Obstetric Anal Sphincter Injury: Vaginal Birth After Cesarean Versus First Vaginal Delivery.

Importance: Modern data regarding the relationship between vaginal birth after cesarean (VBAC) and obstetric anal sphincter injury (OASI) are minimal with mixed results.

Objective: The aim of the study was to determine if VBAC is associated with an increased risk of OASIs.

Study Design: This was a retrospective cohort study of liveborn deliveries from 2018 to 2022 within a large, multihospital academic health system.

Optimizing the Dermatologic Formulary at a Free Clinic.

Objectives: Free clinics provide care to underserved populations nationwide. The Birmingham Free Clinic offers dermatology care and operates an onsite dispensary. Little is known about specialty care services and medication optimization in the free clinic setting.

Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.

Objectives: Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills.

A Qualitative Exploration of Women With Cystic Fibrosis and Urinary Incontinence.

Importance: Women with cystic fibrosis (CF) historically experience a high prevalence of urinary incontinence (UI). However, this area is understudied, especially in the modern era of highly effective modulator therapy (HEMT).

Objective: This study aimed to explore the UI experiences, knowledge, care-seeking behavior, and treatment preferences of women with CF.

Fostering Innovation in Medical Education: Addressing the Void of Entrepreneurship Education in Anesthesiology and Pain Medicine Through Incubator Clubs.

Fewer than 30% of all medical schools have programs that encourage medical design innovation or entrepreneurship at the trainee level. This is particularly evident in the fields of anesthesiology and pain medicine, where utilizing medical devices constitutes a significant part of a clinician's daily practice. To fix this gap, our institution has developed an incubator club where trainees can learn about medical devices and entrepreneurship.

Alternative Lymphatic Drainage Pathways in the Trunk Following Oncologic Therapy.

Background: Anatomic and functional descriptions of trunk and breast lymphedema following breast cancer treatment are emerging as indicators of lymphatic dysfunction. Indocyanine green-lymphangiography has been instrumental in characterizing this dysfunction in the extremity and can be applied to other regions. Previous work has established a validated Pittsburgh Trunk Lymphedema Staging System to characterize such affected areas.

Pelvic Floor Physical Therapy Attendance Among High-Risk Postpartum Patients.

Importance: Limited data describe attendance to pelvic floor physical therapy (PFPT) in a postpartum patient population.

Objectives: The objective was describe attendance to PFPT in a cohort of postpartum women at high-risk of pelvic floor concerns. We secondarily compared attendance between patients with and without evaluation in a postpartum pelvic floor healing clinic (PPFHC).

Prevalence of Cochlear-Facial and Other Non-Superior Semicircular Canal Third Window Dehiscence on High-Resolution Temporal Bone CT.

Background And Purpose: The radiologic prevalence of superior semicircular canal dehiscence in the asymptomatic population has been widely studied, but less is known about the rates of other forms of third window dehiscence. Per the existing literature, the radiologic prevalence of cochlear-facial nerve dehiscence, for example, exceeds that seen in histologic studies, suggesting that conventional CT is unreliable for cochlear-facial dehiscence. These studies relied on nonisometric CT acquisitions, however, and underused multiplanar reformatting techniques, leading to false-positive findings.

Trial of Intravenous Immune Globulin in Dermatomyositis.

Background: Intravenous immune globulin (IVIG) for the treatment of dermatomyositis has not been extensively evaluated.

Methods: We conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis. The patients were assigned in a 1:1 ratio to receive IVIG at a dose of 2.

Motivational Interviewing Strategies for Addressing COVID-19 Vaccine Hesitancy.

Severe acute respiratory syndrome coronavirus 2, or coronavirus disease 2019 (COVID-19), vaccine hesitancy, defined as a behavioral phenomenon whereby individuals neither fully accept nor fully reject the COVID-19 vaccine, presents a major health threat in the midst of the current pandemic. Traditional approaches for addressing vaccine hesitancy in health care lack empirical support and, in some instances, have actually vaccine hesitancy. Thus, there is an urgent need for approaches that effectively address COVID-19 vaccine hesitancy, especially in health care settings.

Are Amphetamines Associated with Adverse Cardiovascular Events Among Elderly Individuals?

Background: Prescription amphetamines are the most common pharmacological treatment for attention deficit hyperactivity disorder (ADHD) and use among older age groups is increasing. The purpose of this study is to assess the risk of adverse cardiovascular events among individuals older than 65 years.

Methods: We conducted a retrospective matched cohort study using TriNetX database with propensity score matching (PSM) to assess the odds of a cardiovascular event among individuals with ADHD exposed to amphetamine compared with individuals with ADHD who were not exposed to this medication.

Primary Graft Dysfunction in Heart Transplant Recipients-Risk Factors and Longitudinal Outcomes.

Before the 33rd Annual International Society for Heart and Lung Transplantation conference, there was significant intercenter variability in definitions of primary graft dysfunction (PGD). The incidence, risk factors, and outcomes of consensus-defined PGD warrant further investigation. We retrospectively examined 448 adult cardiac transplant recipients at our institution from 2005 to 2017.

Magnetic Resonance Elastography of the Liver: A Single-Institution Review of Cases Performed in a 5-Year Interval.

Objective: This study aimed to assess the diagnostic accuracy of magnetic resonance elastography (MRE) in detecting hepatic fibrosis and determining clinically relevant stiffness cutoff values per stage of fibrosis.

Methods: This retrospective study assessed 1488 hepatic MRE evaluations performed at a single institution for 5 years. Mean liver stiffness measurements were collected from 282 patients who had an MRE study within 1 year of histopathologic analysis.

Independent or Integrated Plastic Surgery Residency Pathways: Trends in Representation in Academic Plastic Surgery in the United States.

Introduction: The training pathway for plastic surgery has evolved in recent years with the adoption and rise in popularity of the integrated model. Studies have demonstrated that there may be differences between integrated graduates and independent graduates, specifically in career choices and type of practice. This study seeks to understand if there are differences in representation at academic and leadership positions between graduates of the 2 pathways.

The Importance of Service Learning in Dermatology Residency: An Actionable Approach to Improve Resident Education and Skin Health Equity.

Accessing specialty care such as dermatology is a challenge for patients residing in marginalized communities. In 2019, there were nearly 30 million individuals without health insurance in the United States; furthermore, those from minority backgrounds are less likely to be insured than their White counterparts. Service learning is an educational approach that combines learning objectives with community service to provide a comprehensive scholastic experience, meet societal needs, and fulfill Accreditation Council for Graduate Medical Education requirements.

Optimizing Intraoperative Fluid Replacement for Patients Receiving Mannitol During Neurosurgical Procedures: A Quality Improvement Initiative.

Patients undergoing craniotomy are at increased risk of intravascular volume changes due to the use of mannitol. This quality improvement project was conducted to implement a standardized goal-directed fluid therapy (GDFT) protocol using a dynamic physiologic measure in an attempt to maintain euvolemia in patients undergoing craniotomy with mannitol administration. An evidence-based GDFT protocol was integrated into an existing neurosurgical protocol.

Prevalence of Superior Semicircular Canal Dehiscence on High-Resolution CT Imaging in Patients without Vestibular or Auditory Abnormalities.

Background And Purpose: Prior studies of radiologic superior semicircular canal dehiscence have suggested that CT may overcall dehiscence. However, many of those studies were performed before the advent of multichannel helical CT. Furthermore, there are limited data investigating the prevalence of radiologic superior semicircular canal dehiscence in asymptomatic individuals.

Teaching to Teach: An Effective and Feasible Teaching Curriculum for Internal Medicine Interns.

Objectives: New competency requirements from the Accreditation Council for Graduate Medical Education have prompted greater emphasis on developing residents' teaching skills. Many residents make their first foray into teaching during internship, making it an important yet underrecognized opportunity to develop basic teaching skills. In addition, in the current graduate medical education climate, residents' tasks are compressed into an even shorter time, which has caused teaching opportunities and expectations to be balanced with the need for efficiency.

Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus.

Surgical techniques for the management of recalcitrant osteochondral lesions of the talus have improved; however, the poor healing potential of cartilage may impede long-term outcomes. Repair (microfracture) or replacement (osteochondral transplants) is the standard of care. Reparative strategies lead to production of fibrocartilage, which, compared with the native type II articular cartilage, has decreased mechanical and wear properties.

Interfacility Transport Shock Index Is Associated With Decreased Survival in Children.

Background: Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center.

Methods: We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children's Hospital of Pittsburgh by our critical care transport team.