Clerkship Students' Use of Clinical Reasoning Concepts After a Pre-clinical Reasoning Course.

Background: Many medical schools have incorporated clinical reasoning (CR) courses into their pre-clinical curricula to address the quality and safety issue of diagnostic error. It is unknown how students use concepts and practices from pre-clinical CR courses once in clerkships.

Objective: We sought to understand how students utilize CR concepts from a pre-clinical course during clerkships and to identify facilitators and barriers to the use of reasoning concepts.

Sexual Harassment in Academic Anesthesiology: A Survey of Prevalence, Sources, Impact, and Recommendations.

Background: A report by the American Association of Medical Colleges (AAMC) showed that academic anesthesiology has the highest prevalence of sexual harassment among specialties for both men and women. We aimed to explore the prevalence, sources, and impact of sexual harassment on anesthesiologists in academic centers in the United States and Canada. We also sought recommendations for its mitigation.

Incorporating Economic Evidence in Clinical Guidelines: A Framework From the Clinical Guidelines Committee of the American College of Physicians.

In recognition of accelerating health care spending and alignment with the American College of Physicians (ACP) principles of promoting high-value care, the ACP Clinical Guidelines Committee (CGC) developed a framework to standardize its approach to identifying, appraising, and considering economic evidence in the development of ACP clinical guidelines. This article presents the CGC's process for incorporating economic evidence, which encompasses cost-effectiveness analyses, economic outcomes in randomized controlled trials, and resource utilization (intervention cost) data. Economic evidence is one component of ACP recommendations.

The Appropriate Utilization of Beta-Blockers in Acute Coronary Syndrome Patients: An Improvement Initiative.

Background and objective Beta-blockers are a cornerstone in the management of acute coronary syndrome (ACS), effectively reducing myocardial oxygen demand, preventing recurrent ischemia, and lowering the risk of arrhythmias and reinfarction. Despite several established guidelines, such as those by the American College of Cardiology/American Heart Association (ACC/AHA), advocating their use within 24 hours for eligible patients, beta-blockers remain underutilized in clinical practice. This study aimed to analyze beta-blocker utilization patterns in ACS management and evaluate the impact of targeted improvement initiatives on their appropriate use in eligible ACS patients.

Identification of progressive pulmonary fibrosis: consensus findings from a modified Delphi study.

Background: We sought consensus among practising respiratory physicians on the prediction, identification and monitoring of progression in patients with fibrosing interstitial lung disease (ILD) using a modified Delphi process.

Methods: Following a literature review, statements on the prediction, identification and monitoring of progression of ILD were developed by a panel of physicians with specialist expertise. Practising respiratory physicians were sent a survey asking them to indicate their level of agreement with these statements on a binary scale or 7-point Likert scale (- 3 to 3), or to select answers from a list.

Pediatric Organ Donation, Transplantation, and Updated Brain Death Criteria: An Overview for Pediatricians.

Pediatricians follow patients longitudinally and hold a unique position to address multiple issues, medical and psychosocial, that affect organ donation and transplantation. They are wellpositioned to provide anticipatory guidance during well-child visits and during care for children with end-stage organ failure and can either assist these patients with ongoing medical management or refer these patients for organ transplantation assessment. A pediatrician's trusted relationship with families and patients allows for guidance on medical and ethical issues surrounding brain death, organ donation, and transplantation.

Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Older Postmenopausal Women.

Background: Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.

Methods: We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993-1998). PPI use was determined from medication inventories at baseline and Year-3.

Quality of Cancer Recurrence Data in the National Cancer Database: A Reappraisal of Reporting Readiness.

Background: This study evaluated the quality of cancer recurrence data in the National Cancer Database (NCDB) to determine if missingness and reporting consistency have improved enough to support national research.

Methods: This multi-methods study included NCDB analyses and a cancer registry staff survey. Trends in recurrence data missingness from 2004 to 2021 and multivariable analyses of factors associated with missingness from 2017 to 2021 were evaluated for 4,568,927 patients with non-metastatic cancer.

Identifying Factors that Influence Pediatric Echo Lab Image Quality: Development and Validation of a New Assessment Tool.

No method of evaluating transthoracic echocardiograms (TTE) image quality (IQ) has been validated. Furthermore, structural echo lab elements impacting IQ are unknown. We sought to develop and validate a TTE IQ grading tool and determine patient and echo lab features associated with IQ.

Food for thought: a qualitative assessment of medical trainee and faculty perceptions of nutrition education.

Background: The American Society of Clinical Nutrition recommends 37 to 44 h of undergraduate medical nutrition education. The Total Health Curriculum at Geisinger Commonwealth School of Medicine (GCSOM) contains 14 h of objective-based nutritional instruction. This study aimed to examine the perceptions of key stakeholders regarding the role of nutrition in medicine and to identify barriers, opportunities for improvement, and roles/responsibilities for innovative implementation of nutrition education.

Limited use of opioid prescribing guidelines in Dutch emergency departments: results of a nationwide survey.

Background: In recent years, the Netherlands has experienced a notable increase in opioid prescriptions and associated fatalities. Emergency department (ED) patients exhibit relatively high rates of opioid use (15%) and misuse (23% of patients who present to the ED and use prescription opioids test positive for misuse). To mitigate opioid-related harm, the American College of Emergency Physicians (ACEP) advocates for the use of non-opioid analgesics and minimal opioid prescriptions.

CME preferences and perspectives among practicing radiologists.

Rationale And Objectives: To evaluate radiologists' perspectives regarding American Medical Association Category 1 Continuing Medical Education (Cat-1 CME) activities in private practice (PP) and teleradiology (TR), as well as American Board of Radiology Maintenance of Certification (ABR MOC) program participation status.

Materials And Methods: An electronic survey informed by existing literature regarding physician Cat-1 CME use and opinions was distributed via email to a national radiology practice. The survey was open for seventeen days in 2023, with a single reminder.

Diversity-Related, Student-Led National Medical Organizations: Leadership Opportunities for Learners.

Introduction: In light of the lack of diversity in academic medicine leadership, diversity-related, student-led national medical organizations (NMOs) provide a space for solace and reprieve among common peers while providing an opportunity to develop leadership competencies in a supportive environment. Despite the impact NMOs have had on cultivating generations of leaders in medicine, trainees may not identify opportunities for leadership development that are transferable to future careers in academic medicine.

Methods: We designed and implemented a dynamic 60-minute workshop with an interactive PowerPoint presentation, author-owned video testimonials (from past student leaders of NMOs), two case presentations, and reflection exercises.

A Pioneer in Women's Health, Dr. James Marion Sims (1813-1883).

James Marion Sims, one of the most well-known and respected surgeons in America, lived from January 25, 1813, to November 13, 1883. He was chosen to be the American Medical Association's president in 1876 and was amongst the first American doctors to gain recognition in Europe. He founded New York's first hospital exclusively for women, despite strong opposition.

Primary care follow-up improves outcomes in older adults following emergency general surgery admission.

Background: While preoperative optimization improves outcomes for older adults undergoing major elective surgery, no such optimization is possible in the emergent setting. Surgeons must identify postoperative interventions to improve outcomes among older emergency general surgery (EGS) patients. The objective of this cohort study was to examine the association between early follow-up with a primary care physician (PCP) and the risk of nursing home acceptance or death in the year following EGS admission among older adults.

Impact of Inflammation After Cardiac Surgery on 30-Day Mortality and Machine Learning Risk Prediction.

Objectives: To investigate the impact of systemic inflammatory response syndrome (SIRS) on 30-day mortality following cardiac surgery and develop a machine learning model to predict SIRS.

Design: Retrospective cohort study.

Setting: Single tertiary care hospital.

Updates on the MR safety guidelines - Essentials for radiologists.

Magnetic Resonance Imaging (MRI) is a sophisticated diagnostic tool that utilizes the magnetic properties of biological tissue to generate detailed images of internal structures without the use of ionizing radiation. Despite its benefits in providing high-contrast images of soft tissues, the strong magnetic fields used in MRI present a unique safety challenge. Increasing MRI-related accidents and the prevalence of patients with metallic implants in recent years underscore the critical need for stringent MR safety protocols.

Odds of Metastatic Disease at Diagnosis of Primary Bone and Soft-Tissue Sarcomas of the Extremity and Pelvis Based on Preferred Language and Socioeconomic Factors.

Introduction: The odds of metastatic disease at diagnosis of bone (BS) and soft-tissue sarcomas (STS) of the extremities and pelvis may vary among patients due to several factors. There is limited research comparing the rates of metastatic disease at diagnosis in patients from different demographic and socioeconomic backgrounds.

Methods: Patients with a primary BS or STS of the extremity or pelvis were identified using International Classification of Diseases codes.

Post-Operative Outcome Predictions in Vestibular Schwannoma Using Machine Learning Algorithms.

This study aimed to develop a machine learning (ML) algorithm that can predict unplanned reoperations and surgical/medical complications after vestibular schwannoma (VS) surgery. All pre- and peri-operative variables available in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (n = 110), except those directly related to our outcome variables, were used as input variables. A deep neural network model consisting of seven layers was developed using the Keras open-source library, with a 70:30 breakdown for training and testing.

Dr. Thomas Francis Jr.: A Legacy of Vaccine Innovation and Public Health Advancement.

Dr. Thomas Francis Jr. was an American physician, virologist, and epidemiologist who was a professor of epidemiology at the University of Michigan from 1941 to 1969.

Ultrasound-guided foam sclerotherapy using physician-compounded foam: Position statement from the American vein and lymphatic society.

Chronic venous disease has a major impact on the quality of life of millions of patients. Large randomized controlled trials have established ultrasound-guided foam sclerotherapy (UGFS) as a safe and effective treatment option for both saphenous vein insufficiency and tributary disease. Ultrasound guidance is a critical component of sclerotherapy of non-visible veins.