There has been a lot of publicity about evaluation of chest pain patients in the emergency department (ED) with high sensitivity troponin testing. In the past with older troponin assays, clinicians would evaluate patients, get an ECG, and an initial set of cardiac biomarkers. The subsequent set of biomarkers would be performed at 6-8 hours later before determination of disposition. In the past few years, several studies have been published evaluating point of care troponins, sensitive troponins, and high sensitivity troponins which have changed our practice and evaluation of these patients. An early version of a study was recently released in the Journal of the American College of Cardiology (JACC) stating that for ED chest pain patients, we may be able to discharge patients from the ED with an initial normal ECG and single high sensitivity troponin T (hs-cTnT). So is it true… one and done?
We are very excited this month to bring you our third Global Journal Club. We hope you will participate in an online discussion based on the clinical vignette and questions below from now until March 27th. Respond by commenting below or tweeting (#ALiEMJC).
On Tuesday, March 25, 2014 at 1630 EST, we will be hosting a 30-minute live Google Hangout with Dr. Niklas Nielsen, the lead author of the Targeted Temperature Management (TTM) study, that is informed by the discussion. Later this year a summary of this journal club will be published in Annals of Emergency Medicine.
Today, the New England Journal of Medicine just released a landmark paper by the ProCESS (Protocolized Care for Early Septic Shock) trial investigators. There has already been much buzz about this on various blogs and websites, including St. Emlyn’s, MedPageToday, and MDAware. I received an email from my colleague Dr. Michael Callaham, who shared some direct comments and pearls from Dr. Donald Yealy, (professor and chair of emergency medicine from the University of Pittsburgh Medical Center) who was the first author of this writing team. Thank you to Dr. Yealy for allowing me to share your team’s comments with the ALiEM readership.
Why do we do what we do?
This is the question at the heart of this month’s ALiEM Book Club selection. Drive 1 , by author Daniel Pink, discusses the history of motivational theory before provocatively making the case that we’re doing it wrong. He argues that having met our base desires (food, drink, sex), a reliance on extrinsic motivators (reward and punishment) will stifle intrinsic motivation and prevent us from functioning at our highest capacity. The three features described for optimizing intrinsic motivation are:
- Autonomy: control over task (what we do), time (when we do it), team (who we do it with), and technique (how we do it)
- Mastery: the desire to get better at what we do using a mindset of improvement and working through challenges of appropriate difficulty
- Purpose: being part of a cause that is greater and more enduring than ourselves
It was a few months into my simulation fellowship and I had been devoting a lot of my time to teaching at the medical school. I loved it. I find few things as fun as teaching students who are super motivated to learn. That got me thinking about why learning isn’t always that way. What is it about certain settings that foster a student’s passion to learn while others, that may be presenting the exact same content, cause the same group of students to grumble and disengage?
We are very excited this month to bring you our second Global Journal Club, co-hosted by the team here at ALiEM and the editorial board at the Annals of Emergency Medicine. This month, we are changing things up! We will be providing you, our readers, with a clinical vignette and related journal club questions today at the beginning of the week.The discussion will be held asynchronously starting today through Thursday (for 4 days). Respond by blog comment below or tweet (#ALiEMJC).
On Wednesday, January 22, 2014 at 11 am PST (2 pm EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Perry and Ian Stiell. The video will be embedded on this page. During this period, you will be able to tweet by using the #ALiEMJC hashtag and post comment in the blog comment section below.