To investigate whether the parafoveal capillary architecture predicts clinical course and visual outcomes after ERM surgery.

A total of 71 eyes of 71 patients treated with vitrectomy for idiopathic ERM were enrolled. The parafoveal capillary displacement and fractal geometries were compared according to the stage of ERM. Correlations between the parafoveal capillary displacement in the superficial capillary plexus (SCP), the fractal dimension and lacunarity in the deep capillary plexus (DCP), foveal thickness, and visual outcomes were evaluated.

Compared with eyes with mild ERM, eyes with severe ERM exhibited higher parafoveal capillary displacement in the SCP, lower fractal dimension and higher lacunarity in the DCP, and greater foveal thickness (P < .05). The parafoveal capillary displacement in the SCP and fractal dimension and lacunarity in the DCP improved significantly, particularly at 1 month postoperatively (P < .05) and reached a plateau thereafter. The preoperative fractal dimension in the DCP showed a significant correlation with BCVA at all follow-up time points (P < .05).

The parafoveal fractal dimension in the DCP was significantly correlated with visual acuity before and after ERM surgery. The parafoveal fractal dimension may serve as a predictive marker for visual outcomes after ERM surgery.

The parafoveal fractal dimension in the DCP was significantly correlated with visual acuity before and after ERM surgery. The parafoveal fractal dimension may serve as a predictive marker for visual outcomes after ERM surgery.

Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children and requires medical treatment. Thus far, there have been few reports of the use of extracorporeal life support (ECLS) to provide cardiac support in children with low cardiac output resulting from arrhythmia. We present a case of a newborn in whom ECLS was used to provide support for cardiogenic shock secondary to intractable SVT. A 25-day-old girl presented with a 5-hour history of increasing pallor and listlessness. A clinical examination at presentation revealed retractions and peripheral coldness. An electrocardiogram showed a narrow-QRS tachycardia with a rate of 290 beats per minute. Adenosine triphosphate (maximum, 0.2 mg/kg) and synchronous direct current shock (maximum, 25 J) were ineffective. Chest x-ray showed a cardiac dilatation, and echocardiography showed a structurally normal heart with very poor function. CTx-648 cost The cardiogenic shock caused by SVT was refractory to treatment. The low cardiac output state ith a rate of 180 beats per minute. There was considerable improvement of the heart function within 2 days of starting ECLS; the patient was weaned from ECLS support, and the blood access catheters were decannulated on day 3. After weaning from ECLS support, cardiac function returned to normal.

We hypothesized that a paper documentation and discharge bundle can expedite patient care during an influenza-related surge.

Retrospective cohort study of low-acuity patients younger than 21 years surging into a pediatric emergency department between January and March 2018 with influenza-like illness. Patient visits documented using a paper bundle were compared with those documented in the electronic medical record on the same date of visit. The primary outcome of interest was time from physician evaluation to discharge for patient visits documented using the paper bundle compared with those documented in the electronic medical record. Secondary outcome was difference in return visits within 72 hours. We identified patient and visit level factors associated with emergency department length of stay.

A total of 1591 patient visits were included, 1187 documented in the electronic health record and 404 documented using the paper bundle. Patient visits documented using the paper bundle had a 21% shortened meated surge.

To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic.

Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 (“during COVID-19” or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 (“pre-COVID-19” or group 1).

A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively.

Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.

Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.

Fundamental to the practice of pediatric emergency medicine is making timely and accurate diagnoses. However, studies have shown errors in this process are common. A number of factors in the emergency department environment as well as identifiable errant patterns of thinking can contribute to such challenges. Cognitive psychologists have described 2 types of thinking system 1 (fast) relies primarily on intuition and pattern recognition, whereas system 2 (slow) is more deliberative and analytical. Reviewing how these 2 styles of thinking are applied in clinical practice provides a framework for understanding specific cognitive errors. This article uses illustrative examples to introduce many of these common errors, providing context for how and why they occur. In addition, a practical approach to reducing the risk of such errors is offered.

Fundamental to the practice of pediatric emergency medicine is making timely and accurate diagnoses. However, studies have shown errors in this process are common. A number of factors in the emergency department environment as well as identifiable errant patterns of thinking can contribute to such challenges.