Laboratorian Interpretation of Drug Testing Results in Pain Management: Lessons From College of American Pathologists Proficiency Testing.

Context.—: Accurate interpretation of drug test results is key to appropriate patient care in numerous settings, including pain management. Despite recommendations that providers should consult laboratory professionals for guidance when necessary, literature demonstrating laboratorian expertise in drug test interpretation is lacking.

ULTRA-WIDEFIELD IMAGING DETECTION RATE IN IDENTIFYING PERIPHERAL RETINAL TEARS IN SINGLE VERSUS MONTAGE OF PERIPHERAL STEERING.

Purpose: To compare the detection rate of orthogonal, directed peripheral steering, and automontaged images with ultra-widefield imaging and the factors influencing the ability to identify retinal breaks.

Design: Retrospective cohort study.

Methods: Three hundred and seventy-six treatment-naive eyes (349 patients) that underwent laser retinopexy for retinal breaks between 2015 and 2021 were included.

Increasing the Robustness of SIFT-MS Volatilome Fingerprinting by Introducing Notional Analyte Concentrations.

Selected ion flow tube-mass spectrometry (SIFT-MS) is an analytical technique for volatile detection and quantification. SIFT-MS can be applied in a "white box" approach, measuring concentrations of target compounds, or as a "black box" fingerprinting technique, scanning all product ions during a full scan. Combining SIFT-MS full scan data acquired from multibatches or large-scale experiments remains problematic due to signal fluctuation over time.

Nicotine and Tobacco Alkaloid Testing and Challenges: Lessons Learned From a College of American Pathologists Proficiency Testing Survey.

Context.—: Consequences related to nicotine (NIC) use remain a major health concern, leading to demand for testing to detect NIC, metabolites such as cotinine (COT), and related tobacco alkaloids, including anabasine (ANAB). NIC-related testing is not standardized among laboratories, nor are there clinical or regulatory guidelines to inform decisions such as appropriate screening cutoffs or limits of quantitation.

Service contracting as a policy response for public transport recovery during the Covid-19 Pandemic: A preliminary evaluation.

We examine and assess the service contracting (SC) program implemented for the first time in Metro Manila, Philippines as a response to the impact of the pandemic on road-based public transport sector. We develop an evaluation framework, consisting of three indicators: social amelioration, increase in transport supply and performance improvement. These indicators are the purported objectives of SC.

Medical Management of Pyometra in the Delayed Postoperative Period.

Pyometra is a rare condition in which purulent material becomes entrapped within the uterine cavity. If unrecognized in a timely fashion, life-threatening complications can arise. The following is a case report of a 50-year-old female who presented to the emergency department with abdominal pain and heavy vaginal bleeding.

Therapeutic Drug Monitoring of Second- and Third-Generation Antiepileptic Drugs.

Context.—: Therapeutic drug monitoring has traditionally been widely used for first-generation antiepileptic drugs (AEDs) such as carbamazepine and phenytoin. The last 2 decades have seen the introduction of second- and third-generation AEDs (eg, lamotrigine, levetiracetam, and topiramate) into clinical practice.

Ethanol Biomarker Testing and Challenges.

Context.—: Clinical and forensic testing for ethanol biomarkers, including ethyl glucuronide (EtG) and ethyl sulfate (EtS), is used to discern alcohol use from abstinence. These markers can be key in major decisions, including transplant eligibility or retaining licensure after alcohol misuse.

Risk of Urinary Tract Infection Symptoms after Posthysterectomy Cystoscopy with 50% Dextrose as Compared with Saline Cystoscopy with Indigo Carmine.

Study Objective: Compare odds of postoperative urinary symptoms in women who had cystoscopy after benign laparoscopic hysterectomy with 50% dextrose and with normal saline solution with intravenous indigo carmine.

Design: Retrospective cohort study.

Setting: Two tertiary care centers.

Intra-Articular Laser Treatment Plus Platelet Rich Plasma (PRP) Significantly Reduces Pain in Many Patients Who Had Failed Prior PRP Treatment.

In our practice, Platelet Rich Plasma (PRP) injections effectively reduce pain in most, but not all, arthritic patients. When PRP treatment fails, joint replacement surgery is often the only good alternative. Surface Low-Level-Laser-Therapy (LLLT) has not been helpful for osteoarthrosis in our experience.

Interpretation and Utility of Drug of Abuse Screening Immunoassays: Insights From Laboratory Drug Testing Proficiency Surveys.

Context.—: Urine drug testing is frequently ordered by health care providers. Immunoassays are widely used for drug testing, yet have potential limitations, including variable cross-reactivity.

Adolescent providers' knowledge of human papillomavirus vaccination age guidelines in five countries.

: To examine provider knowledge of HPV vaccination age guidelines in five countries. : A total of 151 providers of adolescent vaccinations in Argentina, Malaysia, South Africa, South Korea, and Spain were interviewed between October 2013 and April 2014. Univariate analyses compared providers' understanding of recommended age groups for HPV vaccination to that of each country's national guidelines.

Opioid Adjuncts: Optimizing Opioid Therapy With Nonopioid Medications.

In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids.

Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy.

Background: Although uterine size has been a previously cited barrier to minimally invasive hysterectomy, experienced gynecologic surgeons have been able to demonstrate that laparoscopic and vaginal hysterectomy is feasible with increasingly large uteri. By demonstrating that minimally invasive hysterectomy continues to have superior outcomes even with increased uterine weights, opportunity exists to meaningfully decrease morbidity, mortality, and cost associated with abdominal hysterectomy.

Objective: We sought to determine if there is an association between uterine weight and posthysterectomy complications and if differences in that association exist across vaginal, laparoscopic, and abdominal approaches.

Minimally invasive gynecologic surgery in the pregnant patient: considerations, techniques, and postoperative management per trimester.

Purpose Of Review: Nonobstetric surgery is performed in 1 : 200 to 1 : 500 of pregnant women in the United States annually. Previously, many argued that laparoscopy was contraindicated during pregnancy because of concerns for uterine injury and fetal malperfusion. Because surgeons have gained more experience with laparoscopy, it has become the preferred treatment modality for many surgical diseases in the gravid patient.

St. Luke's Medical Center Global City--Global Trigger Tool (GTT) Project.

The Global Trigger Tool (GTT) was developed by the Institute of Healthcare Improvement (IHI), to identify and measure the rate of adverse events over time in a healthcare facility. It is a sampling methodology that utilizes "triggers" in the detection of random adverse events and harms and it also measures the adverse events overtime. The Quality and Patient Safety Group of St.

Loop electrosurgical excision procedure: an effective, inexpensive, and durable teaching model.

The effectiveness of simulation training for enhancing operative skills is well established. Here we describe the construction of a simple, low-cost model for teaching the loop electrosurgical excision procedure. Composed of common materials such as polyvinyl chloride pipe and sausages, the simulation model, shown in the accompanying figure, can be easily reproduced by other training programs.

High grade primitive neuroectodermal tumor of the uterus: A case report.

•Primitive neuroectodermal tumor of the uterus is extremely rare.•Diagnosis requires timely evaluation with molecular analysis.•Different combinations of adjuvant chemotherapy have been reported.

Interpretation and utility of drug of abuse immunoassays: lessons from laboratory drug testing surveys.

Context: To assist with patient diagnosis and management, physicians from pain services, drug treatment programs, and the emergency department frequently request that urine be tested for drugs of abuse. However, urine immunoassays for drugs of abuse have limitations.

Objective: To use data from the College of American Pathologists Proficiency Testing Surveys to determine and summarize the characteristics, performance, and limitations of urine immunoassays for drugs of abuse.

Human pregnancy specific beta-1-glycoprotein 1 (PSG1) has a potential role in placental vascular morphogenesis.

Previous studies suggest that human pregnancy specific beta-1-glycoproteins (PSGs) play immunomodulatory roles during pregnancy; however, other possible functions of PSGs have yet to be explored. We have observed that PSGs induce transforming growth factor beta 1 (TGFB1), which among its other diverse functions inhibits T-cell function and has proangiogenic properties. The present study investigates a potential role for PSG1, the most abundant PSG in maternal serum, as a possible inducer of proangiogenic growth factors known to play an important role in establishment of the vasculature at the maternal-fetal interface.

Visual pigments of marine carnivores: pinnipeds, polar bear, and sea otter.

Rod and cone visual pigments of 11 marine carnivores were evaluated. Rod, middle/long-wavelength sensitive (M/L) cone, and short-wavelength sensitive (S) cone opsin (if present) sequences were obtained from retinal mRNA. Spectral sensitivity was inferred through evaluation of known spectral tuning residues.

Genetic evidence for the ancestral loss of short-wavelength-sensitive cone pigments in mysticete and odontocete cetaceans.

All mammals ancestrally possessed two types of cone pigments, an arrangement that persists in nearly all contemporary species. However, the absence of one of these cone types, the short-wavelength-sensitive (SWS) cone, has recently been established in several delphinoid cetacean species, indicating that the loss of this pigment type may be widespread among cetaceans. To evaluate the functional condition of SWS cones in cetaceans, partial SWS cone-opsin gene sequences were obtained from nuclear DNA for 16 species representing 12 out of the 14 extant mysticete (baleen) and odontocete (toothed) families.

Phylogeography, intraspecific structure and sex-biased dispersal of Dall's porpoise, Phocoenoides dalli, revealed by mitochondrial and microsatellite DNA analyses.

Mitochondrial DNA (mtDNA) control-region sequences and microsatellite loci length polymorphisms were used to estimate phylogeographical patterns (historical patterns underlying contemporary distribution), intraspecific population structure and gender-biased dispersal of Phocoenoides dalli dalli across its entire range. One-hundred and thirteen animals from several geographical strata were sequenced over 379 bp of mtDNA, resulting in 58 mtDNA haplotypes. Analysis using F(ST) values (based on haplotype frequencies) and phi(ST) values (based on frequencies and genetic distances between haplotypes) yielded statistically significant separation (bootstrap values P < 0.

First policy then science: why a management unit based solely on genetic criteria cannot work.

In contrast to the goals of the symposium from which this series of papers originated, we argue that attempts to apply unambiguously defined and general management unit criteria based solely on genetic parameters can easily lead to incorrect management decisions. We maintain that conservation genetics is best served by altering the perspective of data analysis so that decision making is optimally facilitated. To do so requires accounting for policy objectives early in the design and execution of the science.

Neuroglycopenic and other symptoms in patients with insulinomas.

Purpose: To characterize neuroglycopenic symptoms in the clinical presentation of patients with insulinomas.

Subjects And Methods: Patients with histologically confirmed islet cell adenomas or carcinomas were identified at a single institution. Patient symptoms and clinical features of the insulinomas were obtained by retrospective medical record review with special attention to neuroglycopenic and autonomic symptoms.