Perceptions and Behaviors of Nurses and Physicians During Bedside Rounds in Medical-Surgical Units.

Background: Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction.

Objectives: To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center.

Methods: A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds.

Exercise-induced venous thrombosis of the upper extremity: A case report.

Paget-Schroetter syndrome, the venous variant of thoracic outlet syndrome, is an uncommon presentation of deep vein thrombosis. In patients with Paget-Schroetter syndrome, the subclavian vein is compressed within the thoracic outlet as a result of repetitive and vigorous arm motions. Repeated endothelial injury leads to stasis in flow and eventual thrombus formation in the subclavian vein and its tributaries.

Implementation and Evaluation of a Pilot Narrative Medicine Curriculum for Internal Medicine Residents.

Background Narrative medicine has been integrated into medical training to enhance competencies such as observation, reflection, and self-care. However, few studies have assessed the impact of a single narrative medicine session using a pre- and post-test study design. The authors of this study sought to implement a pilot narrative medicine curriculum into a large internal medicine residency program and to evaluate its feasibility and impact.

Near-Peer Supervision in Primary Care: Bringing Teaching Teams From the Wards to the Clinic.

Background: Teaching near-peers yields numerous benefits to residents. Opportunities for near-peer teaching are typically restricted to hospital settings. Little is known about the educational potential of outpatient near-peer teaching.

Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds.

Background: Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures.

Objective: This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication.

Rare malignant glomus tumor of the esophagus with pulmonary metastasis: a case report.

Background: Glomus tumors are typically benign soft tissue neoplasms that arise in peripheral cutaneous structures. Visceral organ involvement is exceedingly rare.

Case Description: Here we present a case of malignant glomus tumor of the esophagus with pulmonary metastases in a 57-year-old woman presenting with three weeks of progressive dysphagia, epigastric pain, and 35-pound weight loss.

Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic 'nudges' into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery.

Introduction: Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care.

Lessons From the Development and Implementation of a Palliative Care Elective for Fourth-Year Medical Students: A Pilot Study.

Background: Although palliative care is recognized as an important component of medical school curricula, the content and structure of education in the field is variable and often lacks outpatient exposure. We aimed to develop and implement a palliative care clinical elective for fourth-year medical students incorporating both inpatient and outpatient learning.

Methods: Fourteen medical students participated in a palliative care elective which included 2 weeks on an inpatient consult service and 1 week of outpatient clinic and home hospice visits.

A case of bacteremia complicated by reactive arthritis.

Reactive arthritis has been described infrequently in association with staphylococcal infections, both those secondary to and coagulase-negative staphylococci. We present a case of a 51-year-old male undergoing chemotherapy for pancreatic cancer who presented with joint pain and fevers and was found to have bacteremia. Transthoracic and transesophageal echocardiograms were negative for endocarditis.

Use of Phenobarbital in Delirium Tremens.

The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors.

Preprocedural white blood cell count as a predictor of death and major adverse cardiac events in patients undergoing percutaneous coronary intervention with drug-eluting stents.

Background: Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES).

Methods: Our retrospective study includes 878 consecutive patients who underwent both elective and emergent PCI with DES at the UCLA Medical Center.

Impact of diabetes and acute coronary syndrome on survival in patients treated with drug-eluting stents.

Background: Diabetics who undergo percutaneous coronary intervention (PCI) are at increased risk for death, myocardial infarction, repeat revascularization, and stent thrombosis.

Methods: Our retrospective study includes 887 consecutive patients who underwent PCI with drug-eluting stents (DES) at UCLA Medical Center. The cohort was divided into four groups: group 1, no diabetes and no acute coronary syndrome (ACS); group 2, no diabetes and ACS; group 3, diabetes and no ACS; group 4, diabetes and ACS.

The role of extracorporeal membrane oxygenation in emergent percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock and cardiac arrest.

Patients with myocardial infarction (MI) who have out-of-hospital cardiac arrest and cardiogenic shock have a high mortality rate. Although intra-aortic balloon counterpulsation is frequently used in patients with cardiogenic shock, it does not provide complete hemodynamic support. We report 2 cases in which extracorporeal membrane oxygenation was instituted emergently in the cardiac catheterization laboratory in patients with MI and cardiac arrest who underwent percutaneous coronary intervention and who were hemodynamically unstable despite inotropic agents and intraaortic balloon counterpulsation.

Clinical presentation of patients with in-stent restenosis in the drug-eluting stent era.

Background: Drug-eluting stents (DES) represent a significant improvement in the treatment of coronary artery disease as they decrease restenosis rates by approximately 50% compared with bare-metal stents. In-stent restenosis (ISR) is perceived to be a benign phenomenon because it is a gradual process and may lead to angina pectoris. With bare-metal stents, ISR has been associated with myocardial infarction in approximately 10% to 15% of cases.

Outcomes of nonagenarians who undergo percutaneous coronary intervention with drug-eluting stents.

Background: Age is an important predictor of mortality after percutaneous coronary intervention (PCI). The safety and efficacy of PCI with drug-eluting stents (DES) in nonagenarians have not been extensively studied.

Methods: A retrospective analysis of 889 consecutive patients identified 28 (3.

Expression, purification, and characterization of Bacillus subtilis cytochromes P450 CYP102A2 and CYP102A3: flavocytochrome homologues of P450 BM3 from Bacillus megaterium.

The cyp102A2 and cyp102A3 genes encoding the two Bacillus subtilis homologues (CYP102A2 and CYP102A3) of flavocytochrome P450 BM3 (CYP102A1) from Bacillus megaterium have been cloned, expressed in Escherichia coli, purified, and characterized spectroscopically and enzymologically. Both enzymes contain heme, flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN) cofactors and bind a variety of fatty acid molecules, as demonstrated by conversion of the low-spin resting form of the heme iron to the high-spin form induced by substrate-binding. CYP102A2 and CYP102A3 catalyze the fatty acid-dependent oxidation of reduced nicotinamide adenine dinucleotide phosphate (NADPH) and reduction of artificial electron acceptors at high rates.