Highlights

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Imaging-guided venous catheterization

Neither ultrasound nor near-infrared vascular imaging improved first-attempt success rates when used by nurses to guide peripheral intravenous catheter placement in children, compared with a standard approach without imaging. This pragmatic randomized trial enrolled 418 children, stratified by age, from a pediatric emergency department. The results do not support use of these technologies for routine peripheral intravenous catheterization in children, say the authors. See Research, page 563

One-hour algorithm for diagnosis of MI

An algorithm incorporating baseline levels as well as changes within the first hour of high-sensitivity cardiac troponin T accurately ruled acute myocardial infarction in or out in patients presenting to the emergency department with symptoms suggesting this diagnosis. This multicentre prospective study enrolled 1320 patients in three European countries from 2009 to 2013. The final diagnosis for each patient was adjudicated centrally based on all cardiac testing performed. The algorithm allowed management to be accelerated safely and rapidly in 75.9% of patients with suspected myocardial infarction, say the authors. See Research, page E243

Elder abuse

Elder abuse is common, affecting 5%–10% of older adults. Although evidence to support screening and any particular intervention is weak, physicians must be skilled in handling this important problem. Wang and colleagues discuss an advocacy approach that physicians can adopt to handle suspected cases of elder abuse. See Review, page 575

Restricting private practice in Canada

In the event that constitutional challenges to existing laws succeed, Canadian policy-makers should explore the use of physician contracts as a fallback strategy for limiting two-tier care, say Flood and colleagues in their analysis of international examples of restricted private practice. See Analysis, page 583

Cubital tunnel syndrome

After a three-month history of weakness and tingling in his left hand, a 37-year-old man is found to have hypothenar atrophy and reduced sensation in the little and ring fingers. What tests for nerve function and other investigations are useful? Does he require referral? Middleton and Anakwe address these questions in their discussion of cubital tunnel syndrome. See Decisions, page 593

Incarcerated ovarian inguinal hernia

Inguinal hernias are common in children. Lee and Scampoli review the embryology leading to this finding and provide an approach to diagnosis and management. They caution that some hernias in girls may have ovarian involvement. Early recognition and surgical intervention may reduce the risk of ovarian strangulation. See Cases, page 596

Nipple discharge

Although nipple discharge is benign in most instances, patients with pathologic discharge should be referred for imaging and tissue diagnosis. Clues to pathologic discharge include unilateral and spontaneous discharge that may arise from a single duct or be associated with mass or skin changes. It may be bloody, serous, green or black. See Five things to know about …, page 599

Koplik spots

With the resurgence of measles, physicians may be seeing Koplik spots more often. Xavier and Forgie describe the appearance of Koplik spots, along with fever and an exanthem, in a 10-month-old girl who had been exposed to measles on a domestic flight two weeks earlier. See Clinical images, page 600