Retained gallstones: an elusive complication of laparoscopic cholecystectomy

A young, healthy woman presented to the emergency department multiple times with right upper quadrant pain and subjective fevers for over a year after her laparoscopic cholecystectomy. The patient required multiple hospital visits and extensive work-ups before finally being diagnosed with retained gallstones in her abdomen. After surgical removal of the stones, her symptoms resolved completely. The case highlights the challenges in diagnosing retained gallstones, the substantial burdens they can impose on patients, and the importance of prevention and thorough documentation

A Curious Case of Right Upper Quadrant Abdominal Pain

An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology

A Curious Case of Right Upper Quadrant Abdominal Pain

An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology

FOAM authorship: Whos teaching our learners?

BACKGROUND: Free open-access medical education (FOAM) is extremely popular among learners and educators despite lacking the traditional peer review process. Despite the potential for inaccurate, low-quality, or biased content, little has been published describing FOAM authors. METHODS: We performed a cross-sectional analysis of 12 months of content from the top 25 blogs in the 2020 Social Media Index from August 2020-2021. We recorded the number of posts per site and descriptive characteristics of authors, including gender affiliation, conflicts of interest (COI) statements, and type of practice (academic, community, or hybrid). RESULTS: We identified 2141 posts by 1001 authors. More than half were produced by six websites: EM Docs (266), Life in the Fast Lane (232), EMCrit (188), ALiEM (185), Dont Forget the Bubbles (181), and Rebel EM (174). Most content (1680 posts, 78.5%) lacked a COI statement. Authors were mostly academic (89%), mostly held MD degrees (67.4%), and were mostly men (59.7%). Geographically, most FOAM authors reside in the United States (59.5%), Canada (22.42%), or the United Kingdom (9.4%). CONCLUSIONS: Of all the posts in the top 25 sites in 2020, more than half came from six sites, and authors were largely North American men in academics with MD degrees. Learners, content creators, and educators should consider the ways in which a more diverse authorship pool might bring value to the FOAM educational experience

FOAM authorship: Who’s teaching the learners?

Learning Objectives: Of all posts from the top 25 blogs in 2020, more than half came from six sites, most contained clinical content, and authors were largely North American male academics with MD degrees. Learners, content-creators, and educators must recognize these limitations in utilizing online educational content.Background: While use of Free Open Access Medical Education (FOAM) content has grown over the last decade, concerns about quality assessment remain. Given the disconnect between the high utilization of these resources by learners and the low barriers and oversight to publishing, the authors of FOAM resources require further scrutiny.Objectives: We sought to describe the production and authorship characteristics of the most impactful FOAM blogs.Methods: Based on previous studies, a classification system for post content was developed by to two authors with content expertise in online educational resources. We included 12 months (August, 2019 - May, 2021) of blog posts from each of the top 25 sites in the 2020 social media index (SMI). We recorded the following: number of posts per site and per author, types of post; and author related details such as gender, title, affiliation, degree, location of practice and type of practice (academic, community, or hybrid). Gender was determined based on an online identification tool (genderchecker.com).Results: We identified 2,141 posts by 1,001 authors, with more than half produced by six websites: EM Docs (266), Life in the Fast Lane (232), EMCrit (188), ALiEM (185), Don’t Forget the Bubbles (181), and Rebel EM (174). Most content (1680 posts, 78.5%), lacked a conflicts of interest (COI) statement. Posts averaged 5.9 + 11.1 references and 2.32 + 7.8 comments. Authors were mostly academic (89%), mostly held MD degrees (67.4%), and skewed male (59.7%). Geographically, most FOAM authors reside in the USA (59.5%), Canada (22.42%), or the UK (9.4%).Conclusions: Of all the posts in the top 25 blogs in 2020, more than half came from six sites, most contained clinical content, and authors were largely North American male academics with MD degrees. Learners, content-creators, and educators should consider the ways in which a more diverse authorship pool might bring value to the FOAM educational experience