Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery.

Objective: Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.

The impact of immune-related adverse events on survival outcomes in a racially diverse population, with a focus on non-Hispanic Black patients.

Introduction: The development of immune-related adverse events (irAEs) has been associated with improved survival outcomes in non-small cell lung cancer (NSCLC). However, this association's extent across race and ethnicity remains uncertain. We evaluated the association between the development of irAEs and treatment outcomes across racially diverse groups treated at a safety net hospital.

Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.

Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.

Methods: We conducted a prospective multicenter observational international cohort study.

Nurse Care Management of Opioid Use Disorder Treatment After 3 Years: A Secondary Analysis of the PROUD Cluster Randomized Clinical Trial.

Importance: The Primary Care Opioid Use Disorders (PROUD) treatment trial was a 2-year implementation trial that demonstrated the Massachusetts office-based addiction treatment (OBAT) model of nurse care management for opioid use disorder (OUD) increased OUD treatment in the 2 years after implementation began (8.2 more patient-years of OUD treatment per 10 000 primary care patients). The intervention was continued for a third year, permitting evaluation of 3-year outcomes.

TIA1 Mediates Divergent Inflammatory Responses to Tauopathy in Microglia and Macrophages.

The RNA binding protein TIA1 is known to regulate stress responses. Here we show that TIA1 plays a much broader role in inflammatory cells, being required for the microglial sensome. We crossed TIA1 cKO mice (using a CX3CR1 driven cre element) to PS19 MAPT P301S tauopathy mice.

Dura Opening in Cases with Acute Traumatic Subdural Hemorrhage.

The most common pathophysiological etiology of traumatic subdural hematoma is the rupture of bridging veins that drain the venous blood from the brain parenchyma into the superior sagittal sinus. Treatment of choice for such a hematoma would be craniotomy and evacuation. Opening dura in a stellate fashion during in acute traumatic subdural hematoma surgery might decrease the risk of added injury to bridging veins and decrease possible morbidity due to brain edema.

Preventing Wrong-Level Spine Surgery.

Importance: Wrong-level spine surgery (WLSS), a medical error in which a surgeon operates at an unintended vertebral level, is considered a "never event." However, it continues to be a problem in spine surgery today despite the implementation of preventive measures such as the Universal Protocol. The consequences of this event are severe for both the afflicted patient and the treating physician and may result not only in physical harm but also in costly medicolegal proceedings.

Self-reported exercise engagement and seizure control - A preliminary survey of people with epilepsy at a safety-net hospital.

Benefits of exercise on general health and wellbeing are undeniable. The International League Against Epilepsy has provided some guidance into exercise and sports for epilepsy. However, people with epilepsy are typically misinformed and restricted by fear and lack of evidence about exercise benefits in epilepsy.

The Master Adaptive Clinician Educator: A Framework for Future Educational Leaders in Academic Medicine.

Medical education continues to evolve with technologic advances, cultural changes, and progress in the application of learning theories. One example is Cutrer's concept of the Master Adaptive Learner (MAL), where the trainee self-directs learning and innovates to maintain a level of expertise in a domain. We suggest that this concept can be applied alongside ideas of adaptive and teacher expertise to represent the medical educator of the future-the Master Adaptive Clinician Educator (MACE).

Exploring preferences and support needs for disclosing 47, XXY status: A qualitative study of adults with XXY.

There are minimal guidelines regarding the disclosure of XXY, otherwise called Klinefelter syndrome, in healthcare or within the family. The increased use of cell-free DNA (cfDNA) to screen for fetal aneuploidy and sex chromosomes bolsters the importance of providing genetic counselors, other healthcare professionals (HCPs), and parents with XXY-led disclosure information. The aim of this qualitative study was to discern the preferences of adults of XXY in the disclosure of XXY status across the lifespan to best inform the clinical and social aspects of their care.

Responsibilities of Medical Professionals Amidst Geopolitical Conflict.

The ethical responsibilities of healthcare professionals amidst geopolitical conflict, particularly regarding their impact on patient care and healthcare delivery, present a significant challenge, especially during current strife. With the rise of national and international discord and debate, and the close relationship between war and healthcare, healthcare organizations are increasingly pressured to comment, which can reflect societal engagement, but also pose demands for maintaining professionalism. This article discusses the need for healthcare practitioners to navigate their roles in advocacy without compromising patient care, emphasizing the importance of self-reflection, adherence to ethical standards, and effective communication.

Association of Conscious Sedation With Dexmedetomidine and Outcome in Stroke Patients Undergoing Thrombectomy in the DEVT and RESCUE-BT Trials.

Background And Objectives: Although dexmedetomidine (DEX) is widely administered during endovascular treatment (EVT) to enhance procedural adherence of patients with acute ischemic stroke (AIS) with large vessel occlusion, there is limited research on the association of DEX and outcomes among these patients. Hence, this study aimed to explore the safety and outcomes of DEX during conscious sedation (CS) in a real-world setting among patients undergoing EVT.

Methods: This study was an individual patient-level pooled analysis of 2 multicenter randomized clinical trials RESCUE-BT and DEVT.

Improving Residency Training in Refugee and Immigrant Health Care at an Urban Academic Family Medicine Residency.

As a safety net hospital, Boston Medical Center (BMC) serves a global community of patients and is welcoming new refugee and immigrant patients at an unprecedented rate. Many of these patients are cared for by Family Medicine residents and faculty in both inpatient and outpatient settings. Currently, the care delivered by Family Medicine residents lacks uniformity due to lack of familiarity with the U.

Association of cognitive and structural correlates of brain aging and incident epilepsy. The Framingham Heart Study.

Objectives: Late-onset epilepsy has the highest incidence among all age groups affected by epilepsy and often occurs in the absence of known clinical risk factors such as stroke and dementia. There is increasing evidence that brain changes contributing to epileptogenesis likely start years before disease onset, and we aim to relate cognitive and imaging correlates of subclinical brain injury to incident late-onset epilepsy in a large, community-based cohort.

Methods: We studied Offspring Cohort of the Framingham Heart Study participants 45 years or older, who were free of prevalent stroke, dementia, or epilepsy, and had neuropsychological (NP) evaluation and brain magnetic resonance imaging (MRI).

Non-Opioid Analgesia Protocols After Total Hip Arthroplasty and Total Knee Arthroplasty: An Updated Scoping Review and Meta-Analysis.

Background: Despite their effectiveness in postoperative analgesia regimens for total knee arthroplasty (TKA) and total hip arthroplasty (THA), opioid medications are accompanied by well-known side effects and a risk of long-term dependence. These drawbacks have prompted the exploration of opioid-free analgesia protocols. The purpose of this study was to summarize the nature and extent of evidence available on opioid-free analgesia protocols in THA and TKA management.

Sociodemographic and Clinical Characteristics Associated With Veterans' Digital Needs.

Importance: Telehealth can expand access to care, but digital needs present barriers for some patients.

Objective: To investigate sociodemographic and clinical associations of digital needs among veterans.

Design, Setting, And Participants: This quality improvement study used data collected between July 2021 and September 2023 from Assessing Circumstances and Offering Resources for Needs (ACORN), a Department of Veterans Affairs (VA) initiative to systematically screen for, comprehensively assess, and address social risks and social needs.

Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications.

Cerebral ischemic injury occurs when blood flow drops below a critical level, resulting in an energy failure. The progressive transformation of hypoperfused viable tissue, the ischemic penumbra, into infarction is a mechanism shared by patients with ischemic stroke if timely reperfusion is not achieved. Yet, the pace at which this transformation occurs, known as the infarct growth rate (IGR), exhibits remarkable heterogeneity among patients, brain regions, and over time, reflecting differences in compensatory collateral flow and ischemic tolerance.

Use of 400 µg/mL Peripheral Phenylephrine Infusions During Anesthesia: A Safety Initiative.

During a general anesthetic case, a patient was administered a 400 µg/mL infusion of phenylephrine as opposed to the 40 µg/mL solution typically used in most operating rooms. The patient experienced iatrogenic hypertension, which resolved once the cause was discovered and the phenylephrine was discontinued. A root cause analysis was performed, with multiple factors contributing to the error.

On the concordance between CAPS-5 and PCL-5 scores.

As reported in this journal, Resick and colleagues (2023) investigated discrepancies between scores from two widely used PTSD measures: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers et al., 2013) and the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013), a clinician-rated structured interview and a self-rated questionnaire, respectively.