Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis.

Background: Patient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform.

Objective: This study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania.

Methods: We examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022.

Increasing Popularity of Tattoo-Only Nipple-Areolar Complex Reconstruction: A 15-Year Retrospective Study.

Background: Nipple-areolar complex (NAC) reconstruction can be broadly categorized into surgical reconstruction, tattooing, or both. NAC tattooing has shown continued advances recently, resulting in increased discussion of tattoo-only methods within the literature.

Objective: This study aims to quantify recent trends in choice of NAC reconstruction and explore driving factors.

Genotype-First Analysis in an Unselected Health System-Based Population and Phenotypic Severity of COL4A5 Variants.

Background: Our knowledge of X-linked Alport Syndrome comes mostly from selected cohorts with more severe disease.

Methods: We examined the phenotypic spectrum of X-linked Alport Syndrome in males and females with a genotype-based approach using data from the Geisinger MyCode DiscovEHR study, an unselected health system-based cohort with exome sequencing and electronic health records. Patients with COL4A5 variants reported as pathogenic or likely pathogenic in ClinVar, or protein-truncating variants, were each matched with up to 5 controls without COL4A3/4/5 variants by sociodemographics, diabetes diagnosis, and year of first outpatient encounter.

Serial VerifyNow P2Y12 platelet reactivity units in cerebral aneurysm patients treated with ticagrelor surrounding stent-coiling or flow diversion.

Introduction: Platelet function testing using serial VerifyNow P2Y12 platelet reactivity units (PRUs) is established for guiding clopidogrel antiplatelet therapy in cerebral aneurysm stenting procedures. However, for ticagrelor, the impact of serial PRU testing and the identification of safe PRU ranges remains unexplored.

Methods: Flow diversion stenting ( = 232) and stent-assisted coiling procedures ( = 83) performed 05/2017-12/2021 were reviewed.

Comparison of Procedural Outcomes of Lumenless Fixed-Helix Versus Stylet-Driven Extendable-Helix Lead Systems in Left Bundle Branch Pacing: COMPARE LBBP.

Background: Left bundle branch pacing (LBBP) has emerged as a safe and effective alternative to right ventricular pacing. Traditionally, LBBP is performed with lumenless lead (LLL); however, the use of stylet-driven lead (SDL) is on rise. We aimed to assess acute success and procedural outcomes of SDL versus LLL for LBBP.

LOCAlizaTion and clinical corrElation of Left Bundle Branch Pacing lead: Insights from a computed tomographic angiography (LOCATE LBBP) study.

Background: Left bundle branch pacing (LBBP) provides physiological activation with stable pacing parameters. However, there is a paucity of data on direct assessment of lead stability.

Objectives: The purpose of this study was to assess the stability of an LBBP lead using computed tomographic angiography (CTA) during medium-term follow-up and to correlate the anatomic location of the lead and electrophysiological characteristics of LBBP.

Health Care Transition Programs for Adolescents and Young Adults With Hereditary Cancer Predisposition: A Scoping Review.

Adolescents and young adults (AYA) with increased risk for cancer due to hereditary predisposition, previous cancer treatment, or both are eligible for increased surveillance, chemoprevention, and prophylactic surgery that can improve early detection and prevention of cancers. One way to ensure continuity of cancer prevention care is to support adolescents through the transition from pediatric to adult health care. Yet, there are limited data on the impl ementation of health care transition (HCT) programs for AYA with increased risk for cancer.

A Genome-Wide Association Study and Rare Variant Analysis for Dupuytren Disease in a North American Population.

Purpose: Although European genome-wide association studies (GWAS) have aided in defining genetic associations in Dupuytren disease (DD), North American populations have been infrequently analyzed. Additionally, there are a paucity of rare variant analyses (RVA) for DD, which can help define both trait variability and risk for low-frequency variants. Our purpose was to perform a GWAS and RVA for DD using a North American database.

Early Rates of Revision Surgery in Endoscopic and Open Carpal Tunnel Release.

Purpose: To compare rates of revision surgery between primary endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). In addition, we aimed to assess the influence of fellowship training on revision rates. We hypothesized that ECTR would not be associated with higher rates of revision surgery.

Implementation of Point-of-Care Ultrasound (PoCUS) in Geisinger Health System.

Background Point-of-care ultrasound (PoCUS) is an imaging modality with many inherent benefits, such as increased patient satisfaction, cost savings, and elimination of delays in diagnosis. The popularity of this bedside imaging technique has increased in recent years, and its scope of use for diagnostics and procedures has expanded in many specialties. Research question Can increased implementation of PoCUS within the Geisinger Health System (GHS) reduce the need for other more expensive, time-consuming, and potentially harmful imaging techniques? Methods Investigations were carried out on the uses of PoCUS established in the literature as a bedside diagnostic tool for specific pathologies such as pneumonia, nephrolithiasis, and various fractures.

Post-Intensive Care Syndrome-Mental Health.

Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk factors for psychological problems following critical illness have been identified including early symptoms of acute stress. Assessment of psychological symptoms in ICU patients and survivors remains inconsistent and many do not receive appropriate psychological evaluation, diagnosis, or treatment.

Exploring clinician perspectives of systems-based practice: A physician training challenge.

Introduction: Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP.

Received Self-Care Support and Psychosocial Health Among Older Adults with Non-Dialysis-Dependent Chronic Kidney Disease.

Older age is linked with poorer self-care in the chronic kidney disease (CKD) setting. Informal health supporters (family members and friends) are critical sources of self-care support, but much remains unclear about the characteristics and implications of received support among this patient population. We examined how received self-care support (amount and type) related to positive (CKD management self-efficacy) and negative (depressive symptoms) psychosocial health correlates of self-care in 536 adults aged 65 years and older with non-dialysis-dependent CKD.

Electrophysiologic characteristics and clinical correlation of right ventricular activation during left bundle branch area pacing (RV-LBBAP study).

Background: Left bundle branch area pacing (LBBAP) results in a right bundle branch (RBB) delay pattern because of preexcitation of the left bundle. The mechanism of right ventricular (RV) activation during LBBAP is largely unknown.

Objective: The aim of the study was to analyze the electrophysiologic characteristics of RV activation by mapping the RBB during LBBAP and its clinical correlation.

Academic Career Exploration: Learner Opportunities Through the Office of Faculty Affairs.

Introduction: Early exposure to medical school offices can help to facilitate interest in academic medicine and senior leadership positions. This workshop provides an overview of the roles, responsibilities, and activities within the Office of Faculty Affairs (OFA) and highlights opportunities for trainee engagement and leadership.

Methods: The Kern model was applied in the design of a 60-minute interactive module for medical students.

Techniques for removal of well-fixed implants and cement in revision total elbow arthroplasty.

Revision total elbow arthroplasty (rTEA) is a technically challenging procedure that is associated with high rates of surgical complications. Cement removal remains an important and difficult component of rTEA. Particularly in the case of prosthetic joint infection following TEA, failure to remove all of the cement from the index procedure results in higher rates of recurrent or persistent infection.