Diversity in Family Medicine Research.

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research.

Postmenopausal dyspareunia.

Dyspareunia in the postmenopausal woman is often multifactorial and requires a thorough history, a targeted physical examination, and coordination of multiple disciplines, including medical professionals, pelvic floor physical therapists, and sex therapists. Although we have come a long way since early assessments of painful sex, evaluation and treatment of dyspareunia remain an unmet need. This is particularly true in postmenopausal women in whom it is commonly assumed that pain with penetrative sex is solely a consequence of atrophy.

Improving Patient Safety and Quality in Physical Medicine and Rehabilitation Through Participation in the American Board of Physical Medicine and Rehabilitation Continuing Certification Program.

The American Board of Medical Specialties Continuing Certification Program's Improvement in Medical Practice Standard requires physicians to participate in practice improvement activities. Despite this universal requirement, there has been no assessment of this requirement or its potential impact on patient care. Because of its continuing certification oversight structure, the American Board of Physical Medicine and Rehabilitation is in a unique position to provide this assessment.

The Impact of the Early COVID-19 Pandemic on Inpatient Clinical Experience for Physical Medicine and Rehabilitation Resident Physicians.

The objective of this retrospective, observational study was to quantitatively study the impact of the early COVID-19 pandemic on the inpatient clinical experience of Physical Medicine and Rehabilitation resident physicians in an inpatient rehabilitation facility setting. Inpatient clinical experience as evidenced by admissions, rehabilitation diagnosis, medical emergencies, acute care transfers, and resident work hours from January to June 2019 (prepandemic) were compared January to June 2020 (immediately before and during pandemic). There was a statistically significant decrease in the mean daily admissions in April 2020 and a significant increase in medically complex admissions in June 2020, reflective of medical patterns due to the pandemic.

Reducing topical drug waste in ophthalmic surgery: multisociety position paper.

This position article on reducing topical drug waste with ophthalmic surgery was written by the Ophthalmic Instrument Cleaning and Sterilization Task Force, comprising representatives of the ASCRS, American Academy of Ophthalmology, American Glaucoma Society, and Outpatient Ophthalmic Surgery Society. Drug waste significantly increases the costs and carbon footprint of ophthalmic surgery. Surgical facilities should be permitted to use topical drugs in multidose containers on multiple patients until the manufacturer's labeled date of expiration, if proper guidelines are followed.

Sepsis Electronic Decision Support Screen in High-Risk Patients Across Age Groups in a Pediatric Emergency Department.

Objective: This study aimed to compare the performance of a pediatric decision support algorithm to detect severe sepsis between high-risk pediatric and adult patients in a pediatric emergency department (PED).

Methods: This is a retrospective cohort study of patients presenting from March 2017 to February 2018 to a tertiary care PED. Patients were identified as high risk for sepsis based on a priori defined criteria and were considered adult if 18 years or older.

Contact Allergy Cross-reactions and Thresholds: A Review.

Consideration of contact allergen concomitant reactivity, which encompasses cross-reactors, co-reactors, and pseudo cross-reactors, is an important aspect of patient care, yet information on how these terms are differentiated and used in clinical practice is lacking. In this review, we provide definitions of cross-reactors, coreactors, and pseudo cross-reactors and discuss the utility of the American Contact Dermatitis Society Contact Allergen Management Program database cross-reactor groupings. We also discuss limitations to the current categorization of cross-reactivity and recommend incorporating new terms, including "apparent cross-reactor" and "derivative cross-reactor," when classifying cross-reactors.

Children's Hospital Transfers From Referring Emergency Departments: Which Patients Bypassed the Pediatric Emergency Department?

Objectives: Children are increasingly transferred from emergency departments (EDs) to children's hospitals for inpatient care. The existing literature on the use of direct admission (DA) specifically among pediatric patients transferred from referring EDs remains sparse.The objective of this study was to identify demographic, clinical, and contextual factors associated with the use of direct-to-inpatient versus ED-to-inpatient admission among patients transferred to children's hospitals from EDs.

A Brief, Just-in-Time Sedation Training in the Pediatric Emergency Department Improves Performance During Adverse Events Encountered in Simulated Procedural Sedations.

Background: Procedural sedation (PS) is commonly performed in emergency departments (EDs) by nonanesthesiologists. Although adverse events (AEs) are rare, providers must possess the clinical skills to react in a timely manner. We previously described residents' experience and confidence in PS as part of a needs assessment.

Atopic Dermatitis Biomarkers and the Movement Toward Personalized Treatment.

Atopic dermatitis (AD) is a heterogeneous disorder with varying phenotypes. Although AD has long been associated with barrier dysfunction, the pathogenesis of this disease is more complex, involving many molecular markers in different functional domains. Biomarkers can be helpful in different ways, including predicting prognosis, measuring treatment response, and gauging disease severity.

FGF23 (Fibroblast Growth Factor-23) and Incident Hypertension in Young and Middle-Aged Adults: The CARDIA Study.

Blacks have the highest prevalence of hypertension in the United States. Higher levels of FGF23 (fibroblast growth factor-23) have been associated with worse cardiovascular outcomes. Whether FGF23 is associated with rising blood pressure (BP) and racial differences in incident hypertension is unclear.

Early Response to Warfarin Initiation and the Risk of Venous Thromboembolism After Total Joint Arthroplasty.

Background: Venous thromboembolism chemoprophylaxis with warfarin is common after total joint arthroplasty. Early response to warfarin initiation has been theorized to engender a transient increase in the risk of venous thromboembolism. We hypothesized that a rapid rise in the international normalized ratio is a risk factor for venous thromboembolism after total joint arthroplasty.

Traumatic colon injury in damage control laparotomy-A multicenter trial: Is it safe to do a delayed anastomosis?

Background: Delayed colonic anastomosis after damage control laparotomy (DCL) is an alternative to colostomies during a single laparotomy (SL) in high-risk patients. However, literature suggests increased colonic leak rates up to 27% with DCL, and various reported risk factors. We evaluated our regional experience to determine if delayed colonic anastomosis was associated with worse outcomes.

Multidose Adenosine Used to Facilitate Microsurgical Clipping of a Cerebral Aneurysm Complicated by Intraoperative Rupture: A Case Report.

In some cases of cerebral aneurysm clipping, direct clip application to the aneurysm neck may be difficult or the aneurysm may rupture unexpectedly. In these cases, a clip may be temporarily applied to the parent artery to reduce aneurysmal wall tension, facilitate permanent clip placement, or control bleeding if the aneurysm ruptures. In certain circumstances, even applying a temporary clip may be challenging.