Use of a structured approach and virtual simulation practice to improve diagnostic reasoning.

Objectives: In 2015, the National Academy of Medicine IOM estimated that 12 million patients were misdiagnosed annually. This suggests that despite prolonged training in medical school and residency there remains a need to improve diagnostic reasoning education. This study evaluates a new approach.

Investigating Social Determinants of Health in an Urban Direct Primary Care Clinic.

Direct primary care (DPC) is an emerging model of care distinguished by lower price points for quality comprehensive services. The affordability of DPC attracts a broad patient population that may encompass a wide range of socioeconomic needs. It is critical to identify social determinants of health (SDH) in DPC practices to design strategies aimed to mitigate social risk factors, especially for vulnerable populations that can only afford DPC.

Greater than 5-year follow-up of outpatient L4-L5 lumbar interspinous fixation for degenerative spinal stenosis using the INSPAN device.

Background: Lumbar spinal stenosis is treated with decompression directly such as laminectomies and indirectly with an interspinous device through distraction and extension block. Interspinous devices (IPD) have also been used as an adjunct to spinal fusion. However, the design for IPD to treat spinal stenosis does not fixate the spine while the design for spinal fusion is designed to fixate the spine.

Paramedic Pain Management Practice with Introduction of a Non-opiate Treatment Protocol.

Introduction: There is concern about the initiation of opiates in healthcare settings due to the risk of future misuse. Although opiate medications have historically been at the core of prehospital pain management, several states are introducing non-opiate alternatives to prehospital care. Prior studies suggest that non-opiate analgesics are non-inferior to opiates for many acute complaints, yet there is little literature describing practice patterns of pain management in prehospital care.

Experience of using a 3-blade LES-Tri retractor over 5 years for lumbar decompression microdiscectomy.

Background: Lower back pain is the fifth most common reason for visiting a physician in the United States. Degenerative disc disease, degenerative spondylolisthesis, arthritis, and facet arthrosis are leading causes for lumbar spinal stenosis. The previous gold standard involved open laminectomy combined with medial facetectomy and foraminotomy.

Treatment of Bilateral Giant Fusiform Petrocavernous Aneurysms.

Aneurysms of the petrous segment of the internal carotid artery (ICA) are exceedingly rare. They are thought to arise from traumatic, mycotic, or congenital etiologies. We present a case of bilateral giant fusiform aneurysms of the petrocavernous ICA treated with bilateral flow-diverting stent placement.

Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients.

Children with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) are at risk for fluid overload (FO) despite the normal estimated glomerular filtration rate (eGFR). It has been shown that survival in the intensive care unit (ICU) is inversely proportional to FO. Therefore, fluid removal, or prevention of FO, in these critical cases has the potential to improve survival.

Combined Extra- and Intrapleural Hematoma After Blunt Chest Injury in an Anticoagulated Patient.

The objective of this study was to describe the atypical presentation of combined intrapleural and extrapleural hematomas in patients on anticoagulant therapy and explain the best workup and treatment for this pathology. This case report details the presentation, initial treatment, initial workup, and subsequent final treatment and workup of an elderly female patient that arrived at our trauma facility after suffering a blunt force trauma. The patient received anticoagulation therapy for her comorbidities prior to this incident.

Abdominal Apoplexy: A Case Study of Idiopathic Spontaneous Lesser Sac Hematoma.

Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare event associated with high mortality. There have been multiple case reports of spontaneous rupture of middle colic pseudoaneurysms in the literature. Herein, we present a case of a 51-year-old female that presented with spontaneous rupture of the middle colic artery and associated massive intraabdominal hematoma without findings of a pseudoaneurysm.

Total Spinal Anesthesia Following an Interscalene Block Treated with Intravenous Lipid Emulsion.

Total spinal anesthesia following interscalene block is a rare and life-threatening complication of regional anesthesia. A 56-year-old woman underwent an uncomplicated left shoulder bone spur removal under general anesthesia with an interscalene nerve block at an outpatient surgical center. Subsequently, she developed bilateral mydriasis, paralysis of all extremities, and respiratory arrest.

Placing ball and socket cervical total disc replacement using instant center of rotation.

Background: Authors aim to evaluate the correct placement of TDR using the instant center of rotation (ICR) as a guide.

Methods: Placement of disc would be divided into three groups using a standard of 1 mm from the ICR: Posterior to ICR, In line with ICR and Anterior to ICR.

Results: 49 patients, mean age was 39.

Evaluating shared decision-making in periviable counseling using objective structured clinical examinations.

Objective: To develop and test an Objective Structured Clinical Examination to evaluate the use of shared decision-making (SDM) in periviable counseling among fourth-year OB/GYN residents.

Methods: Residents counseled a standardized patient presenting with preterm premature rupture of membranes at 23 weeks' gestation. Braddock's 9-item measure of SDM was adapted to a 10-item scoring rubric; rating each: 0 (absent), 1 (partial), or 2 (complete).

Texting Brief Podcasts to Deliver Faculty Development to Community-Based Preceptors in Longitudinal Integrated Clerkships.

Introduction: Longitudinal integrated clerkships (LICs) are an increasingly popular clerkship model that relies heavily on community-based preceptors. The availability of an engaged and prepared community-based faculty is crucial to the success of these programs. Teachers in these programs are often geographically separate from medical school campuses, are engaged in busy practices, and have limited time to devote to faculty development activities.

Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery.

Introduction: Outpatient surgery has a great opportunity to demonstrate the role of using mobile video conference (VC) postoperatively. Our patients use technology to help decision making in finding physicians. The authors aim to assess patient's perception on the use of mobile apps for VC with the surgeon and/or staff.

To Pay or Not to Pay Community Preceptors? That Is a Question ….

: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.

A Prospective Analysis of the Supine and Sitting Straight-Leg Raise Test and Its Performance in Litigation Patients.

Background: The supine straight-leg raise (SLR) test has the potential to be exploited by malingering patients. The sitting SLR is believed to be less recognizable, therefore decreasing the chance of fabrication. The authors aim to compare the supine and sitting SLR test in patients with radiculopathy.

Sentinel sign in standalone anterior cervical fusion: Outcomes and fusion rate.

Background: The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.

Methods: 48 consecutive patients undergoing standalone ACDF (S-ACDF) (Group 1) were compared to control group of 49 patients who had ACDF with ACP (Group 2).

Results: Analysis of follow-up at the one year period postoperative outcomes between groups 1 and 2 demonstrated no intergroup statistical significant difference in VAS neck, arm and NDI scores p = 0.

A Rare Axonal Variant of Guillain-Barré Syndrome following Elective Spinal Surgery.

Acute motor and sensory axonal neuropathy (AMSAN) is a rare axonal variant of Guillain-Barré syndrome. AMSAN is considered the most severe form of GBS, known for its rapid onset of severe symptoms, and often leading to quadriparesis within 7 days of initial symptom onset. We present a case of a middle-aged Caucasian female who developed AMSAN 2 weeks following an elective spinal surgery.

A psoas splitting approach developed for outpatient lateral interbody fusion versus a standard transpsoas approach.

Background: The technique of transpsoas lateral interbody fusion has been adopted to avoid direct anterior interbody fusion, but lateral fusions have been limited to disc spaces above L5 and are associated with neurologic injuries especially to the lumbar plexus when approaching L4-5. The authors aim to demonstrate a psoas splitting technique to decrease risk of complications associated with the standard transpsoas technique.

Methods: Medical records of 84 patients with prospectively collected data reviewed.

Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy: Technical note.

Background: Authors aim to report on the outcomes of combining selective anterior cervical decompression and fusion (ACDF) with laminectomy in patients with cervical spondylotic radiculomyelopathy (CSR).

Methods: 10 patients with ACDF and posterior laminectomy reviewed.

Results: 60% female population, mean age 61 ± 3 years, mean BMI 24.

Myopic shift in a pseudophakic eye with an accommodating IOL following vitrectomy with gas tamponade.

Purpose: To report the case of a patient with Crystalens, an accommodating posterior-chamber intraocular lens (IOL), who experienced a myopic shift following subsequent vitrectomy with gas tamponade. We propose a hypothesis as to why this myopic shift occurred and analyze its validity based on current literature.

Observations: A patient had cataract surgery with implantation of a Crystalens AT-50AO +21D.

Soft tissue swelling incidence using demineralized bone matrix in the outpatient setting.

Aim: To assess use of demineralized bone matrix (DBM) use in anterior cervical discectomy and fusion (ACDF) in outpatient setting.

Methods: One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone (PEEK) cages. Two groups created, Group 1 (75) outpatients and control Group 2 (70) hospital patients.

Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study.

Background: Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines for patients taking antipsychotic medications.