An one-stop career platform detailing Schools & Universities offering English language, Bachelor, Master and PhD programs with course fee, living cost, scholarships, visa details, etc.
---------------------------
Cyprus College
cycollege.ac.cy
The college was founded in 1961 with the purpose to provide a well rounded education of high calibre where students can acquire the necessary academic knowledge.
---------------------------
Wroclaw University
international.uni.wroc.pl
Founded in 1702 by Leopold I Habsburg. Since the beginning of 20th century the university has produced 9 Nobel Prize winners.
---------------------------
Volyn University
vdu.edu.ua
The history dates back to 1940. At present, the university includes 4 institutes, 14 faculties and 73 departments.
---------------------------
Berkeley College
berkeleycollege.edu
Through the power of internet, Berkeley college online brings the classroom to you anywhere in the world with the same high level of support as On-Campus classes.
---------------------------
AIS
ais.ac.nz
New Zealand's largest international degree provider. The programmes are focused on the global marketplace.
---------------------------
WORLD UNIVERSITY DIRECTORY
Medical Education Emergency Medicine Journal current issue
<p>Welcome to the December issue of <I>EMJ</I>, it is a good time to reflect on and celebrate the research progress in emergency medicine in 2024, which is so inspiring. It is also a good time to consider the areas of emergency medicine such as mental health where more research is much needed. We continue to see a worrying rise in mental health presentations globally so it is timely to have number of papers in this issue pertaining to mental health and psychosocial issues. The first paper by Giannouchos and colleagues from America investigates the association of self-injury-related ED attendance with homelessness. They conducted a retrospective, secondary data analysis using a nationally representative sample of ED visits by adults aged 25–64 years in the USA from the 2016 to 2021 National Hospital Ambulatory Medical Care Survey. The incidence rate ratio for self-injury-related ED visits was 3.14 (95% CIs 2.05 to...
<p>Suspected stroke is a common scenario for emergency medical services (EMS) which typically triggers urgent transportation to the nearest stroke-admitting hospital with prenotification according to local protocols.<cross-ref type="bib" refid="R1">1 2</cross-ref><cross-ref type="bib" refid="R2"></cross-ref> This linear pathway is appropriate for the majority of presentations and facilitates access to time-critical treatments, such as intravenous thrombolysis. However, suspected stroke is also a heterogeneous population, and it is likely that care delivery and resource utilisation would be improved by earlier triage for two subgroups at opposite ends of the clinical severity spectrum:</p> <p>1. Patients with transient symptoms suggestive of transient ischemic attached (TIA), who could avoid immediate hospitalisation if rapid outpatient specialist review is available.</p> <p>2. Patients with ongoing severe symptoms indicative of possible large vessel occlusion, who might benefit from bypassing the nearest hospital in favour of a comprehensive stroke centre (CSC) with the facilities required to provide mechanical thrombectomy.</p> <p>As there are...
<sec><st>Background</st>
<p>Early assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with TIA present to emergency medical services (EMS) but may not require hospitalisation. Paramedics could identify and refer patients with low-risk TIA, without conveyance to the ED. Safety and effectiveness of this model is unknown.</p>
</sec>
<sec><st>Aim</st>
<p>To assess the feasibility of undertaking a fully powered randomised controlled trial (RCT) to evaluate clinical and cost-effectiveness of paramedic referral of patients who call EMS with low-risk TIA to TIA clinic, avoiding transfer to ED.</p>
</sec>
<sec><st>Methods</st>
<p>The Transient Ischaemic attack Emergency Referral (TIER) intervention was developed through a survey of UK ambulance services, a scoping review of evidence of prehospital care of TIA and convening a specialist clinical panel to agree its final form. Paramedics in South Wales, UK, were randomly allocated to trial intervention (TIA clinic referral) or control (usual care) arms, with patients’ allocation determined by that of attending paramedics.</p>
<p>Predetermined progression criteria considered: proportion of patients referred to TIA clinic, data retrieval, patient satisfaction and potential cost-effectiveness.</p>
</sec>
<sec><st>Results</st>
<p>From December 2016 to September 2017, eighty-nine paramedics recruited 53 patients (36 intervention; 17 control); 48 patients (31 intervention; 17 control) consented to follow-up via routine data. Three intervention patients, of seven deemed eligible, were referred to TIA clinic by paramedics. Contraindications recorded for the other intervention arm patients were: Face/Arms/Speech/Time positive (n=13); ABCD2 score >3 (n=5); already anticoagulated (n=2); crescendo TIA (n=1); other (n=8). Routinely collected electronic health records, used to report further healthcare contacts, were obtained for all consenting patients. Patient-reported satisfaction with care was higher in the intervention arm (mean 4.8/5) than the control arm (mean 4.2/5). Health economic analysis suggests an intervention arm quality-adjusted life-year loss of 0.0094 (95% CI –0.0371, 0.0183), p=0.475.</p>
</sec>
<sec><st>Conclusion</st>
<p>The TIER feasibility study did not meet its progression criteria, largely due to low patient identification and referral rates. A fully powered RCT in this setting is not recommended.</p>
</sec>
<sec><st>Trial registration number</st>
<p> <A HREF="ISRCTN85516498">ISRCTN85516498</A>.</p>
</sec>
<p>Subarachnoid haemorrhage (SAH) can be a difficult diagnosis in patients who present to the emergency department (ED) with acute headache but are alert with no neurological deficit.<sup><cross-ref type="bib" refid="R1">1</cross-ref></sup></p> <p>The classical teaching is that SAH cannot be excluded by non-contrast CT and so patients should proceed to lumbar puncture (LP) if the initial CT is normal. However, there has been a recent shift in practice—driven by emerging evidence<cross-ref type="bib" refid="R1">1 2</cross-ref><cross-ref type="bib" refid="R2"></cross-ref>—away from routinely offering LP to exclude SAH.</p> <p>In this issue of the <I>EMJ</I>, the Trainee Emergency Research Network (TERN) report on the subarachnoid haemorrhage in the Emergency Department (SHED) study.<cross-ref type="bib" refid="R3">3</cross-ref> SHED was a multicentre prospective cohort study that asked whether a normal CT brain within 6 hours is sufficient to exclude SAH in patients attending an ED with acute headache. The SHED investigators recruited adults with non-traumatic acute headache reaching maximal intensity within 1 hour and...
<sec><st>Background</st>
<p>People presenting to the ED with acute severe headache often undergo investigation to exclude subarachnoid haemorrhage (SAH). International guidelines propose that brain imaging within 6 hours of headache onset can exclude SAH, in isolation. The safety of this approach is debated. We sought to externally validate this strategy and evaluate the test characteristics of CT-brain beyond 6 hours.</p>
</sec>
<sec><st>Methods</st>
<p>A prospective, multicentre, observational cohort study of consecutive adult patients with non-traumatic acute headache presenting to the ED within a UK National Health Service setting. Investigation, diagnosis and management of SAH were all performed within routine practice. All participants were followed up for 28 days using medical records and direct contact as necessary. Uncertain diagnoses were independently adjudicated.</p>
</sec>
<sec><st>Results</st>
<p>Between March 2020 and February 2023, 3663 eligible patients were enrolled from 88 EDs (mean age 45.8 (SD 16.6), 64.1% female). 3268 patients (89.2%) underwent CT-brain imaging. There were 237 cases of confirmed SAH, a prevalence of 6.5%. CT within 6 hours of headache onset (n=772) had a sensitivity of 97% (95% CI 92.5% to 99.2%) for the diagnosis of SAH and a negative predictive value of 99.6% (95% CI 98.9% to 99.9%). The post-test probability after a negative CT within 6 hours was 0.5% (95% CI 0.2% to 1.3%). The negative likelihood ratio was 0.03 (95% CI 0.01 to 0.08). CT within 24 hours of headache onset (n=2008) had a sensitivity of 94.6% (95% CI 91.0% to 97.0%). Post-test probability for SAH was consistently less than 1%. For <I>aneurysmal</I> SAH, post-test probability was 0.1% (95% CI 0.0% to 0.4%) if the CT was performed within 24 hours of headache onset.</p>
</sec>
<sec><st>Conclusion</st>
<p>Our data suggest a very low likelihood of SAH after a negative CT-brain scan performed early after headache onset. These results can inform shared decision-making on the risks and benefits of further investigation to exclude SAH in ED patients with acute headache.</p>
</sec>
<sec><st>Background</st>
<p>Acute aortic syndrome (AAS) requires urgent diagnosis with computed tomographic angiography (CTA). Diagnostic strategies need to weigh the benefits of detecting AAS against the costs of using CTA with a low yield of AAS when the prevalence of AAS is low. We aimed to estimate the cost-effectiveness of diagnostic strategies using clinical probability scoring and D-dimer to select patients with potential symptoms of AAS for CTA.</p>
</sec>
<sec><st>Methods</st>
<p>We developed a decision analytical model to simulate the management of patients attending hospital with possible AAS. We modelled diagnostic strategies that used the Aortic Dissection Detection Risk Score (ADD-RS) and D-dimer to select patients for CTA. We used estimates from our meta-analysis, existing literature and clinical experts to model the consequences of diagnostic strategies on survival, health utility, and health and social care costs. We estimated the incremental cost per quality-adjusted life-years gained by each strategy compared with the next most effective alternative on the efficiency frontier.</p>
</sec>
<sec><st>Results</st>
<p>A strategy based on the Canadian guideline (CTA if ADD-RS>1 or ADD-RS=1 with D-dimer >500 ng/mL) is cost-effective but would result in high rates of CTA if applied to an unselected population (AAS prevalence 0.26%). The strategy is also cost-effective and would result in lower rates of CTA if applied to a more selected population, such as those with a non-zero clinical suspicion of AAS (prevalence 0.61%). For patients currently receiving CTA, using ADD-RS>1 or D-dimer >500 ng/mL to select patients for CTA is cost-effective.</p>
</sec>
<sec><st>Conclusions</st>
<p>A strategy using ADD-RS>1 or ADD-RS=1 with D-dimer >500 ng/mL to select patients for CTA appears cost-effective but primary research is required to evaluate this strategy in practice and determine how suspicion of AAS is identified.</p>
</sec>
<sec><st>Background</st>
<p>The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic.</p>
</sec>
<sec><st>Methods</st>
<p>A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED. This survey provides scores for 12 separate domains and a global assessment of safety (scale 0–10). The survey was repeated in 2021 after the first wave of the COVID-19 pandemic. After the second survey, the researchers constructed a Pareto Chart (based on the responses from the surveys), demonstrating the most important problems to develop improvement proposals.</p>
</sec>
<sec><st>Results</st>
<p>The 2019 questionnaire was completed by 125 AED workers and 65 PED workers. The 2021 questionnaire was completed by 79 AED workers and 50 PED workers. The global assessment of safety in the AED was 6.13 points at baseline and increased to 7.58 points (p<0.001) after COVID-19. The global assessment for the PED was 6.8 points at baseline and increased to 7.62 points after COVID-19 (p<0.001). In both services, the dimension that was most favourably assessed was ‘Teamwork in the Service’ while ‘Provision of Staff’ was least favourably assessed. The Pareto charts showed four dimensions contributing more than 50% of negative responses: ‘Provision of staff’ and ‘Hospital Management support for patient safety’ coincided in both services.</p>
</sec>
<sec><st>Conclusion</st>
<p>The baseline perception of the culture of safety was higher in the PED but improved in both services during the COVID-19 pandemic. Adverse situations can provide an opportunity to improve patient safety culture.</p>
</sec>
<sec id="s1"><st>Clinical introduction</st> <p>A 71-year-old man presented to the ED with progressive headache and neck pain. The patient had no visual, neurological, chest or abdominal symptoms. Temperature was 38.8°C, he was fully conscious with no signs of meningeal irritation. C reactive protein was 85 mg/L. CXR and brain CT were unremarkable; cerebrospinal fluid analysis was normal. Because of the persistent symptoms, a cervical spine CT was performed during follow-up (<cross-ref type="fig" refid="F1">figure 1</cross-ref>).</p> </sec> <sec id="s2"><st>Question</st> <p>What is the most likely diagnosis?</p> <p><l type="letterupper"><li><p>Acute calcific tendinitis of the longus colli muscle (ACTLC)</p> </li><li> <p>Rheumatoid arthritis (RA) of the cervical spine</p> </li><li> <p>Pseudogout of the atlantoaxial junction</p> </li><li> <p>Odontoid fracture type I</p> </li></l></p></sec> <sec id="s3"><st>Answer: C</st> <p>Pseudogout of the atlantoaxial junction (crowned dens syndrome (CDS))</p> <p>The cervical spine CT showed calcifications with a ‘crowned dens’ configuration (<cross-ref type="fig" refid="F2">figure 2</cross-ref>, ), which is pathognomonic for pseudogout of the atlantoaxial junction.<cross-ref...
<sec><st>Background</st>
<p>Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes.</p>
</sec>
<sec><st>Methods</st>
<p>We conducted a retrospective analysis of data from the Japanese Association for Acute Medicine-OHCA Registry for patients <18 years of age with OHCA between June 2014 and December 2019. All patients received prehospital CPR by emergency medical service (EMS). The aetiologies of arrest included traumatic and atraumatic causes. The primary outcome measure was a 1-month neurological outcome of moderate disability or better (Pediatric Cerebral Performance Category 1–3). We calculated the dynamic probability and cumulative proportion of 1-month moderate disability or better neurological outcomes. Dynamic probability calculates patient outcomes during CPR per min. We performed multivariate logistic regression analysis to explore the association between longer CPR duration (as an ordinal variable) and 1-month poorer neurological outcomes.</p>
</sec>
<sec><st>Results</st>
<p>Among 1007 eligible children, 252 achieved return of spontaneous circulation and 53 had a 1-month moderate disability or better neurological outcome. The dynamic probability of a 1-month moderate disability or better neurological outcome dropped below 0.01 at 64 min (0.005, 95% CI 0.001 to 0.017). The cumulative proportion of a 1-month moderate disability or better neurological outcome exceeded 0.99 at 68 min (1, 95% CI 1 to 1). With increasing CPR time from CPR initiation by EMS, both crude and adjusted ORs for 1-month neurological outcomes gradually decreased.</p>
</sec>
<sec><st>Conclusion</st>
<p>Using a large Japanese database of paediatric OHCA patients, we found that longer CPR duration was associated with a lower likelihood of a 1-month moderate disability or better neurological outcome. Less than 1% of paediatric patients exhibited 1-month moderate disability or better neurological outcomes when total CPR duration is more than 64 min.</p>
</sec>
<sec><st>Background</st>
<p>Despite pronounced increases in homelessness and mental health problems in the USA over the past decade, further exacerbated during the pandemic, and the higher prevalence of mental health conditions among individuals experiencing homelessness, no study has examined trends in self-injury-related ED visits by individuals experiencing homelessness using up-to-date nationwide data. To address this gap, we aimed to investigate the association of self-injury-related ED visits with homelessness and to examine trends in these ED visits by individuals experiencing homelessness.</p>
</sec>
<sec><st>Methods</st>
<p>We conducted a retrospective secondary data analysis using a nationally representative sample of ED visits by adults aged 25–64 years in the USA from the 2016–2021 National Hospital Ambulatory Medical Care Survey. We examined whether intentional self-injury-related ED visits and hospitalisations resulting from an ED visit were associated with homeless status using survey-weighted multivariable generalised linear regression models and whether trends in such visits changed over the study period.</p>
</sec>
<sec><st>Results</st>
<p>Our analysis covered 419.4 million ED visits from 2016 to 2021. Individuals experiencing homelessness constituted 1.8% (7.4 million) of ED visits. Overall, 1.8% of ED visits (7.7 million) were related to intentional self-injuries. Nearly 1 in every 10 ED visits (9.6%) by individuals experiencing homelessness were related to self-injuries, compared with 1.7% among housed counterparts (p<0.001). The adjusted incidence rate ratio for self-injury-related ED visits was 3.14 (95% CI 2.05 to 4.83) for individuals experiencing homelessness compared with housed individuals. Finally, individuals experiencing homelessness accounted for 12.0% and 11.7% of self-injury-related ED visits in 2020 and 2021, respectively (pandemic years), compared with an average of 8.4% in the previous years.</p>
</sec>
<sec><st>Conclusion</st>
<p>Among adults aged 25–64 years, experiencing homelessness was significantly associated with self-injury-related ED visits, and an increase in the rate of such visits among individuals experiencing homelessness was observed during 2020 and 2021. Future studies should assess longer-term trends in these visits and explore interventions to address the societal, health and mental healthcare needs in order to improve the health outcomes of these marginalised individuals.</p>
</sec>
<p>Emergency department (ED) encounters among patients experiencing non-fatal opioid-involved overdoses continue to increase.<cross-ref type="bib" refid="R1">1</cross-ref> Across Georgia, ~13 000 non-fatal drug-involved overdoses present to EDs, annually. Patient interventions capable of ensuring timely access to recovery services following these encounters are warranted. Peer recovery coaches (PRCs) are persons in long-term recovery from substance use disorders (SUD) who leverage their experience to serve as liaisons between patients and clinicians, and aid patients in navigating SUD recovery services.<cross-ref type="bib" refid="R2">2 3</cross-ref><cross-ref type="bib" refid="R3"></cross-ref> PRCs are active in the Atlanta community, trained and independently certified by a credentialing organisation endorsed by the state. PRCs help to reduce ED utilisation and improve care outcomes<cross-ref type="bib" refid="R4">4</cross-ref>; however, ED infrastructure and scarcity of qualified personnel limit access to PRCs. Before hiring PRCs in our ED, a large public hospital with a Level I trauma centre seeing >150 000 annual encounters, recovery service referrals were clinician-driven and not...
<p>Olanzapine long-acting injection is a commonly used antipsychotic drug formulation in the treatment of schizophrenia. Postinjection delirium/sedation syndrome (PDSS) is a potential side effect of this intramuscular depot, for which patients are often presented at the ED. In this article, we give an overview of the current literature outlining the key aspects of managing this syndrome in a critical care setting, illustrated by a typical fictional clinical case. We discuss several useful and practical aspects of PDSS for emergency physicians and critical care physicians, including pharmacological background, common symptoms, diagnostic criteria and therapeutic options.</p>
<sec id="s1"><st>Clinical introduction</st> <p>A 50-year-old construction worker presented to the ED with a history of fall. He had pain in the right foot and difficulty weight bearing. The patient was assessed and diagnosed to have a closed isolated injury to the right foot (<cross-ref type="fig" refid="F1">figure 1</cross-ref>). The foot was neurovascularly intact. Examination only showed painful restriction of plantar flexion of the big toe.</p> </sec> <sec id="s2"><st>Question</st> <p>What is the most likely diagnosis?</p> <p><l type="letterupper"><li><p>Dislocation of the first metatarsophalangeal joint</p> </li><li> <p>Rupture of the extensor hallucis longus tendon</p> </li><li> <p>Great toe interphalangeal joint dislocation</p> </li><li> <p>Fracture of base of proximal phalanx of great toe</p> </li></l></p></sec> <sec id="s3"><st>Answer: A</st> <p>Dislocation of the first metatarsophalangeal joint</p> </sec> <sec id="s4"><st>Explanation</st> <p>The patient has type 1 traumatic dislocation of the first metatarsophalangeal joint (FMTPJ) (Jahss classification<cross-ref type="bib" refid="R1">1</cross-ref>). The presence of a skin dimple on the dorsomedial aspect of the FMTPJ and plantar...
<p>A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In adult patients presenting to the ED with diabetes-related visual symptoms, how effective is using a portable handheld fundus camera in diagnosing diabetic retinopathy?</p>
<p>MEDLINE, Embase and Cochrane databases were searched for relevant evidence. Altogether, 237 papers were found using the search strategy developed. 12 provided the best evidence to answer the three-part question. The data on first author name, publication year, country of origin, study type, study sample size, participant’s gender, reported effect sizes, main findings and limitations were extracted from the relevant studies and listed in a table.</p>
<p>Following a thorough examination and review of the literature, our analysis identified 12 articles for detailed evaluation. Of these, three provided the most compelling evidence concerning the use of portable handheld fundus cameras for the diagnosis of diabetic retinopathy in emergency settings. Ruan <I>et al</I> (2022) reported superior image quality and a sensitivity of 82.1% (95% CI: 72.1% to 92.2%) with a specificity of 97.4% (95% CI: 95.4% to 99.5%) for a handheld camera combined with artificial intelligence interpretation. Jin <I>et al</I> (2017) demonstrated high-quality images with 63% rated as excellent, showing a comparable efficacy to a traditional tabletop camera. Das <I>et al</I> (2022) found that Remidio and Pictor handheld cameras had high success rates and image quality, with sensitivities of 77.5% (95% CI: 65.9% to 89.0%) and 78.1% (95% CI: 66.6% to 89.5%), respectively, comparable to the Zeiss tabletop camera’s sensitivity of 84.9% (95% CI: 78.2% to 91.5%). The clinical bottom line is that the best available evidence supports the effectiveness of portable handheld fundus cameras for diagnosing diabetic retinopathy in emergency settings.</p>
<p>Detection of rapid loss of intravascular volume due to haemorrhage or fluids can be a time-sensitive data point in critical situations. Clinical evaluation can be difficult and prior research has shown inaccuracies leading to increased morbidity and mortality.<cross-ref type="bib" refid="R1">1</cross-ref> One way to measure this is through the assessment of capillary refill time (CRT), which has been shown to significantly vary between physicians.<cross-ref type="bib" refid="R2">2</cross-ref> However, goal-directed fluid management often uses manual CRT measurements as a guiding metric. The goal of this study was to evaluate technology (PeriFRL by ProMedix Inc) to objectively measure CRT before and after healthy subjects donated blood. The hypothesis was that the CRT would become prolonged after donation.</p> <p>All adult subjects over 17 years gave consent. All subjects over three separate 1-day periods who signed up to donate blood were approached. The subjects had basic demographics taken and the PeriFRL device applied before and...
<p>Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.</p>
<p>This month’s update is by the Emergency Medicine team in South East Scotland. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.</p> <p>The papers are ranked as:</p> <p><l type="unord"><li><p>Worth a peek—interesting, but not yet ready for prime time.</p> </li><li> <p>Head turner—new concepts.</p> </li><li> <p>Game changer—this paper could/should change practice.</p> </li></l></p> <sec id="s1"><st>Peri-intubation hypoxia after delayed versus rapid sequence intubation in critically injured patients on arrival to trauma triage: a randomized controlled trial by Bandyopadhyay <I>et al</I></st> <p><b>Topic: Trauma</b></p> <p><b>Outcome rating: Head turner</b></p> <p>While many trauma patients require intubation, critically injured patients with agitation or confusion may struggle to tolerate standard preoxygenation. This study investigated whether delayed sequence intubation (DSI), with the administration of ketamine 3 min prior...
<p>I read with interest the frailty practice review by Van Oppen <I>et al</I> in which they suggest that existing emergency department (ED) guidelines and protocols poorly represent older people living with frailty. They recommend that clinicians caring for these patients should not only appraise the available evidence in the context of an individual’s situation and values but also consider the person’s personal preferences to truly deliver person-centred care.<cross-ref type="bib" refid="R1">1</cross-ref> They highlight the fact that evidenced-based treatment pathways in the ED, which often work well for the younger patients, may predispose the frail older patient to unnecessary repeated investigations of little value to them, losing sight of the issues that matter most to them.<cross-ref type="bib" refid="R1">1</cross-ref> As frail older patients often have multiple physical and psychosocial problems and may have different goals for their care, they need a very different approach that addresses their needs, desires and quality of...
<sec id="s1"><st>Vignette 1</st> <p><qd><p>It all began when I realised that my memory was becoming a problem, both at work and at home. Simple words that used to come effortlessly suddenly required extra effort to find. It’s like grasping for something that should be there but isn’t. Usually if I stopped trying, the word came eventually. At first, I chalked it up to the demands of a busy life, juggling work, and family commitments. Like many of us, I didn't have the time or inclination to worry about my own health concerns.</p> <p>One day, I decided to confide in some colleagues my age and was surprised to discover that I wasn’t alone. They too had experienced memory issues, mood swings, and a general sense of bleurgh. What struck me was that they all wished they had started HRT earlier. (Age 44)</p> </qd></p></sec> <sec id="s2"><st>Vignette 2</st> <p><qd><p>I know this job is...
Home
Contact Us
Back to "News Updates - Homepage"
