciences and humanities researchers (NR3 = 13), patients/disabilir exploring the SA of emerging technologies using the Policy Delphi method. Primary hyperparathyroidism is a morbid disease that affects multiple organ systems and causes a multitude of debilitating symptoms if not properly diagnosed and treated. Minimally invasive parathyroidectomy is now the standard of care for the treatment of primary hyperparathyroidism. In the hands of experienced high-volume surgeons, the success rate of this treatment is approximately 95%. Preoperative planning with 4-dimensional computed tomography (4DCT) is becoming increasingly common as a first line imaging modality. It is important for general radiologists to become familiar with this type of study in order to better assist their surgical colleagues. This image-rich review will discuss hyperparathyroidism, benefits, and weaknesses of different imaging modalities, 4DCT imaging protocol, relevant anatomy, expected appearance, and location of parathyroid adenomas, ectopic and atypical appearances, multigland disease and important mimics. AIMS The optimal management of stage III non-small cell lung cancer (NSCLC) is widely debated and is a rapidly evolving area. However, less than one in five stage III patients in England receive optimal multimodality treatment. The aim of this study was to map commonalities and differences in clinician judgement as well as infrastructure and resources for managing stage III NSCLC. MATERIALS AND METHODS We carried out a national survey of practice in stage III NSCLC management in the UK using a 30-min web-based survey. Invitations were sent via e-mail to the British Thoracic Oncology Group and the Society of Cardiothoracic Surgery membership and a healthcare professional market research panel. RESULTS In total, 160 respondents completed the survey. Although opinion was variable, there was a preference for surgery and adjuvant chemotherapy in stage III N2 (single station) NSCLC that could be treated with lobectomy, but this preference switched to chemoradiotherapy in single-station N2 requiring a pneumonectomy or multi-station N2. The PD-L1 status influenced the treatment decision in 'potentially resectable' N2 for a number of clinicians who opted for concurrent chemoradiotherapy with adjuvant durvalumab when PD-L1 ≥ 1%. A joint clinic with surgeons and oncologists was considered the most important factor for shared decision making with patients. There are barriers to recommending trimodality treatment, e.g. concerns over the negative impact on quality of life. A proportion of clinicians favoured palliative treatment in certain clinical scenarios, including supraclavicular fossa lymph node metastases, patients with borderline fitness or high PD-L1 expressors >50%. DISCUSSION This survey has highlighted the need for infrastructure development, such as reflex PD-L1 testing and joint surgical and oncology clinics. Further research into the impact of multimodality treatment on quality of life and education to improve confidence in multimodality treatment could all drive improvements in stage III NSCLC management. BACKGROUND It is common practice for emergency physicians to give parenteral opioids for acute pain, however, some treating physicians have concerns that using parenteral opioids can lead to nausea and vomiting when used alone. Therefore, antiemetics are often given prophylactically with opioids for nausea and vomiting in the emergency department (ED). This systematic review evaluates the use of prophylactic antiemetics with parenteral opioids for the treatment of acute pain in the ED. METHODS A 10-year literature search using keywords was performed in PubMed for English-language human studies. Abstracts were screened to identify high-quality studies, which then underwent a more rigorous structured review. The recommendations are made based on the literature review. RESULTS Eight articles met criteria for structured review and citation in this article. These include one review article, two randomized controlled trials, three prospective observational trials, one retrospective study, and one pre- and post-intervention trial.
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