Notes

EGFRvIII peptide nanocapsules as well as bevacizumab nanocapsules: a nose-to-brain multitarget approach versus glioblastoma.
configurations. In torsion, the constructs have shown different stiffness (p less then 0.001) with a minimum value of 0.66 Nm/deg for the Rhomboid configuration, which was significantly less stiff than the Anterior configuration (1.20 Nm/deg [p less then 0.001]). There was no difference between the Diamond and H configurations (p=0.177) or between them and the Hashtag configuration (p=0.215). DISCUSSION An external fixator construct directly bridging the femur and tibia without interconnections is the most stable and produces MRI scans without image artifacts that would interfere with diagnostic quality. LEVEL OF EVIDENCE V, basic science study, diagnostic imaging and mechanical testing. The global spread of COVID-19 is placing unprecedented demands on healthcare services. In this time of crisis, innovative and adaptive methods of practising will be required across all health professions. In order to maximise the use of current available resources, it is vital that existing services are comprehensively reviewed and full use is made of any unrealised potential among healthcare providers. Community pharmacy is one of a number of health professions that has a key role to play in responding to the current pandemic. SAR7334 datasheet As the scope of community pharmacy practice varies considerably across countries, it is important to examine ways in which the profession can assist with the public health response to COVID-19 and maintaining the continuity of healthcare services. This article seeks to highlight roles and activities that community pharmacists can undertake to help in relieving pressure on other areas of the health service, such as general practice. This information could help to inform future decisions about the restructuring of existing health services by governments, public health bodies and policy makers in response to public health crises such as COVID-19. BACKGROUND Capsule endoscopy has been considered the first-line approach for the investigation of obscure gastro-intestinal bleeding since its approval in 2001. Our study aims to evaluate the diagnostic yield of capsule endoscopy in the investigation of this condition. We also analyse the incidence of non-small-bowel lesions missed after conventional endoscopy and later detected by capsule endoscopy in patients with suspected obscure bleeding. METHODS A total of 290 patients with negative conventional endoscopy referred to our centre to undergo a capsule endoscopy examination for the investigation of obscure gastro-intestinal bleeding. We considered as non-small-bowel lesions those outside the tract between the second duodenal portion and the ileocecal valve. We also looked for actively bleeding lesions at the time of the exam. RESULTS Intestinal preparation was good, adequate or poor in 74.1%, 8.4%, and 17.5% of the tests, respectively. Caecum was reached in 92.4%. Capsule retention occurred in 0.7%. Mean small bowel transit time was 5hours and 13minutes. Diagnostic yield was 73.8%. An actively bleeding lesion was noticed in 39.3% of positive tests. Capsule endoscopy revealed clinically significant non-small-bowel lesions missed at gastroscopy or colonoscopy in 30.3% of patients, 43.2% of which were bleeding. CONCLUSIONS Capsule endoscopy has high diagnostic yield and safety in the investigation of obscure gastro-intestinal bleedings. Given the high percentage of non-small-bowel lesions detected, it may be appropriate to consider an endoscopic second look before performing a capsule endoscopy study. BACKGROUND Acute pain represents one of the most common reasons for emergency department (ED) visits. In the opioid epidemic that North America faces, there is a significant demand for novel effective pain control modalities, especially in the acute setting. OBJECTIVES The goal of this study was to review all the indications and summarize the efficacy of the Erector Spinae Plane Block (ESPB) in the ED. METHODS PubMed, EMBASE, and MEDLINE, as well as CINAHL databases were searched according to the PRISMA guidelines to find any study reporting on the use of ESPB in the ED. RESULTS Ten studies were published reporting on seven different indications for the use of ESPB in the ED. It was most commonly used for rib and spine fractures. Other indications included mechanical pain, burn injuries, herpes zoster, renal colic, and acute pancreatitis. All the studies demonstrated a significant reduction in pain after administration of ESPB. Furthermore, it has been reported to improve respiratory function and was not associated with any complications after administration. CONCLUSIONS ESPB is an easy-to-administer interfascial plane block that has several indications and promising potential for acute pain management in the ED. The easily identified landmarks coupled with its low complication rate makes it an appealing technique to be used by emergency physicians in the context of acute pain management. Further studies should investigate any other possible indications and compare its efficacy with other techniques, such as epidurals and serratus anterior blocks. BACKGROUND Inhaled β-agonists are the cornerstone of acute treatment for asthma and chronic lung disease. Upon emergency department (ED) discharge, patients optimally receive prescriptions for metered-dose inhalers (MDIs) with instructions on their proper use. Yet prior studies suggest that ED personnel have limited knowledge of proper MDI techniques. It is unclear how effectively brief education will improve this knowledge to enable them to provide adequate patient instructions. OBJECTIVE Our aim was to evaluate ED medical personnel's baseline knowledge of MDI use and the utility of brief education on their ability to use MDIs. METHODS After providing written consent, a spirometry nurse evaluated emergency physicians and nurses on their ability to properly perform three (open-mouth/two-finger, spacer, and closed-mouth) MDI techniques. The same spirometry nurse then gave a short educational session demonstrating the proper MDI techniques. Two weeks later, the nurse re-evaluated the same personnel on their MDI techniques. RESULTS All emergency medical personnel initially performed poorly in demonstrating proper MDI technique, averaging 29.8% steps done correctly. Two weeks after their educational session, they improved greatly, averaging 89.4% steps done correctly. CONCLUSIONS This study demonstrated both that ED personnel had poor initial knowledge about MDI techniques and that a brief educational intervention improved most people's ability to use, and presumably to instruct patients/parents in proper use of, MDIs.
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