What are effective medical treatments for adults with acute migraine?

Medications collectively referred to as "triptans" (eg, sumatriptan, naratriptan, etc) have been shown to be effective for acute migraine (strength of recommendation [SOR]: A). Nonsteroidal anti-inflammatory drugs (NSAIDs)--including aspirin, ibuprofen, naproxen sodium, diclofenac potassium, ketoprofen, tolfenamic acid, and ketorolac-- are also effective (SOR: A). The combination of acetaminophen/aspirin/ caffeine is effective (SOR: B). Parenteral dihydroergotamine (DHE), when administered with an antiemetic, is as effective as, or more effective than meperidine, valproate, or ketorolac (SOR: B). Prochlorperazine is more effective than metoclopramide in headache pain reduction (SOR: A). Isometheptene mucate/dichloralphenazone/ acetaminophen is as effective as low-dose oral sumatriptan (SOR: B)

What is the best way to evaluate an acute traumatic knee injury?

The Ottawa Knee Rules can guide the use of radiography in adults who present with isolated knee pain. However, information on use of these rules in the pediatric population is limited (strength of recommendation [SOR ]: A, based on systematic review of high-quality studies and a validated clinical decision rule). Specific physical examination maneuvers (such as the Lachman and McMurray tests) may be helpful when assessing for meniscal or ligamentous injury (SOR : C, based on studies of intermediate outcomes)

What is the best approach to benign paroxysmal positional vertigo in the elderly?

A canalith repositioning maneuver(CRM), such as the Epley or Semont maneuver, should be the first-line treatment for benign paroxysmal positional vertigo (BPPV) in the elderly (strength of recommendation [SOR]: A, several good-quality randomized controlled trials [RCTs])

A Review of Continuous Quality Improvement Processes at Ten Medical Schools

The Liaison Committee on Medical Education now expects all allopathic medical schools to develop and adhere to a documentable continuous quality improvement (CQI) process. Medical schools must consider how to establish a defensible process that monitors compliance with accreditation standards between site visits. The purpose of this descriptive study is to detail how ten schools in the Association of American Medical Colleges’ (AAMC) Southern Group on Educational Affairs (SGEA) CQI Special Interest Group (SIG) are tackling practical issues of CQI development including establishing a CQI office, designating faculty and staff, charging a CQI committee, choosing software for data management, if schools are choosing formalized CQI models, and other considerations. The information presented is not meant to certify that any way is the correct way to manage CQI, but simply present some schools’ models. Future research should include defining commonalities of CQI models as well as seeking differences. Furthermore, what are components of CQI models that may affect accreditation compliance negatively? Are there “worst practices” to avoid? What LCME elements are most commonly identified for CQI, and what are the successes and struggles for addressing those elements? What are identifiable challenges relating to use of standard spreadsheet software and engaging information technology for support? How can students be more engaged and involved in the CQI process? Finally, how do these major shifts to a formalized CQI process impact the educational experience

Culture in the Rise of Tiger Economies: Scottish Expatriates in Dublin and the 'Creative Class' Thesis

This article evaluates the contributions which Richard Florida's seminal 'creative class' thesis might make to ongoing efforts to re-inscribe 'culture' back into political economy explanations of the rise of Tiger economies. It reflects upon the value of reconsidering both the role of skilled migrants in Tiger states and the factors which attract skilled migrants to these economies in the first instance. Based upon analyses of a series of focus groups conducted with Scottish expatriates currently working in Dublin, the article specifically attempts to gauge how far the creative class thesis can be stretched to account for the locational preferences of talented migrants. Whilst Florida's work undoubtedly sheds light on aspects of expatriate existence which might not otherwise have been obvious, its ability to account for the relationships which have existed between technology, talent and tolerance in the Celtic Tiger must be questioned. Moreover, if political economy and Floridian readings are to do more than simply inform one another, there will be a need to establish more clearly the complex ways in which developmental states intersect with skill flows and cosmopolitan cultural agendas. Copyright (c) 2006 The Author. Journal Compilation (c) 2006 Joint Editors and Blackwell Publishing Ltd.