EuSEM Non Invasive Ventilation Fellowship

Just received this from the EuSEM Young Doctors (YMED):

EuSEM Young Doctors fellowship on non-invasive ventilation

 

Dear colleague,
We wish to invite EM trainees and young EM specialists from across Europe to apply as a candidate for our EuSEM Young Doctors 2-week fellowship in non-invasive ventilation. During these 2 weeks the participants will get profound teaching in non-invasive ventilation through high-quality theoretical sessions and live teaching on emergency department patients.

It will take place in autumn or winter 2016 in Andrea Hospital Vercelli, Italy, under the auspices of prof. dr. Roberta Petrino, president-elect of EuSEM. Dates will be chosen in consultation with the participants.

2 participants will be chosen after a selection process.

Candidates will be eligible for our programme when they are:

  • full-paid EuSEM member
  • Trainee in Europe
  • Trainee in EM (or proven strong interest, eg. for countries where no specialty exist) < 35yr old, or young EM specialist and < 35yr old
  • Applicants can’t participate in a country where they live (once more than 1 country is available in our fellowship programme)
  • Participants can’t apply again if successfully selected

Candidates will be selected on the base of the following selection criteria:

  • Motivation letter
  • Research/publications
  • Committed to teaching peers (proven by previous projects)
  • Successfully passed EBEEM part A, or part A and B
  • Recommendation letter
  • Proof of English (TOEFL, IETLS, FCE)
  • Overal appraisal

Points will be given for each item. The selection committee will be composed of high-profile EuSEM committee members.

Travel and accommodation will be sponsored.

Please send the requested documents together with your curriculum vitae to yemdsection@gmail.com !

CPAP

Application deadline is June 30, 2016, 23h59 Central European Summer Time.

Narcan for the road?

     I could bullet point plenty of statistics, but I don’t think I have to convince you: there is an opioid epidemic and it is getting worse.
      We all have treated patients for opioid overdose in the ED. We also frequently identify substance abusers who are at high risk for future overdose. Aside from referring these patients to detox centers and encouraging enrollment in methadone maintenance programs, what else can we do to potentially save a life? Should we be considering prescribing narcan for the road? In the the fall of 2015, the FDA approved the first intranasal naloxone product and narcan nasal spray is now available in pharmacies (over the counter in 14 states).
     The most common formulation administers 2mg–1mg per nostril. Data shows time to patient response is equivalent to that of IM administration. There are many advantages of intranasal naloxone, chief among them being the reduction of needle stick injury to rescue providers and the possibility of lay person delivery.
     Concerned your prescription will encourage risky behavior? Data shows it won’t. Not willing to provide a patient with Narcan–how about calling in a prescription for a loved one living with a drug abuser unbeknownst to the patient?
I wrote my first prescription for intranasal narcan last week. I can’t say this will become my routine practice,  but it is something we should consider.
Layperson naloxone kit
References:
1) Dietze, Paul & Cantwell, Kate. Intranasal naloxone soon to become part of evolving clinical practice around opioid overdose prevention. Addiction. 14 Mar 2016. Volume 111, Issue 4, pages 584-586
2) Kerr, D., A. M. Kelly, et al. (2009). “Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose.” Addiction 104(12): 2067-74

It’s PEM Academic Meeting Season and John Oliver Rails on Bad Science

Whether you’re asking the questions, teaching trainees, or incorporating evidence into your daily practice, many of us in PEM rely on sound research. With many recovering from the nerdy hangover of the recent Pediatric Academic Societies meeting and this week’s Society for Academic Emergency Medicine meeting activities, I have been thinking about how to digest the all of the posters, platform presentations, and calls for further studies on every topic. John Oliver—Daily Show correspondent turned incredulous HBO news anchor—dedicated a 20-minute segment on how science is interpreted and reported today. And spoiler alert: He was not pleased. He pointed out the varying outlandish scientific report such as how much your dog hates hugs and the importance of flatulence. It’s a humorous yet sobering reminder of the common pitfalls of interpreting science and how the incentives in academic publishing can be distorting. Watching the segment is entertaining. But if you’ve become too busy for humor and joy, this is what I took away from this. Studies—especially small ones—need validation before they are genaralizeable yet the incentives for performing these studies are small. Researchers get kudos for new discoveries yet are ignored or even mocked (behind closed doors, of course) for validating existing results and “not adding anything new.“ People may cherry pick findings they want to hear. I am guilty of this, as I am a big proponent of exercising very little based on just the headline of a New York Times article. If you read the headline, you might do the same. Statistics may be misleading. Practice change should not be based on glancing at the p-values without looking at the methods and actual results. While sometimes painful, journal clubs and critical reading may be a remedy for this when done well. The media may mean well but can simplify and distort conclusions. Some journalists are as guilty as some academics of reading abstracts and press releases before taking a few shortcuts in an effort to get in front of the news cycle. Many of these flaws in science have always existed although the growth of digital media also amplifies many of them. How will PEM—which many of us consider a young and innovative specialty—handle this delicate academic balance?

Психолог Киев – Психологическая помощь и услуги психолога в Киеве – Практический психолог, цены

Психолог Киев – Психологическая помощь и услуги психолога в Киеве – Практический психолог, цены Психолог Киев – Психологическая помощь и услуги психолога в Киеве – Практический психолог, цены

Марчук Наталья психолог и психотерапевт

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консультацию

Будем на связи

Записаться на консультацию

Отзывы

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Услуги психолога в киеве

Борисовна

Психоаналитический психотерапевт, наблюдательный член Украинской ассоциации психоаналитической психотерапии (УАПП) члена Европейской федерации психоаналитической психотерапии (ЕФПП).

Практический опыт: более 15 лет

Оказано помощь: более 2000 раз.

Основные направления деятельности:

  • Семейные отношения
  • Детская терапия
  • Панические атаки

Контактный номер: <="#popup" class="open-popup-link btn">Записаться на прием

Стоимость услуг психолога:

Название услуги Описание Стоимость за сессию
Индивидуальная консультация («Стандарт») Если обращаетесь к психологу и пока не готовы к длительной психотерапевтической работе, вполне возможно, что достаточно будет 1 встречи , которая поможет Вам понять самого себя. 400 грн.
«Фокус помощь» Вы получаете возможность решить свою проблему так быстро, как это возможно. Обычно это 10-15 сессий. 400 грн.
«Постоянный клиент» Для клиентов, работа с которыми рассчитана на более длительное время 400 грн.
«Семейная» При обращении нескольких членов семьи. 500 грн.

Психотерапевтические услуги:

Психоаналитическая психотерапия

Глубинная терапия личностных проблем

Семейная консультация

Работа с семейной парой – налаживание отношений, поиск выхода из конфликта, улучшение коммуникации

Детский психолог

Диагностика, адаптация к дет. саду-школе, решение невротических проблем

Подростковый психолог

Помощь в детско-родительских отношениях, работа с подростковым протестом, агрессией

Место и время консультации

Место консультации

Вы встречаетесь с аналитиком в его кабинете, который обустроен специально для психотерапевтических сессий. Обстановка в кабинете располагает к спокойствию, расслаблению. Никто не будет отвлекать или мешать Вам в работе.

Время консультаций и длительность терапии:

В психоанализе четко закреплено время и количество встреч психоаналитика и клиента. Обычно назначается 2-3 встречи в неделю в определенное время. Аналитическая сессия длится 45 минут – оптимальное количество времени для того, чтобы раскрыть себя и не чувствовать усталости. Длительность терапии определяется индивидуально.

Отзывы наших клиентов

 

 
by Anonymous on <="http:///otzyvy/">Blank Business Name
 
Yura, Yura.mazuruk.@gmail.com, 380633410041
 

Моя история прихода к психологу Наталье, начинается с того ,что я запутался сам в себе. Я как бы знал что мне делать и в тоже время не знал… Наверное эта ситуация знакома многим. Буду краток, мне кажется что каждый из нас нуждается во взгляде на наш внутренний мир, и лутше когда это днлает профессионал своего дела.. С признательностью и уважением Юра. =))

 

 
by Anonymous on <="http:///otzyvy/">Blank Business Name
 
Виталий, meluk@meta.ua
 

Спасибо Наталье за помощь, у нас с женой были очень сильные разногласия, постоянно были ссоры, которые почти всегда заканчивались истерикой и хлопаньем дверей. Казалось, что все идет к разводу. Знакомые посоветовали обратиться к психологу, нашли Наталью через интернет – с выбором не прогадали. Уже через пару консультация увидели заметные улучшение. Сейчас наша семья как будто заново переродилась, спасибо большое Наталье за это. Побольше бы таких людей как вы, здоровья вам и счастья. Все отзывы

Место консультации психолога

 
  • г. Киев, пер. офис 304
  • Создание сайта My-master

The post Психолог Киев – Психологическая помощь и услуги психолога в Киеве – Практический психолог, цены appeared first on Clinical EM.

The Dysfunctional Dictionary of Developmental Delay


Children who have not reached a developmental milestone frequently present to primary care.  Sometimes the concern is raised by a parent but often it is another family member, a teacher or a health care professional who spots the ‘delay’.   Often, there is no significant problem.  Some children just do their developing differently.  This is not developmental delay.  However, true developmental delay is quite prevalent and the terminology used is frankly misleading both to clinicians and parents.  Understanding what is wrong with the words used is the key to coming to grips with this difficult subject.

The Dysfunctional Dictionary of Child Development

Milestones – this word is used to describe the age at which a child should do a thing.  In the same way that children behave unpredictably, they may not meet these targets.  These ‘norms’ are based on population studies.  Because children vary they may not fall within a specific milestone norm.  Some children skip a milestone entirely (e.g. crawling) but hit their next milestone (e.g. cruising) normally.

Developmental delay – This term suggests that a child is simply late getting to a developmental level.  If there is a pathological developmental delay, this is unlikely to be the case.  If a child has true delay, they will almost certainly be permanently behind their chronological age. In other words they will not 'catch up'.  (see diagram above)

Developmental delay – Another problem is that the term implies there is always a neurodevelopmental cause.  This fails to give weight to the fact that delay can be due to something which obstructs development.

Global Developmental Delay – A child has GDD if they are delayed in at least two of the developmental domains.  They can be developing normally in the other two and is therefore a misnomer.

Developmental impairment – This is a more accurate term than developmental delay.  It’s just that I think that it doesn’t sound very nice.

Intellectual impairment – this is the correct term if we are talking about the over 5 year old.  Developmental delay or impairment should only be used for the under five year old.  Who knew?

Of course we need terminology and this vocabulary is what we have to work with.  We just need to know the limitations of the words we use so that they cause minimal confusion.

What is a primary care clinician to do when a child has a possible developmental delay?  Because there is so much variability in children it is reasonable to watch and wait (in the absence of red flags) when there is a ‘late’ milestone in an isolated domain.  If the delay persists or involves more than one domain then the chances of a significant problem is higher.

It is worth considering the causes of delay that can be relatively easily identified.  Delay in one domain is more likely to have such a cause.  For example, a child under the age of 2 who is not meeting their gross motor milestones may have dislocated hips.*  A child with speech delay may have ‘glue ear’.  These problems will obstruct development so early identification of such things can be life-changing.

Another cause that could be identified in Primary care is Muscular Dystrophy.  Although rare, this is an important cause of delayed mobility in boys.  A normal Creatinine Kinase (CK) is an easy way to rule this out if a boy is not achieving gross motor milestones.



What should I do in primary care?
  • Take the history
  • Examine the child including
    • Primitive reflexes
    • Tone and posture
    • Head circumference
  • If delay is limited to one domain, look for an identifiable/ treatable cause
    • Speech – hearing test/ speech and language assessment
    • Gross motor – check lower limbs including hip dislocation. Test CK in boys.
    • Fine motor – test visual acuity
    • Social – encourage environmental stimulation if appropriate.  Consider possible autistic spectrum disorder.
  • Observe initially if appropriate or refer if red flags
While most cases of true developmental delay are idiopathic, advances in genetic testing mean that a cause can often be found. Although this rarely leads to specific treatment that does not mean that we should not investigate for a cause.  It is very important to most parents to find out why their child has developmental delay both for understanding and to help get appropriate support.  In addition a diagnosis may have a recurrence risk in future pregnancies.

Edward Snelson
@sailordoctor
Dysfunctional Lexicographer


*Congenitally dislocated hips is now more correctly named 'Developemental Dysplasia of the Hip')