OBJECTIVES. The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers.METHODS. The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/ families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003 and phase II (October 1, 2003, to July 8, 2004. Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II.RESULTS. Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention. A LTHOUGH THERE IS no cure for asthma, self-management can prevent acute asthma exacerbations and irreversible damage to airway function, and improve patients' quality of life (QoL). 1,2 Accordingly, children and their families need to be a key focus for self-management education. 3 National Asthma Education and Prevention Program (NAEPP) guidelines provide a blueprint for such education. 1 To evaluate the status of childhood asthma and its care, assess health care provider adherence to guidelines, and create an integrated system of asthma care, the Hawaii Child Asthma Research to Elevate Standards (CARES) program was developed. The program was directed from the University Tertiary Care Pediatric Teaching Center at the John A. Burns School of Medicine, Kapi'olani Medical Center for Women and Children. Because the medically underserved areas of northeast and west Oahu coincide with the highest incidence of asthma within Honolulu County, 4 medical institutions serving these communities were invited to develop the program jointly. A multiethnic, culturally sensitive approach to data collection was developed to obtain accurate information from this diverse population to develop and implement an emergency department (ED)-based asthma education program for patients, families, and ...

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs commonly used to treat both the acute and chronic injuries sustained by athletes during training and competition. In many parts of the world, NSAIDs can be purchased over-the-counter and used without any physician oversight. However, the chronic nature of overuse injuries requires NSAIDs to be taken orally for an extended period of time. As a result, they can have significant adverse effects on athletes, namely gastrointestinal (GI), renal, and cardiovascular damage. Dyspepsia and upper GI ulceration and bleeding are of great concern in chronic NSAID use, and as such oral NSAIDs are generally contraindicated in those with a history of peptic ulcers or irritable bowel disease. In the setting of chronic overuse soft tissue or joint disease, topically administered NSAIDs offer an alternate route of administration that has the potential to deliver a similar level of pain and anti-inflammatory relief while bypassing the harmful side effects associated with oral intake. Topically applied NSAIDs are able to achieve high concentrations within the targeted site of action while simultaneously keeping plasma concentrations low, offering several advantages over oral administration. One commonly used generic NSAID is ibuprofen (2-(4-isobutylphenyl)propanoic acid). First synthesized in the 1960s, ibuprofen has since become widely available as an over-the-counter pharmaceutical. In this review, we outline new and different techniques that have been used to deliver ibuprofen into diseased tissues, including supersaturations, microemulsions, gels, nanosystems, and microneedles. We also review relevant clinical trials comparing transdermally delivered ibuprofen to placebo and orally administered ibuprofen.

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Introduction The SARS-CoV Disease (COVID-19) pandemic has upended health care systems and one of the casualties has been the trainee recruitment process since social distancing and travel restrictions make an in-person experience improbable. At the University of California, Davis (UCD), our Pain Division transitioned our internally validated multiple mini-interview (MMI) process to a virtual environment Methods Applicants signed a confidentiality agreement prior to their interviews and were invited to watch a series of videos orienting them to the process and to the program itself. All faculty raters interviewed candidates using a total of 6 non-medical MMI scenarios with corresponding questions and scoring rubrics through the Zoom platform. Applicants were then welcomed to voluntary informal conversations with the current fellow trainees and faculty. An optional survey was sent to the applicants post-interview to assess their overall satisfaction with the virtual process. Results The survey analyzed the following using a 5 point Likert scale: Overall Satisfaction, Video Overview Program, Interview Day Details, Video Tour, Web-Based Interviews, Process was Fair, and finally a question on Informed Decision regarding receiving sufficient information to formulate their rank list. All respondents (80% response rate) reported being either satisfied or very satisfied with each of the aspects of the interview process detailed above. Conclusions While technical difficulties and confidentiality issues are of concern when offering an entirely web based recruitment, our group was able to transition traditional in-person MMI to a virtual platform using a similar structure which was well-received by applicants

Objectives: Splanchnic artery aneurysms (SAA) are rare, and little is known about their natural history and management. We reviewed our single-center experience managing this patient population.Methods: A retrospective review of the Yale radiology database from January 1999 to December 2016 was performed. Only patients with a SAA and a computed tomography (CT) scan of the abdomen were selected for review. Patient demographics, aneurysm characteristics, Fig.