Debate: the per rectal/digital rectal examination exam in the emergency department, still best practice?

BACKGROUND: Emergency medicine practice in the UK and Ireland offers a junior and middle grade doctor great learning opportunities that force engagement with multiple specialties, life-saving procedures, exposure to a myriad of patient presentations, and opportunities for best practices in medicine. MAIN BODY: The emergency department (ED) can be a hectic and dynamic environment; communication from the ED to specialists is essential to ensure best clinical outcomes for patients. The "per rectal" (PR) or "digital rectal exam" (DRE) can be a very difficult diagnostic test for even the most skilled operator to discern pathological versus normal; we propose this is especially the case in the emergency department patient population. Some specialists require this exam performed by an unskilled junior doctor with varying results prior to reviewing a referred and sick patient. The PR/DRE benefits may be limited in the ED setting for some pathologies, and the result of the exam may have limited impact in the overall treatment plan in the ED. CONCLUSION: This short paper reviews the indications, benefits, shortfalls, and limitations of the PR/DRE in the emergency department setting and offers novel alternatives to maximize best practice, ensure best clinical outcomes for patients, and, to first, do no harm.

Commentary: expectations for global health program prioritization from a selection of international students studying at a European university.

BACKGROUND: Some university curricula struggle to present evidence-based promotion of global health principles and global health diplomacy within an undergraduate setting. The de facto global health paradigm has experienced significant stress and pressure from epidemics, war and violence, climate change and resource challenges. These stressors may lead to increased morbidity and mortality, in turn requiring medical professionals to play a larger role in global health action across borders. METHODS: In the academic year 2014-2015, an English-speaking international medical school promoted a global health forum with pre-course readings and a pre-attendance quiz. All students from the university were invited to attend and the event was not mandatory. RESULTS: The one-day-event culminated in expert speakers, discussions and a post-event questionnaire to gauge students' reactions and expectations as future physicians regarding the most pressing global health topics. Emphasis was also placed on what future doctors foresee as pressing issues in forthcoming global health policy and programming. This paper is a brief commentary of the Global Health Forum in Prague 2014, and presents novel results from a post-event student questionnaire, with conclusions provided by students on innovative global health policy.