Sex and Racial Differences in High-Density Lipoprotein Levels in Acute Coronary Syndromes.

Background: This study aimed to assess sex and racial differences related to high-density lipoprotein cholesterol (HDL-C) levels in those presenting with acute coronary syndromes (ACS).

Methods: Records from patients with ACS presenting to the Emergency Department of University of Florida Hospital Jacksonville from 2009 to 2012, were reviewed. Detailed medical history was obtained.

Comparison of Weight-Based Dosing versus Fixed Dosing of 23.4% Hypertonic Saline for Intracranial Pressure Reduction in Patients with Severe Traumatic Brain Injury.

Context: Hypertonic saline (HTS) is a pharmacologic therapy used in patients with severe traumatic brain injuries to decrease intracranial pressure (ICP) associated with cerebral edema.

Aims: The purpose of this study was to compare ICP reduction between fixed doses of 23.4% HTS and weight-based doses.

Opioid Overdose Risk in Patients Returning to the Emergency Department for Pain.

Objective: Using the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) in patients returning to the emergency department (ED) for pain and discharged with an opioid prescription, we assessed overall opioid overdose risk and compared risk in opioid naive patients to those who are non-opioid naive.

Design: This was a secondary analysis from a prospective observational study of patients ≥ 18 years old returning to the ED within 30 days. Data were collected from patient interviews and chart reviews.

Effect of atorvastatin on lipogenic, inflammatory and thrombogenic markers in women with the metabolic syndrome.

Background And Aim: Specific drug therapy to target the underlying proinflammatory and prothrombotic state in patients with metabolic syndrome (MS) is lacking. We sought to study the effect of high-intensity atorvastatin on markers of lipogenesis, inflammation and thrombogenesis, in women with MS in the absence of cardiovascular disease or diabetes.

Methods And Results: This randomized double-blinded controlled trial included 88 women with MS (according to National Cholesterol Education Panel Adult Treatment Panel III criteria) and low atherosclerotic cardiovascular risk.

Effectiveness of preventive onabotulinumtoxin A injections for migraine headaches is dependent on the circadian time of administration.

We have previously shown that quarterly preventive onabotulinumtoxin A (BTA) injections administered to diurnally active patients for chronic migraines (CM) associate with increased discomfort when performed in the morning. The purpose of this study was to further examine if the effectiveness of preventive BTA injections depends on the procedure's circadian timing. A total of 90 diurnally active patients with a medical history of CM and undergoing BTA injection therapy were enrolled in the study.

Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults.

Objective: The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center.

Effect of circadian rhythm on the pain associated with preventive onabotulinumtoxinA injections for migraines.

The aim of our research was to assess if the pain and discomfort following each quarterly onabotulinumtoxinA (BTA) injection given to prevent daily headaches/migraines is circadian time-dependent so as to determine the best administration time for least discomfort and minimal follow-up pain. A total of 61 diurnally active patients with a medical history of chronic migraine headaches and undergoing preventative BTA injection therapy for the first time were enrolled in the study. Patients were randomly assigned to morning or afternoon clinics, but had the ability to choose within the assigned clinic the injection time that best fits their schedule.

Gender differences in Epworth Sleepiness Scale revealed by paired patient-spouse scoring.

Purpose: Evaluation of daytime sleepiness in the clinical sleep practice is commonly performed by administering the Epworth Sleepiness Scale (ESS). Our study investigates gender differences of ESS responses in patients (PTs) with a primary complaint of nighttime sleep disruption as they relate to ESS responses obtained from PTs' spouses (Ss).

Methods: One hundred and sixty-four patient-spouse (PT-S) pairs were recruited for the study and asked to independently complete ESS questionnaires consisting of 8 sleepiness scenarios (Q1-Q8).

Assessment of the American College of Surgeons National Surgical Quality Improvement Program Calculator in Predicting Outcomes and Length of Stay After Ivor Lewis Esophagectomy: A Single-Center Experience.

Background: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) calculator is a useful tool used by physicians to better inform patients on the surgical risk of postoperative complications. It makes use of the NSQIP database to derive the chance for several adverse outcomes to occur postoperatively given certain patient's factors. The aim of this study was to assess its applicability in a series of patients undergoing an Ivor Lewis esophagectomy.

Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps.

Virtual surgical planning (VSP) promises higher accuracy, efficiency, and superior patient outcomes, helping normalize outcomes from surgeons of different experience levels. A systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The objective was to evaluate the accuracy and secondarily efficiency of VSP compared with free-hand surgery, for mandibular reconstruction with free flaps.

Prognostic significance of venous invasion in node-negative head and neck squamous cell carcinoma.

Background: Venous invasion (VI) is not frequently evaluated on routine histologic examination of head and neck squamous cell carcinoma (HNSCC), and the prognostic significance is largely unknown. Studies have shown that extramural venous invasion is an adverse prognostic factor in colorectal carcinoma. To our knowledge, this is the first study evaluating the prognostic significance of venous invasion in node-negative (without clinical or pathologic evidence of lymph node involvement) HNSCC, utilizing the elastic stain.

Post-Parkland Shooting: Development and Assessment of Experiential Training in Adolescent Depression and Post-Traumatic Stress Disorder for Primary Care Providers.

Primary care pediatric providers (PCPs) could facilitate early intervention for youth impacted by trauma, yet lack appropriate training. Experiential training for PCPs following a school shooting helped improve PCP confidence and practices in caring for youth with depression and post-traumatic stress disorder.

Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic.

Introduction And Aim: Direct-acting antiviral (DAA) agents are highly effective for treatment of chronic hepatitis C virus (HCV) yet access to treatment remains a serious challenge. The aim of this study was to identify barriers to treatment initiation with DAA-containing regimens in an urban clinic setting.

Materials And Methods: A retrospective cohort of all chronic HCV patients seen in an urban academic practice in Jacksonville, FL, USA from 1/2014 to 1/2017 was analyzed.

Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia.

Objectives: To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices.

Methods: A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria.

Pediatric guanfacine exposures reported to the National Poison Data System, 2000-2016.

The purpose of this study was to characterize the frequency, reasons for exposure, clinical manifestations, treatments, duration of effects, and medical outcomes of pediatric guanfacine exposures reported to the National Poison Data System (NPDS) from 2000 to 2016. Data extracted from poison control center call records for pediatric (0-5 years, 6-12 years, and 13-19 years), single-substance guanfacine ingestions reported to NPDS between 2000 and 2016 was retrospectively analyzed. A total of 10927 cases were identified for analysis.

Impact of Experiential Training With Standardized Patients on Screening and Diagnosis of Adolescent Depression in Primary Care.

Purpose: Primary care providers (PCPs) report inadequate training in depression care. The objective of this study was to examine the long-term impact of PCP training with standardized patients on screening and diagnosis of adolescent depression in primary care.

Methods: A retrospective review of electronic medical and billing records for adolescent (aged 12-18 years) well-visits assessed the frequency of screening and new diagnoses of depression.

Admission characteristics predictive of in-hospital death from hospital-acquired sepsis: A comparison to community-acquired sepsis.

Purpose: Healthcare associated (HA) sepsis is associated with increased resource utilization and mortality compared with community acquired (CA) sepsis. The purpose of this study was to identify independent predictors of in-hospital mortality from HA-sepsis.

Materials And Methods: Retrospective study of adult patients admitted with HA or CA-sepsis.

Comparison of EUS-guided versus percutaneous and transjugular approaches for the performance of liver biopsies.

Background: Liver biopsy through endoscopic ultrasound (EUS) has become a novel approach for tissue acquisition. We aim to evaluate the adequacy of EUS-guided liver biopsies in comparison to those obtained through interventional radiology (IR) techniques.

Methods: A retrospective single-center analysis was performed of all IR (transjugular or image-guided percutaneous) and EUS-guided liver biopsies performed at an academic medical center from January 2016 to January 2018.

Overutilization of Computed Tomography for Odontogenic Infections.

Purpose: There is clear overuse of computed tomography (CT) in the emergency setting, which is associated with a long-term potential for malignancy. This study aimed to determine the rate of overuse of CT for odontogenic infection workup and the correlation of history and physical examination (H&P) findings to diagnose moderate- to high-risk infections.

Materials And Methods: A retrospective cross-sectional study was implemented to determine the rate of overuse of CT for odontogenic infections.

Twenty years of pediatric gunshot wounds in our community: Have we made a difference?

Background/purpose: Pediatric gunshot wounds (GSWs) carry significant incidence, mortality, and cost. We evaluated 20 years of GSW demographics at this level 1 trauma center and constructed a risk map triangulating areas of high incidence with risk factors.

Methods: Children 0-18 years suffering a GSW between 1996 and 2016 were identified via our trauma registry.

Cost-effectiveness of surgeon performed intraoperative specimen ink in breast conservation surgery.

Background: Re-excision rates after breast conservation surgery are reported to be 20%-40%. Inaccuracies with specimen orientation may affect margin assessment. This study examined whether the addition of surgeon performed intraoperative inking of the lumpectomy specimen after adoption of margin guidelines would be cost-effective.

Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis.

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care.

Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015.