The Elements of Style for Interruptive Electronic Health Record Alerts.

Background: The proliferation of electronic health record (EHR) alerts has led to widespread alert fatigue and clinician burnout, undermining the effectiveness of clinical decision support and compromising patient safety.

Objective: We introduce a comprehensive style guide for designing interruptive alerts (IAs) in EHR systems to improve clinician engagement and reduce alert fatigue that has been approved by our institutional alert governance committees. This style guide addresses critical aspects of IAs, including format, typography, color-coding, title brevity, patient identification, and introductory text.

Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation.

Background: Representation trends of women, older adults, and ethnic/racial minorities in randomized controlled trials (RCTs) of atrial fibrillation (AF) are uncertain.

Methods: We systematically reviewed 134 AF related RCTs (phase II and III) encompassing 149,162 participants using Medline and ClinicalTrials.gov through April 2019 to determine representation trends of women, older patients (≥75 years), and ethnic/racial minorities.

Bilateral Primary Marginal Zone Lymphoma of the Breast - A Rare Breast Malignancy.

Extranodal marginal zone lymphoma (EMZL) presents only rarely within the breast, although the incidence of breast EMZL has increased in the past decade for unclear reasons. Due to its rarity, the etiology, course, and treatment response of this cancer are less studied. Case Report: We present the case of a 64-year-old female who had bilateral diffuse irregularity in a trabecular pattern on screening mammogram.

Thrombus or vegetation: A mystery causing ST elevation myocardial infarction with infective endocarditis of mechanical aortic valve.

Acute myocardial infarction (MI) in the setting of infective endocarditis (IE) of mechanical cardiac valve is a rare phenomenon. The most challenging aspect is the recognition between septic embolus versus thromboembolism from prosthesis in the setting of sub-therapeutic INR especially when the coronary vasculature is normal and etiology is not clear. We are presenting a case of 56-year-old patient who developed ST elevation MI during treatment of IE of mechanical aortic valve.

Refractory gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms, esophageal injury, and/or complications. Use of proton pump inhibitors (PPI) remains the standard therapy for GERD and is effective in most patients. Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered, according to individual patient characteristics.

Endoscopic treatments for dysplastic Barrett's esophagus: resection, ablation, what else?

Background: Endoscopic eradication therapy for dysplastic Barrett's esophagus (BE) comprises resection and mucosal ablation techniques. Over the years, these techniques have been tried with success, not only for dysplastic Barrett's epithelium but also for non-dysplastic Barrett's epithelium and early adenocarcinoma. Endoscopic resection is usually carried out for visible lesions, either as endoscopic mucosal resection (EMR), which is practiced widely in Western countries, or as endoscopic submucosal dissection, which is more popular in Japan and throughout Asia.