Motocross-associated head and spine injuries in adult patients evaluated in an emergency department.

Background: Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.

Objectives: To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).

Methods: We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015.

Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients.

The objective was to examine the impact of a multipayer patient-centered medical home (PCMH) on health care utilization for behavioral health patients seen at a tertiary care emergency department (ED). A retrospective health records review was performed for PCMH and non-PCMH patients who presented and received a psychiatric consultation during a 2-year period in the ED of the Mayo Clinic Hospital in Rochester, Minnesota. Univariable and multivariable associations with the outcomes of admission and return visits within 72 hours were evaluated using logistic regression models and summarized with odds ratios (ORs) and 95% confidence intervals (CIs).

Does Administration of Oral Versus Intravenous Antibiotics for Third Molar Removal Have an Effect on the Incidence of Alveolar Osteitis or Postoperative Surgical Site Infections?

Purpose: To compare the incidence of postoperative alveolar osteitis (AO) and surgical site infections (SSIs) in 2 separate cohorts of patients undergoing elective third molar removal: those who received postoperative oral (PO) antibiotics and those who received perioperative intravenous (IV) antibiotics.

Materials And Methods: A retrospective cohort study of all patients 14 to 30 years old undergoing elective outpatient third molar removal under a single surgeon's service over a 12-year period was completed. Patients undergoing third molar removal during the first 72 months received postoperative PO antibiotics alone.

Are We Using the Best Tumor Size Cut-points for Renal Cell Carcinoma Staging?

Objective: To compare the predictive ability for oncologic outcomes among current tumor size cut-points and clinically relevant alternatives to determine which are optimal.

Methods: Patients who underwent radical or partial nephrectomy between 1970 and 2010 for T1-2Nx/N0M0 renal cell carcinoma (RCC) were identified. Associations between tumor size and progression-free survival (PFS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses and Cox models.

Experimental and mathematical analysis of cAMP nanodomains.

In their role as second messengers, cyclic nucleotides such as cAMP have a variety of intracellular effects. These complex tasks demand a highly organized orchestration of spatially and temporally confined cAMP action which should be best achieved by compartmentalization of the latter. A great body of evidence suggests that cAMP compartments may be established and maintained by cAMP degrading enzymes, e.

PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool.

Background: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning.

Severity of Preoperative Proteinuria is a Risk Factor for Overall Mortality in Patients Undergoing Nephrectomy.

Purpose: Chronic kidney disease may adversely affect survival following nephrectomy. Proteinuria is increasingly used as a marker of kidney disease. However, the relationship between preoperative proteinuria and survival after nephrectomy remains incompletely characterized.

Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery.

Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center.

Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children.

Introduction: The recent increase in multidrug-resistant (MDR) Escherichia coli infections is not well described in children. We determined the risk factors and outcomes of extraintestinal E. coli infections in children in our region.

Effect of spinal needle characteristics on measurement of spinal canal opening pressure.

Objective: A wide variety of spinal needles are used in clinical practice. Little is currently known regarding the impact of needle length, gauge, and tip type on the needle's ability to measure spinal canal opening pressure. This study aimed to investigate the relationship between these factors and the opening-pressure measurement or time to obtain an opening pressure.

Surgical Treatment and Outcomes of Patients With Extramammary Paget Disease: A Cohort Study.

Background: Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma occurring mainly in the anogenital region. Traditional management with wide local excision has shown high recurrence rates, thus Mohs micrographic surgery (MMS) has emerged as a promising treatment option.

Objective: To compare long-term outcomes after treatment with MMS or excision for primary EMPD.

Renal Cell Carcinoma with Isolated Lymph Node Involvement: Long-term Natural History and Predictors of Oncologic Outcomes Following Surgical Resection.

Background: Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement has historically been associated with poor prognosis. However, a subset of patients may experience long-term survival.

Objective: To examine the natural history of RCC with isolated LN involvement following surgical resection with long-term follow-up, and to evaluate clinicopathologic features associated with disease progression and survival.

Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department.

Background: Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.

Objectives: Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).

Rate of recurrent anaphylaxis and associated risk factors among Olmsted County, Minnesota, residents: A population-based study.

Background: The rate and risk factors for recurrence of anaphylaxis are not well known.

Objective: To measure the rate and risk factors for recurrent anaphylaxis in a population-based cohort in Olmsted County, Minnesota.

Methods: We conducted a population-based cohort study using the Rochester Epidemiology Project, a comprehensive medical records linkage system, to obtain records of patients who presented to medical centers within the Olmsted County area with anaphylaxis from January 1, 2001, through December 31, 2010.

Patient factors associated with 30-day complications after partial nephrectomy: A contemporary update.

Introduction: Patient-level factors associated with perioperative complications after partial nephrectomy (PN) have not been well described in a contemporary series.

Methods: Single-institution retrospective study evaluating patients undergoing open, laparoscopic, and robotic PN between 2001 and 2012. Univariable and multivariable logistic regression models were evaluated to assess factors associated with complications within 30 days of surgery.

Oral Progestogens Versus Levonorgestrel-Releasing Intrauterine System for Treatment of Endometrial Intraepithelial Neoplasia.

Background: Limited therapeutic guidelines exist regarding medical therapy, ideal dosing, duration of therapy, or recommendations for timing of endometrial reassessment for women with endometrial intraepithelial neoplasia (EIN) who desire fertility preservation or who are not optimal surgical candidates. We aimed to determine the effectiveness of oral progestogens (OP) versus the levonorgestrel-releasing intrauterine system (LNG IUS) in the medical treatment of EIN.

Methods: We retrospectively identified women with EIN at our institution from 2007 through 2014 and compared the outcomes of those treated with OP versus LNG IUS.

Impact of scribes on emergency department patient throughput one year after implementation.

Objectives: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation.

Methods: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity.

Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity.

Introduction: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation-may lead to more external transfers to find care.

Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014.

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions.

Introduction: Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) healthcare providers regarding two methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery.

Methods: This observational study adhered to survey reporting guidelines.

Use of the term "rule out" in requisition forms may cause diagnostic delays in dermatopathology practice.

Background: Timely pathologic diagnosis relies on the communication of specific clinical information in the requisition form (RF). Clinical information may use nonspecific terms such as "rule out", the use of which may result in diagnostic delays and the unnecessary application of pathology stains and sections.

Objective: This study was designed to evaluate the relationship between use of the term "rule out" and time to diagnosis, and the use of additional pathology stains and sections in integrated and non-integrated dermatopathology practices.

Urinary collecting system invasion is associated with poor survival in patients with clear-cell renal cell carcinoma.

Objectives: To evaluate the prognostic significance of urinary collecting system invasion (UCSI) in a large series of patients with clear-cell renal cell carcinoma (RCC).

Materials And Methods: Patients with clear-cell RCC treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urological pathologist re-reviewed all slides.

Radiographic size of retroperitoneal lymph nodes predicts pathological nodal involvement for patients with renal cell carcinoma: development of a risk prediction model.

Objectives: To evaluate the ability of clinical and radiographic features to predict lymph node (pN1) disease among patients with renal cell carcinoma undergoing radical nephrectomy (RN), and to develop a preoperative risk prediction model.

Patients And Methods: In all, 220 patients with preoperative computed tomography scans available for review underwent RN with lymph node dissection (LND) from 2000 to 2010. Radiographic features were assessed by one genitourinary radiologist blinded to pN status.

Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology.

Background: Teledermatopathology has evolved from static images to whole slide imaging (WSI), which allows for remote viewing and manipulation of tissue sections. Previous studies of WSI in teledermatopathology predated College of American Pathologists (CAP) telepathology validation guidelines.

Objective: We conducted a comprehensive retrospective WSI validation study of routine dermatopathology cases, adhering to CAP guidelines.

Emergency Department Presentation of Patients with Spontaneous Coronary Artery Dissection.

Background: Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present.

Objectives: We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers' awareness and recognition of this condition.