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The article discusses the framework established by the International Federation for Emergency Medicine in evaluating the standards for Emergency Medicine training. Topics covered include conducting various types of assessments focusing on knowledge-based, performance-based in simulated environment and in the actual workplace, the difference between formative and summative appraisal, and the implementation of regular quality review to check stakeholders, trainees, and assessors.

The left ventricular hypertrophy (LVH) is one of the most important organ damage targets in hypertension. Despite the involvement of multiple factors, the genetic factors have been shown to have an important function in the pathogenesis of LVH. The aim of our study was to evaluate the role of mitochondria in LVH for Chinese hypertensives. A systematic and extended mutational screening for the mitochondrial genome has been initiated in a large cohort of Chinese population by the Geriatric Cardiology Clinic at the Chinese PLA General Hospital, Beijing, China. Specific mutations within the mitochondria were further evaluated. Changes of total RNAs (tRNAs) were measured by northern blotting using nonradioactive digoxigenin (DIG)-labeled oligodeoxynucleotides specific for each RNA. Rates of oxygen consumption in intact cells were determined with av YSI 5300 oxygraph. Sequence analysis of mitochondrial DNA in one Chinese pedigree identified a novel A–G transition at position 4401 (A4401G) at the junction of tRNAMet and tRNAGln. The noncoding region mutation appeared to affect the processing of precursors in these mitochondrial tRNAs. The reduction in the rate of respiration and marked decreases in the steady-state levels of tRNAMet and tRNAGln were detected in the cells carrying this mutation. The novel mutation was absent in 270 Chinese control patients. In conclusion, the noncoding mitochondrial sequence alteration (A4401G) alters mitochondrial function, implicating this mutation in the pathogenesis of LVH in Chinese hypertensives.European Journal of Human Genetics (2009) 17, 172–178; doi:10.1038/ejhg.2008.151; published online 13 August 2008 [ABSTRACT FROM AUTHOR]

A fifty-seven-year-old male patient on warfarin therapy presented to the emergency department with severe abdominal pain that had started after a cough episode and persisted for four days. Ultrasonography showed an extensive hematoma, 17x14x7 cm in size, but failed to determine whether it was located intra-abdominally or in the abdominal wall. Computed tomography confirmed the diagnosis of abdominal wall hematoma (25x21x10 cm). The patient was treated conservatively, and abdominal findings resolved progressively in three days. This case report illustrates that ultrasonography findings may sometimes be inconclusive and, in the early period, computed tomography may be required to confirm the diagnosis of abdominal wall hematomas. Giant abdominal wall hematomas can be successfully treated with conservative methods even physical findings of acute abdomen accompany the clinical picture. To our knowledge, this is the largest abdominal wall hematoma hitherto reported in the literature.

Objective: The aim of the study was to evaluate the value of physical findings to predict fracture in patients with acute wrist trauma., Methods: This prospective clinical study was conducted over a period of four months from December 1998. The patients who were older than 18 years and presenting with acute wrist trauma within 24 hours of the time of injury were included in the study. Magnetic resonance imaging (MRI) was done for the patients who had inconsistency between clinical and radiographic diagnosis., Results: Fifty-five patients were included in the study. Four fractures were diagnosed on the MRI of eight patients who have contradiction between clinical diagnosis and X-ray studies. The positive predictive values of edema, localized tenderness, pain on active and passive motion, pain with grip and pain in supination were found as 95.2%, 67.3%, 77.3%, 91,7%, 89.3%, and 96%, respectively. Physical findings having high sensitivity were found as localized tenderness (94.3%), pain on the active and passive motion (97.1%, 94.3%, respectively). Pain on the active and passive motion were determined as physical findings with highest negative predictive values (%90.9, %89.5, respectively)., Conclusion: Edema, pain on grip and supination, and especially pain on passive and active motion and localized tenderness can be valuable to predict or rule out fracture in acute wrist trauma cases who have no deformity.

The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.

Emergency physicians are continuously under stress because of overcrowded departments, severity of cases, and their work schedules. In addition to this work stress, unregular social and family life are the main components of ongoing burn out process in these professionals. Burn out is the end point of the process which is complicated by the loss of professional enthusiasm and satisfaction, and negative behavioral approach to the patients. This review includes detailed statements on specific headlines, such as residency period, shift system, sleep management, risk of physical and psychological diseases, and stress management for emergency physicians.