Initial US tertiary health care system experience using caplacizumab in patients with immune thrombotic thrombocytopenic purpura.

Several international registries have reported on the efficacy of caplacizumab for the treatment of immune thrombotic thrombocytopenic purpura (iTTP). Similar real-world data from the United States (US) are limited. In this single center retrospective study, we sought to describe caplacizumab prescribing patterns and review clinical outcomes for US patients with iTTP.

Trainee-initiated dictations of endocrine surgeries: Implications for education and reimbursement.

Introduction: Our university-based surgery department recently transitioned to attending-only authorship of operative reports. We performed a mixed-methods investigation to determine if trainee-initiated endocrine surgical reports were associated with under-coding of specific procedures.

Methods: Endocrine operations performed from July 2020 to June 2022 were identified from billing data.

Predominant approaches to measuring pregnancy-related anxiety in Sub-saharan Africa: a scoping review.

Background: Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregnancy-related anxiety in LMICs have utilized scales developed in high-income countries, despite significant variations in pregnancy-related anxiety due to socioeconomic and cultural contexts. This review surveyed existing literature in order to identify which scales have been used to measure pregnancy-related anxiety in SSA.

Multi-institutional study examining intraoperative entrustment and resident sex.

Introduction: Single-site studies have found variable associations between gender and entrustment-based interactions during surgical residency. We sought to assess the relationship between resident sex and intraoperative entrustment at multiple institutions.

Methods: Surgical cases were observed at four university-based training programs.

Decreasing Utilization of Vaginal Hysterectomy in the United States: An Analysis by Candidacy for Vaginal Approach.

Introduction And Hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach.

Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion.

Firearm violence and associated factors among young adults presenting to emergency departments in three cities: Baseline results from Project SPARK.

Objective: Recent shifts in U.S. violence dynamics call for updated violence epidemiology among general emergency department (ED) samples of young adults.

Health effects and user perceptions of the US Customs and Border Patrol One™ mobile application: A qualitative analysis among asylum seekers at the Mexico-US border.

Background: The number of migrants at the Mexico-US border has increased to historic levels, and frequently changing immigration policy impacts this population as they await entry into the US. This study evaluated the usability and health effects of the Customs and Border Protection (CBP) One™ mobile application among asylum seekers near the US port of entry in Reynosa, Mexico.

Methods: We conducted semi-structured qualitative interviews with 20 asylum seekers in Reynosa, Mexico, in February 2023.

Health Policy Implications of Digital Replantation.

There have been dwindling numbers of replantations in the United States. Despite the advocacy for centralization in hand trauma, the fundamental landscape and attitudes of surgeons toward replantation have remained lackluster. There is growing and substantial evidence to demonstrate the superior outcomes of replantation in comparison to revision amputation in most scenarios.

Safe Ketamine Use and Pregnancy: A Nationwide Survey and Retrospective Review of Informed Consent, Counseling, and Testing Practices.

Ketamine is contraindicated in pregnancy given the lack of knowledge about potential effects on a developing fetus. This study aimed to characterize current clinical practices specific to pregnancy and reproduction related to the use of ketamine for the treatment of psychiatric illness. Online surveys were sent to outpatient ketamine clinics across the United States inquiring about practices related to pregnancy.

Variation in surgical approach and postoperative complication among older adults undergoing ventral hernia repair.

Background: Surgical decision-making for preference-sensitive operations among older adults is understudied. Ventral hernia repair (VHR) is one operation where granular data are limited to guide preoperative decision-making. We aimed to determine risk for VHR in older adults given clinically nuanced data including surgical and hernia characteristics.

Antibiotic use and class absenteeism in children with influenza-like-illness in an emergency department.

Background: Children with influenza-like-illness (ILI) often require clinician clearance or antibiotics to return to child care or school. Study objectives were to examine the association between antibiotic receipt during an Emergency Department (ED) visit for ILI and the outcomes of class absenteeism and illness duration.

Methods: A secondary analysis of 251 children aged 2 months to 12 years with uncomplicated ILI discharged from the ED from December 1, 2018 to November 30, 2019 was conducted.

Racial and Ethnic Disparities in Outcomes After the Development of Ascites: A National Cohort Study.

Introduction: Ascites, a severe complication of cirrhosis, significantly impacts patient morbidity and mortality especially in Black patients. Access to disease optimizing care has been proposed as a potential driver of this disparity. In this study, we evaluate TIPS utilization across racial and ethnic groups.

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.

Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established.

Risk factors for readmission after sepsis and its association with mortality.

Background: Sepsis is associated with an approximately 20 % 30-day readmission rate and with subsequent mortality.

Objectives: To determine the demographics, comorbidities that had been documented prior to sepsis onset, processes of care, commonly administered laboratory tests measured near discharge, and post-sepsis infections that may be associated with readmission and, secondarily, whether readmission is an independent risk factor for 90-day mortality.

Methods: Using a database of patients who met Sepsis-3 criteria divided into Construction and Validation groups, we used logistic regression to estimate the factors independently associated with readmission within 30 days after discharge and proportional hazard regression to estimate the factors independently associated with 90-day mortality.

Longitudinal changes in the US emergency department use of advanced neuroimaging in the mechanical thrombectomy era.

Purpose: To describe ED neuroimaging trends across the time-period spanning the early adoption of endovascular therapy for acute stroke (2013-2018).

Materials And Methods: We performed a retrospective, cross-sectional study of ED visits using the 2013-2018 National Emergency Department Sample, a 20% sample of ED encounters in the United States. Neuroimaging use was determined by Common Procedural Terminology (CPT) code for non-contrast head CT (NCCT), CT angiography head (CTA), CT perfusion (CTP), and MRI brain (MRI) in non-admitted ED patients.

Improving Quality of Care for Status Epilepticus: Putting Protocols into Practice.

Purpose Of Review: Timely treatment of status epilepticus (SE) improves outcomes, however gaps between recommended and implemented care are common. This review analyzes obstacles and explores interventions to optimize effective, evidence-based treatment of SE.

Recent Findings: Seizure action plans, rescue medications, and noninvasive wearables with seizure detection capabilities can facilitate early intervention for prolonged seizures in the home and school.

Skeletal Muscle Complex Between the Vagina and Anal Canal: Implications for Perineal Laceration.

Introduction And Hypothesis: The anatomy of the skeletal muscles located between the vagina and anus is important during complex obstetric laceration reconstructions. We aimed to clarify the composition of skeletal muscles located between the vagina and anal canal and their three-dimensional configuration relevant to perineum repair.

Methods: This observational study involved ten female cadavers.

Pathogenesis, Diagnosis, and Management of Chronic Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to occur as a sequelae of thromboembolic processes in the pulmonary vasculature. The pathophysiology of CTEPH is multifactorial, including impaired fibrinolysis, endothelial dysregulation, and hypoxic adaptations. The diagnosis of CTEPH is typically delayed considering the nonspecific nature of the symptoms, lack of screening, and relatively low incidence.

Data-driven mathematical modeling of sleep consolidation in early childhood.

Across early childhood development, sleep behavior transitions from a biphasic pattern (a daytime nap and nighttime sleep) to a monophasic pattern (only nighttime sleep). The transition to consolidated nighttime sleep, which occurs in most children between 2- and 5-years-old, is a major developmental milestone and reflects interactions between the developing homeostatic sleep drive and circadian system. Using a physiologically-based mathematical model of the sleep-wake regulatory network constrained by observational and experimental data from preschool-aged participants, we analyze how developmentally-mediated changes in the homeostatic sleep drive may contribute to the transition from napping to non-napping sleep patterns.