The impact of race and ethnicity on diffuse large B-cell lymphoma outcomes within the veterans health administration (VHA).

We performed a retrospective chart review of 6266 randomly selected DLBCL patients treated in the VHA nationwide between 1/1/2011 and 12/31/2021. The 3178 patients who met inclusion criteria were predominantly male (97%) and white (75%). Median age of diagnosis for Black patients was 63 years vs 69 years for the entire cohort ( < 0.

Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations.

Introduction: This study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.

Methods: This prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date.

Social Media among Medical Students and Personnel Here to Stay.

Social media is no longer new, even in the professional medical world. It is an established and relatively public medium, and all users would do well to understand the risks associated with it. Medical personnel-whether medical student or staff physician-must familiarize themselves with it to ensure positive outcomes.

"The Questions Shape the Answers": Assessing the Quality of Published Survey Instruments in Health Professions Education Research.

Purpose: Surveys are widely used in health professions education (HPE) research, yet little is known about the quality of the instruments employed. Poorly designed survey tools containing unclear or poorly formatted items can be difficult for respondents to interpret and answer, yielding low-quality data. This study assessed the quality of published survey instruments in HPE.

Common Findings and Predictive Measures of Opioid Overdoses.

Purpose: This research examines autopsy findings from fatal opiate/opioid intoxications in New Hampshire for cerebral edema, pulmonary edema, and urinary bladder distension in the interest of finding predictability of such cases.

Methods: Autopsy reports of 150 decedents, between 20 and 40 years old, were reviewed. Subjects were divided into three groups as follows: 50 whose cause of death was opioid intoxication excluding fentanyl, 50 who died from fentanyl, and 50 who, lacking intoxication, died from cardiac issues, seizure disorders, or positional asphyxia as the control group.

Confronting an Upsurge in Opiate Deaths with Limited Resources.

The dramatic increase in drug-related deaths in the last decade has presented fiduciary and logistical difficulties to medicolegal jurisdictions of all types and sizes. New Hampshire, with a centralized state medical examiner system of death investigation, has been confronted with the task of investigating these drug-related deaths against the backdrop of statutory hurdles inhibiting a nimble response to the situation. This has led to a collaborative approach with law enforcement and the state Department of Justice in terms of triaging drug deaths to full autopsy versus external examination with toxicology testing.

Additive Effects of Cointoxicants in Single-Opioid Induced Deaths.

A forensic drug database (FDD) was used to capture comprehensive data from all drug-related deaths in West Virginia, with deaths also included from the northern New England states of Maine, Vermont, and New Hampshire. All four states serve predominantly rural populations under two million and all have similar state medical examiner systems that employ statewide uniform death certification policies and practices. This study focused on 1482 single opioid deaths (fentanyl, hydrocodone, methadone, and oxycodone) in the FDD from 2007-2011.

Surveys of Health Professions Trainees: Prevalence, Response Rates, and Predictive Factors to Guide Researchers.

Purpose: To establish a baseline overall response rate for surveys of health professions trainees, determine strategies associated with improved response rates, and evaluate for the presence of nonresponse bias.

Method: The authors performed a comprehensive analysis of all articles published in Academic Medicine, Medical Education, and Advances in Health Sciences Education in 2013, recording response rates. Additionally, they reviewed nonresponse bias analyses and factors suggested in other fields to affect response rate including survey delivery method, prenotification, and incentives.

Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis.

Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men.

An essential role for Gα(i2) in Smoothened-stimulated epithelial cell proliferation in the mammary gland.

Hedgehog (Hh) signaling is critical for organogenesis, tissue homeostasis, and stem cell maintenance. The gene encoding Smoothened (SMO), the primary effector of Hh signaling, is expressed aberrantly in human breast cancer, as well as in other cancers. In mice that express a constitutively active form of SMO that does not require Hh stimulation in mammary glands, the cells near the transgenic cells proliferate and participate in hyperplasia formation.

Sexual assault forensic examiners' training and assessment using simulation technology.

Introduction: More than 190,000 sexual assaults involving persons aged 12 years or older occur annually in the United States. For these victims, a forensic examination is the first step in the process to justice. Assessment and treatment of victims, as well as the meticulous collection and documentation of evidence, are vital for a strong case.

Asphyxial games in children and adolescents.

Asphyxial games, as played by young adolescents, and going by various names, are not new phenomena. What seems to be different at present is an increase in lethality introduced by the increasing use of ligatures and "playing" the game alone. The authors present a properly certified but insufficiently appreciated case followed 2 years later by 2 closely spaced but unrelated deaths in young adolescent males that made known this practice in New Hampshire youth.

Role of chemical tests and scene investigation in determination of range of fire.

Forensic pathologists have historically found several characteristics of the entrance wound invaluable in determining range of fire in gunshot fatalities. Among these characteristics are the pattern and constituents of any deposited material such as soot and/or gun powder residues. We describe a case in which the application of previously described characteristics, in the absence of laboratory testing and examination of the crime scene, would have led to an erroneous conclusion with potentially grave consequences.

Prothrombin G20210A mutation and sudden death.

The authors present a case of sudden death in a previously healthy 36-year-old male. At autopsy there were bilateral pulmonary thromboemboli and right ventricular dilatation. Histologic findings in the lungs included recanalized, old thrombi and evidence of pulmonary hypertension.

A review of displaced olecranon fractures treated conservatively.

Twenty-two patients with a total of 23 fractures of the olecranon were reviewed after an average period of 26 months (range 5-96 months). All fractures were either comminuted, transverse or oblique fractures with separation of the fragments and all were treated without operation by early active mobilization within 10 days of fracture. Results compare favourably with cases treated by operation.

The isoelastic, noncemented total hip arthroplasty. Preliminary experience with 400 cases.

The first 400 patients having cementless isoelastic total hip arthroplasties with a polyacetyl femoral component stem were assessed by independent observers with a minimum review time of two years. Six percent of the patients had died at the time of review; these were mainly elderly patients with subcapital fractures. Ninety-seven percent of the surviving patients appeared for a complete clinical and radiological review.

Long-term follow-up evaluation of screw-and-graft fusion of the lumbar spine.

The long-term results of 134 screw-and-graft fusions of the lumbar spine for treatment of chronic low-back pain with or without acute sciatic nerve symptoms were observed for over 16 years. Clinically, the results were excellent or good in 80% of patients at a mean review interval of nine years. There were no differences in success rates between single-level L4/5 and lumbosacral fusion or two-level fusions.

Long-term review of ring total hip arthroplasty.

In a five- to 12-year follow-up survey of 179 sequential cementless Ring metal-on-metal total hip arthroplasties, 55 (31%) of the patients were found to have died as a result of nonorthopedic conditions. Analysis of the records demonstrated that 20% of these patients had had poor results attributable to pain. Of the remaining 124 patients, 116 (94%) attended for full clinical and radiologic review yielding a total of 154 hips.

Primary subacute epiphyseal osteomyelitis: a report of three cases.

Three patients with primary subacute epiphyseal osteomyelitis are reviewed. All had a history of minor trauma and complained of pain and limp; none was systemically ill. Plain radiographs demonstrated a well-defined lytic lesion in the epiphysis.

A simple method of arthrodesis of the first metatarsophalangeal joint.

Eighty-seven feet have been reviewed after arthrodesis of the first metatarsophalangeal joint stabilised by chromic catgut. Radiological union was present in 90% of patients at the mean review time of six years. Twenty-four patients had significant metatarsalgia before operation and only two failed to improve afterwards.

Subtrochanteric fracture after Garden screw fixation: a review of predisposing factors and management in nine cases.

Nine cases of subtrochanteric fracture are reviewed following 300 fixations of subcapital fractures with Garden screws. In six cases technical operative errors were considered to contribute to the fracture. It is stressed that adequate reduction and suitably placed crossed Garden screws are demanding requirements and that every attempt should be made to avoid making extra holes with guidewires.