Introduction|br /|The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.|br /|Methods|br /|The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality.|br /|Results|br /|In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality
Most cases of blunt hepatic trauma are treated nowadays non-operatively. This type of conservative treatment has resulted in increased complication rate. Delayed complications occur in cases that didnt require surgical intervention during the first 24 hours. The most common late complication is hemorrhage. We report a case of two weeks delayed hemorrhage after blunt hepatic trauma in an adult. We describe the diagnostic procedures, the surgical treatment and review the relevant literature.
The technological advances in computed tomography (CT), with faster image acquisition resulting in higher resolution, result in making CT a more widely and intensively used imaging modality in trauma patient care. Thoraco-abdominal CT in addition appears to have additional diagnostic value compared to conventional radiography, especially in severely injured trauma patients.. Nowadays, both clinical data and conventional radiology are used to determine which patient should undergo body CT scanning. Currently there are no widely accepted guidelines for the use of a standard TRAuma CT (TRACT). Although many retrospective and several prospective cohort studies have been published on this topic, the data are not sufficient to sustain evidence-based practice in decision-making.. The aim of this study is, to establish the additional effectiveness and costs of routine thoraco-abdominal CT in blunt trauma patients versus conventional radiological imaging and to determine which clinical parameters ...
Occult cardiac injury following blunt trauma is more common than generally suspected. Myocardial contusion is not rare, however, it is generally a benign disorder which often remains undiagnosed. We report a case of a right atrial rupture after blunt chest trauma causing a tamponade. A 24-year-old man was involved in a violent car accident and he presented in a state of collapse. A multislice computed tomography indicated a pericardial effusion (Figure 1). A transthoracic echocardiography was performed and confirmed pericardial effusion which was hyperechoic (Figure 2, Movie 1). Concerns about a possible mass in the right atrium led to examination with transesophageal echocardiography (Figure 3, Movie 2) which revealed the presence of a voluminous mass in the right atrium. The patient successfully underwent cardiac surgery to remove the mass, identified as a blood clot, and to repair the atrial tear. The present case is of special interest because of the rarity of documented incidents of blunt chest
Patients involved in high-energy blunt trauma involving rapid deceleration are at significant risk for blunt aortic injury. The majority of blunt aortic injuries are due to motor vehicle collision. In the United States, blunt aortic injury is the sec
New generation spiral CT scanners permit multiple consecutive CT examinations on the same trauma patient in a short period of time. The purpose of this study was to evaluate the diagnostic role and therapeutic impact of routine spiral CT chest in multiply injured patients or patients with a suspicious mechanism of injury. This prospective study included 443 patients with blunt chest trauma. All patients underwent a spiral CT chest as part of their routine evaluation. Radiological interpretation of chest x-rays, CT scan findings, and changes in management plan guided by these findings were recorded. The mechanism of injury was road traffic accidents in 422 patients (95.26%). Out of the 167 patients with normal chest radiograph, 136 (81.43%) were found to have an abnormality on chest CT. The management was changed in the form of additional investigations or unplanned intervention in 92 patients (20.76%). Additional investigations included transoesophageal echocardiography (n = 7), bronchoscopy (n ...
SPU 2019 Abstracts: Renal ultrasound to evaluate for blunt renal trauma in children: a retrospective comparison to gold standard diagnostic test study
TY - JOUR. T1 - Guidelines for the diagnosis and management of blunt aortic injury. T2 - An east practice management guidelines work group. AU - Nagy, K.. AU - Fabian, Timothy. AU - Rodman, G.. AU - Fulda, G.. AU - Rodriguez, A.. AU - Mirvis, S.. PY - 2000/1/1. Y1 - 2000/1/1. N2 - The EAST work group was composed of trauma surgeons, thoracic surgeons, and a trauma radiologist. The literature review included a 30 year span and consisted of 137 articles. The work group applied the quality assessment instrument developed by the Brain Trauma Foundation and later adopted by the EAST Practice Management Guidelines committee. The assessment instrument provided an evidence-based guideline to classify each article. Articles were reviewed and defined within the three classes; Class 1: Insufficient evidence to support a standard of care, Class II: Prospective non-comparative clinical study or a retrospective analysis based on reliable data, Class Ill: Retrospective case series or data base review. One ...
Traumatic aortic injury (TAI) is most often caused by blunt trauma (refered to as BTAI) and is best described in terms of injury location, type and and severity: abdominal aortic injury aortic pseudoaneurysm thoracic aortic injury minimal aor...
Blunt carotid and vertebral artery injury, collectively termed blunt cerebrovascular injury, are rare but potentially devastating events. In the past, blunt carotid injury was associated with mortality rates ranging from 23 to 28 percent, with 48 to
OBJECTIVES: The continued advances in imaging and stent/stent-graft technology have considerably expanded the indications for endovascular approach also in vascular trauma. We report our institutional experience with endovascular treatment of periphe
TY - JOUR. T1 - Hepatic trauma. T2 - Contemporary management. AU - Trunkey, Donald. PY - 2004/4. Y1 - 2004/4. N2 - In the introduction, I posed several questions that were issues/controversies. The answers will probably be interpreted as equally controversial. I do not believe there is strong evidence that the incidence of liver injuries has increased. Diagnostic modalities have contributed to this seeming increase, as well as population increases and the concentration of severe liver injuries in trauma centers, now present in 35 states. I believe there are more blunt injuries now, relative to penetrating injuries. The peak of penetrating injuries occurred in the 1970s and 1980s and lasted almost 2 decades. I believe some authors are overly enthusiastic for nonoperative management. I am particularly critical of authors who do not include all components of the surgical armamentarium into their treatment of severe liver injuries. I also believe that the complications following nonoperative ...
PubMed Central Canada (PMC Canada) provides free access to a stable and permanent online digital archive of full-text, peer-reviewed health and life sciences research publications. It builds on PubMed Central (PMC), the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature and is a member of the broader PMC International (PMCI) network of e-repositories.
BACKGROUND: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity. METHODS: This study was a retrospective review of trauma registry data prospectively collected on 26,237 blunt trauma patients admitted to all trauma centers (n = 26) in one state over 24 months (January 1996-December 1997). Age-dependent and injury severity-dependent differences in mortality, ICU length of stay (LOS), and hospital LOS were evaluated by logistic regression analysis. RESULTS: Elderly (age | or = 65 years, n = 7,117) patients had significantly higher mortality rates than younger (age | 65 years) trauma patients after stratification by Injury Severity Score (ISS), Revised Trauma Score, and other preexisting comorbidities. Age | 65 years was
PURPOSE: Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft.. METHODS: Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, ...
Mediator dependent Promotes development of sepsis & multiple organ failure (MOF) Marshall Crit Care Med 2001, Adrie et al. Intensive Care Med 2000; Hack et al. Adv Immunol 1997 Sepsis remains one of the leading causes of mortality in critically ill patients Martin et al., N Engl J Med 2003; Vincent et al. Clin Infect Dis 2002; Bone Ann Intern Med - 35 % of severely injured blunt trauma patients develop sepsis/multiple organ failure (MOF) Regel et al. World J Surg 1996; Nast-Kolb et al. J.Trauma 2001; Sauaia et al. J Trauma 1998 Immune dysfunction in critical illness
Clearing the Cervical Spine in blunt trauma patients with head injury: Guidelines are under revision for identifying c-spine injuries after trauma. The new guideline does state that MR imaging is no longer required to clear the c-spine as the negative predictive values for CT are 98.9 percent for ligament injury and 100 percent for unstable c-spine injury ...
Liver trauma:. The liver is one of the most frequently damaged organs in blunt trauma, and liver trauma is associated with a significant mortality rate.. Epidemiology. In blunt abdominal trauma, the liver is injured ~5% (range 1-10%) of the time.. Clinical presentation. Patients can present with right upper quadrant pain, right shoulder tip pain (from diaphragmatic irritation), hypotension and shock .. Aetiology. The mechanism for liver trauma can be from blunt (e.g. motor vehicle collision, fall, direct blow, etc.) or penetrating trauma (e.g. gunshort, stabbing).. Types. Most (~80%) of liver injuries are minor (grades I to III). There is a range of injuries:. ...
In this article, we provide a summary of nonoperative management of locally advanced rectal cancer in the modern era. Our focus is on technical details of tumor response and patient assessment after chemoradiotherapy, as well as a review of existing clinical data. 2
Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Merck Veterinary Manual was first published in 1955 as a service to the community. The legacy of this great resource continues as the Merck Veterinary Manual in the US and Canada and the MSD Manual outside of North America.. ...
There has been a slow shift toward nonoperative management of many injuries that used to demand a quick trip to the operating room. Liver and spleen injury is one of the best examples, with extremely good success rates (95%). Kidneys fall into this category, too.. The pancreas is another solid organ. Perhaps we can do the same thing? A number of pediatric surgeons have been attempting to manage children with pancreatic injury. Low grade injuries (principally contusions) have been managed expectantly for some time. Could higher grade injuries (duct injury) be managed this way as well? How about using repeat imaging, percutaneous drainage, stenting via ERCP, and TPN to avoid the OR in hemodynamically stable kids?. A recent paper looks at this practice critically. Nine years of registry data at two Level I pediatric centers was reviewed to identify all high grade (III-IV) pancreatic injuries. They isolated 39 children with this injury (which is quite a few!). They were separated into two groups ...
For over 35 years, Biokinetics mission has been to protect the human body from blunt impact injury, ballistic threats and blast effects.
Antihypertensives, Angiotensin converting enzyme inhibitors, , Hypertension: ZOFENIL is indicated in the treatment of essential hypertension with mild to moderate. - Myocardial infarction in acute phase: ZOFENIL is indicated for the treatment initiated during the first 24 hours of a myocardial infarction in acute phase, with or without signs or symptoms of heart failure, hemodynamically stable patients not receiving thrombolytic therapy.
Cancer Therapy Advisor provides pediatricians with the latest information to correctly diagnose the latest child medical disorder conditions, recommend procedures and guides. Visit often for updates and new information.
Facts and figures about NEO-Synephrine. This product is used in the treatment of nasal congestion and as a vasopressor to increase the blood pressure in unstable patients. It works by constricting the blood vessels which decreases congestion and raises blood pressure.
Looking for online definition of nonpenetrating wound in the Medical Dictionary? nonpenetrating wound explanation free. What is nonpenetrating wound? Meaning of nonpenetrating wound medical term. What does nonpenetrating wound mean?
PURPOSE OF REVIEW: To discuss the emergency department evaluation and management of children with blunt abdominal trauma. The review will focus on both the clinical data that can help reduce the use of computed tomography in the evaluation of patients with blunt abdominal trauma and the evidence for the increased use of nonoperative management of patients with blunt abdominal trauma. RECENT FINDINGS: We will examine the recent literature focusing on the utility of physical examination, laboratory data and imaging (both ultrasonography and computed tomography) in detecting intraabdominal injury. SUMMARY: Recent research suggests that physical examination in combination with bedside ultrasonography may identify children at risk for intraabdominal injury. Screening laboratory data appears to be less sensitive to detect these injuries, but is useful in selected patients. Nonoperative management is appropriate in a majority of cases. Further research is needed to determine which low-risk patients ...
TY - JOUR. T1 - Gunshot injuries to the liver. T2 - The role of selective nonoperative management. AU - Demetriades, Demetrios. AU - Gomez, Hugo. AU - Chahwan, Santiago. AU - Charalambides, Kyriakos. AU - Velmahos, George. AU - Murray, James. AU - Asensio, Juan. AU - Berne, Thomas V.. PY - 1999/4. Y1 - 1999/4. N2 - Background: Selective nonoperative management of blunt liver injuries has become standard practice in most trauma centers. We evaluated the role of selective nonoperative management of gunshot wounds to the liver. Study Design: This was a retrospective review of gunshot wounds to the liver treated in a level I trauma center. Patients with peritoneal signs or hemodynamic instability were operated on without delay. Patients with a soft, nontender abdomen and no signs of heavy bleeding were selected for nonoperative management. Liver injury was diagnosed by CT scan. If peritonitis or signs of substantial internal bleeding developed, an operation was performed; otherwise the patient was ...
Small Intestine Perforation, Blunt Abdominal Injury vs. Obstructive Ileus due to Adhesions. Small Intestine Perforation, Blunt Abdominal Injury vs. Obstructive Ileus due to Adhesions Left picture: This child has sustained a blunt abdominal trauma as part of a battered child syndrome. The diagnosis is a free intestinal perforation; according to the findings on revision, the perforation is localized in the jejunum on the antimesenteric side, and is visible in the picture at the bottom on the left side. Right picture: The reason for the described clinical presentation is not a constipation; rather, an obstructive ileus due to postoperative adhesions is present which could have been suspected not only from the clinical presentation, but also by a precise history with former abdominal surgery. Compare that with the picture at the bottom on the right side showing an adhesion running over the mesentery and covering two intestinal loops with already compromised blood supply. Besides a complete history, ...
A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient ...
Background: Lung contusion affects 17%-25% of adult blunt trauma patients, and is the leading cause of death from blunt thoracic injury. Statins are lipid-lowering drugs with recently suggested anti-inflammatory and antioxidant properties. Cyclo-oxygenase-2 (COX-2) is a key enzyme in the production of prostaglandins (PG), and evidence suggests that COX-2 plays an important role in the pathogenesis of acute lung injury (ALI).. Aims: The current study aims at evaluating the beneficial effects of statins and COX-2 receptor inhibitors on ALI elicited by blunt trauma to the chest.. Methods: After approval by the institutional ethics and a scientific committee, and obtaining informed consent , patients admitted to the emergency department (ED) due to blunt trauma with a diagnosis of lung contusion will be enrolled in the study.The effects of statins and COX 2 inhibitors on ALI will be assessed by recording clinical parameters and measuring inflammatory mediators levels in the serum and in the ...
The patient suffered no complications following the procedure and was discharged after 48 hours of clinical observation.. Discussion. Splenic injury most commonly occurs as a result of BAT due to motor vehicle collisions. Less commonly it may present following BAT sustained in an assault.. Following the pioneering work of paediatric surgeons, the traditional management of splenic injuries has shifted from operative exploration and splenectomy to selective non-operative management (SNOM).[1] Progressive development in the quality and accessibility of accurate imaging modalities and interventional technology has extended the window of opportunity for splenic salvage.. The management options for splenic injury include SNOM, angiographic embolisation and surgical exploration. Management selection is dependent on haemodynamic status, the grade of injury and the presence or absence of associated injuries. Availability of the requisite skills and resources also influences the management approach ...
Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Injury to the lower chest may cause splenic or liver injuries. Abdominal trauma is divided into blunt and penetrating types. While penetrating abdominal trauma (PAT) is usually diagnosed based on clinical signs, diagnosis of blunt abdominal trauma is more likely to be delayed or altogether missed because clinical signs are less obvious. Blunt injuries predominate in rural areas, while penetrating ones are more frequent in urban settings. Penetrating trauma is further subdivided into stab wounds and gunshot wounds, which require different methods of treatment. Signs and symptoms are not ...
Although blunt chest traumas can present to the emergency department from a variety of etiologies, motor vehicle collisions and falls account for the majority of cases. This statistic holds true in Saint John, for which Dr. Lohoar presented some recent data (see slides). Several important conditions arising from blunt chest trauma were discussed, including lung contusion, hemothorax (HTX), cardiac tamponade and pneumothorax (PTX). In particular, discussion was centered around decisions surrounding chest tube placement for PTX and HTX. Emergency chest tube insertion is the definitive initial management for either of these potentially deadly presentations. The decision to place a chest tube in a hemodynamically stable patient with radiological evidence of PTX following blunt trauma is influenced by a number of factors. Today in rounds, we discussed how experience is paramount to successful chest tube placement. The balance between practitioner experience and patients need for urgent decompression ...
Blunt chest trauma usually occurs from deceleration accidents. So falls, auto accidents & sports are where this type of injury most frequently occurs.
Care guide for Blunt Chest Trauma (Ambulatory Care). Includes: possible causes, signs and symptoms, standard treatment options and means of care and support.
Myocardial dysfunction may result from severe trauma. Therefore, left (LV) and right ventricular (RV) function were prospectively assessed by ECG-gated blood pool radionuclide (RN) angiography in 25 consecutive patients who had sustained severe trauma including blunt chest injuries. Focal abnormalit …
Tamer Nabil, Wael Aziz, Salah Saaed. Cairo University Medical School.. Introduction: The Key issue in the choice of investigation is the cardiovascular stability of the patient. Diagnostic peritoneal lavage (DPL) is no longer the gold standard for determination of the need for laparotomy in blunt abdominal trauma not only because more specific and sensitive diagnostic procedures are available like delayed laparoscopic exploration (DLE), but also to avoid the unnecessary laparotomies even in cases of true positive DPL. The aim of this study is to compare conservative versus DLE for blunt abdominal trauma management as regards accuracy of diagnosis, decreasing incidence of complication, decreasing the need for unnecessary laparotomies and to shorten the hospital stay.. Material and Methods: 28 hemodynamically stable patients with blunt abdominal trauma (BAT) were selected randomly and divided into two group, there was no statistically significant difference in the mode of trauma between the two ...
A comparative study of three diagnostic methods used in assessing blunt abdominal trauma revealed that contrast-enhanced sonography proved to have a high diagnostic value than the other two methods.
Aim : The goal of this study was to describe the epidemiology, clinical presentation, diagnostic methods, and outcome in a large series of children with blunt cardiac injury BCI. Methods : A multicenter retrospective review of all individuals less than 18 years of age diagnosed with a BCI from 1983 to 1993 was conducted. Cases included all...
a) Grade 1: Intimal flaps at the level of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma ...
Discussion. Blunt carotid artery injury (BCI) is rare, with a reported incidence of 0.33% in some series.[1] Despite advances in imaging modalities and management options, the morbidity and mortality associated with BCI is over 30%, largely due to stroke.[1] Bilateral injuries to the ICA are exceptionally rare, with experience limited to case reports only.[2]. A high index of suspicion is essential in detecting this often clinically occult injury. Biffl et al.[3] have shown that aggressive screening using the Denver screening criteria (Table 1) to decide on the need for investigation[4] has increased the detection rate for BCI from 0.1% to 0.86%. In addition, they showed an improvement in neurological outcome in asymptomatic BCI patients who were anticoagulated.. Biffls grading system based on investigative angiographic findings has management and prognostic implications outlined- in Table 2.[4] Grade I and II injuries are of particular concern and require follow-up angiography owing to the ...
INTRODUCTION. Approximately 8% to 10% of abdominal traumas result in an injury to the kidney; 80% of the injuries are produced by blunt trauma [1]. Traumatic, synchronous multiorgan injury in the setting of anomalous anatomy adds to the complexity of surgical exposure and creates a formidable hemostatic challenge. Thus, early recognition of a congenital anomaly is essential in directing a surgical strategy that aims to achieve unconstrained operative exposure.. We present a case of multiorgan injury secondary to blunt abdominal trauma that was sustained during a motor vehicle accident (MVA). We describe the preoperative evaluation that led to the identification of a horseshoe kidney (HSK) and other associated intra-abdominal injuries.. CASE REPORT. A 30-year-old male was brought to a level I trauma center following a high-speed MVA. At the time of presentation, he was hemodynamically stable. He complained of diffuse abdominal pain and pain over the posterior neck and lower thoracic spine. A ...
In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children.
This Pediatric Trauma EXTRA CME supplement (free to Pediatric Emergency Medicine Practice subscribers) provides evidence-based recommendations for the evaluation and management of pediatric patients who present with blunt abdominal trauma
TY - JOUR. T1 - Role of duodenography in the diagnosis of blunt duodenal injuries. AU - Timaran, C. H.. AU - Daley, B. J.. AU - Enderson, B. L.. PY - 2001. Y1 - 2001. N2 - Background: The differentiation of duodenal perforation from duodenal hematoma is not always possible with computed tomography (CT). Our diagnostic guideline has included duodenography to investigate CT findings of periduodenal fluid or wall thickening. However, the utility of duodenography as a diagnostic study in blunt abdominal trauma is not defined. We evaluated duodenography as a diagnostic test in patients with suspected blunt duodenal injuries (BDIs). Methods: During a 10-year period, 96 patients out of 25,608 trauma admissions had CT findings of possible BDI and underwent duodenography. Demographic and clinical data, diagnostic methods, and management were derived from prospectively collected data. CT and duodenography studies were reviewed and correlated with surgical findings and outcome. All CT scans were obtained ...
REBOA now being explored and in place for patients with suspected or diagnosed intra-abdominal hemorrhage secondary to penetrating torso injuries, blunt trauma patients with suspected pelvic fracture and isolated pelvic hemorrhage and patients with penetrating injury to the pelvis or groin area with life-threatening hemorrhage. ...
SafetyLit is produced by the SafetyLit Foundation in cooperation with San Diego State University and the World Health Organization.
Pulmonary insufficiency continues to be a major cause of death following trauma of many types. In combat casualties, direct injury to the lung is the most common cause of arterial hypoxemia, though contusion of the chest wall by a high velocity bullet may actually produce a greater pulmonary injury than when the lung is penetrated. Similarly, the familiar civilian injuries that occur when the chest is crushed against the steering wheel may produce severe contusion of the underlying pulmonary parenchyma while the chest wall remains intact. An experimental method for producing a standard injury to the lung through the intact chest wall was developed, and the acute changes in cardiopulmonary function following injury have been studied. The physiologic changes associated with healing of the injury were documented.
Cyberounds is an interactive grand rounds moderated by distinguished academics, exclusively for physicians, medical students and other selected health professionals.