Beyond milestones and percentiles: Revisiting non-cognitive and non-interpretive skills in radiology.

While there is no precise formula for a great radiology resident, certain attributes and achievements may herald success during training. We briefly review prior works exploring predictive factors and evaluation metrics of top resident performance, noting that those focusing on non-cognitive attributes are over twenty years old. As radiology practice and education has substantially evolved in the interim, we revisit this topic from a contemporary perspective.

Healthcare system variability and inpatient maternal mortality in the United States.

Objective: To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban/rural designation, teaching/non-teaching status, regional location, and insurance coverage.

Methods: This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012-2014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes.

Rx -to- OTC switch increased access and lowered cost of topical adapalene.

Topical adapalene gel is an effective and well tolerated acne treatment that transitioned from prescription to over-the-counter (OTC) availability in 2016. Historically, prescription to OTC transitions have lowered costs to patients and payers and increased access to medications. This study used sales and prescriber data to assess access to topical retinoid therapies and their costs in the pre- and post- Rx-to-OTC transition.

Decolonial framework for applying reflexivity and positionality in global health research.

Contemporary research practices link to colonial and imperialist knowledge creation and production and may promote harmful perspectives on marginalized and oppressed groups. We present a framework for a decolonial approach to research in global health and health promotion applicable across research settings. This framework is aimed at anticipating and alleviating potentially harmful practices inherent in dominant research methods.

IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction.

Cold agglutinins produced in the setting of B cell neoplasms, such as lymphoplasmacytic lymphoma and plasma cell myeloma, can mediate autoimmune haemolytic anemia. Transfusion of these patients can exacerbate cold agglutinin-mediated haemolysis. Moreover, the workup for these reactions represents a diagnostic challenge due in part to false negative direct antiglobulin tests (DATs).

Oral versus intravenous iron for anemia in pregnancy: a cost-effectiveness analysis.

Our findings suggest that treating antepartum anemia with currently available iron therapies would result in significant cost-savings and reductions in adverse outcomes associated with anemia in this context. Ferric carboxymaltose likely confers the greatest overall benefit among competing options. This conclusion is robust to uncertainty, even when the cost these therapies is significantly higher than is demonstrated in the literature.

Patient experiences in receiving telegenetics care for inherited cardiovascular diseases.

Telegenetics played an important role in providing genetic services to patients during the COVID-19 pandemic. In particular, at our institution, it enabled us to expand our genetic counseling and testing services to non-local family members of patients outside of our prior catchment area. However, as telegenetics continues to be utilized even as social distancing is no longer required, further information is needed regarding the impact of this modality on patient experience within cardiogenetics.

Cryptococcal pneumonia and meningitis in a renal transplant recipient with a false negative serum cryptococcal antigen due to postzone phenomenon.

Cryptococcal infection can cause significant morbidity and mortality in immunocompromised patients. We present a patient who was diagnosed with cryptococcal meningitis and pulmonary disease in the setting of a history of renal transplantation. The diagnosis was made based on growth of in blood cultures and identification of cryptococcal antigen (CrAg) in cerebral spinal fluid (CSF) using a lateral flow assay (LFA).

Placement of a tracheoesophageal prosthesis using intraoperative ultrasound: A novel technique.

Introduction: In patients who undergo a total laryngectomy, one of the most common techniques for voice rehabilitation is a tracheoesophageal prosthesis. Typically, this is accomplished using an endoscope down the oesophagus to visualise puncturing of the posterior tracheal wall; however, we present a case in which the use of an endoscope was not feasible, and a novel technique had to be utilised.

Case Report: A mid-70s male who had a total laryngectomy secondary to laryngeal carcinoma was undergoing tracheoesophageal puncture for prosthesis placement, when it was noted that he had significant stenosis of his proximal oesophagus, precluding the use of an endoscope.

Management of Localized Prostate Cancer in Men With Human Immunodeficiency Virus: Analysis of a Large Retrospective Cohort.

Introduction: We aimed to characterize the clinicopathological characteristics and outcomes of HIV-positive patients with clinically localized, prostate cancer (PCa).

Methods: A retrospective study was conducted of HIV-positive patients from a single institution with elevated PSA and diagnosis of PCa by biopsy. PCa features, HIV characteristics, treatment type, toxicities, and outcomes were analyzed by descriptive statistics.

Impact of Minimally Invasive Approach to Radical Cystectomy in Bladder Cancer Patients with Malnutrition.

Malnutrition is associated with higher rates of complications following radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer. The newer robotic approach to RC has yet to be analyzed against the open approach in malnourished patients with respect to perioperative complications. A retrospective cohort analysis of RC patients with a postoperative diagnosis of bladder cancer and non-disseminated disease was performed.

Prevalence and predictors of outcomes among ESRD patients with COVID-19.

Background: End-stage renal disease patients on hemodialysis (ESRD) patients are at high risk for contracting COVID-19. In this propensity matched cohort study, we examined the prevalence of COVID-19 in emergency room (ER) patients and examined whether clinical outcomes varied by ESRD status.

Methods: Patients who visited George Washington University Hospital ER from April 2020 to April 2021 were reviewed for COVID-19 and ESRD status.

Role of Race and Insurance Status in Prostate Cancer Diagnosis-to-Treatment Interval.

Introduction: Numerous studies have shown that both race and insurance status may affect prostate cancer (PCa) workup and treatment. Preliminary investigations have shown that these factors may be associated with treatment delays, which may indicate inequitable care and increase risk of tumor progression. This investigation aimed to assess whether race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy, and biopsy-to-prostatectomy.

Appearance of medullary and cortical veins on multiphase CT-angiography in patients with acute ischemic stroke.

Objective: We sought to determine if interhemispheric asymmetry of cortical and medullary veins evaluated on CT angiography can provide a more accurate prediction of outcome in patients with acute ischemic stroke when compared to hemispheric asymmetry of cortical or medullary vein drainage alone.

Methods: We retrospectively reviewed a database of patients with anterior circulation distribution acute ischemic stroke, who were evaluated by multiphase CTA. Cortical veins were evaluated using the adopted Prognostic Evaluation based on Cortical vein score difference In Stroke (PRECISE) system.

The Association of Maternal Satisfaction with Childbirth by Length of Second Stage.

Objective: The aim of this study was to quantify patient satisfaction by hour of second stage of labor and subsequent delivery mode.

Study Design: Pilot cross-sectional study of nulliparous women delivered at George Washington University Hospital between April 2018 and March 2019. Patients completed three survey questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), and Six Simple Questions (SSQ).

Labor Induction Outcomes with Outpatient Misoprostol for Cervical Ripening among Low-Risk Women.

Objective: In 2012, two Kaiser Permanente Northern California (KPNC) hospitals began offering outpatient cervical ripening with oral misoprostol under a study protocol. We evaluated inpatient time from admission to delivery and adverse maternal and neonatal outcomes associated with outpatient use of misoprostol for cervical ripening among low-risk women with term pregnancies.

Study Design: We conducted a retrospective cohort study comparing three groups: women who received misoprostol (1) outpatient, under a study protocol; (2) inpatient, at the study sites; and (3) inpatient, at all KPNC hospitals.

Adverse Childhood Experiences and Obesity: A One-to-One Correlation?

Introduction: Adverse childhood experiences (ACEs) have been associated with physical and emotional problems such as obesity and depression in adulthood. This study evaluated the relationship between ACE scores and the severity of obesity.

Methods: We conducted a cross-sectional study of 119 adult patients at the GW Weight Management Clinic.

Current use, training, and barriers in point-of-care ultrasound in hospital medicine: A national survey of VA hospitals.

Background: Point-of-care ultrasound (POCUS) can reduce procedural complications and improve the diagnostic accuracy of hospitalists. Currently, it is unknown how many practicing hospitalists use POCUS, which applications are used most often, and what barriers to POCUS use exist.

Objective: This study aimed to characterize current POCUS use, training needs, and barriers to use among hospital medicine groups (HMGs).

Practices of sickle cell disease genetic screening and testing in the prenatal population.

Background: Genetic screening and testing are technologies historically underutilized in Black populations despite predicting diseases like sickle cell disease (SCD), which is predominantly found in Blacks. We surveyed prenatal patients to understand choices, beliefs and experiences surrounding genetic screening and testing, specifically for SCD.

Methods: In this cross-sectional study, we surveyed 322 women during prenatal visits.

Palliative care: An update for internists.

All clinicians should maintain basic skills in general palliative care to help address the needs of patients and families. Because keeping up with the information provided by the growing palliative care literature can be challenging, we conducted a detailed search via Medline for palliative care articles published in 2020 in top peer-reviewed medical journals. Using a consensus-driven process of selection, we reviewed and summarized 11 articles to enhance knowledge of the practice-changing palliative care literature for general internists.

Point-of-Care Ultrasound for the Trauma Anesthesiologist.

Purpose Of Review: With advances in technology and availability of handheld ultrasound probes, studies are focusing on the perioperative care of patients, but a limited number specifically on trauma patients. This review highlights recent findings from studies using point of care ultrasound (POCUS) to improve the care of trauma patients.

Recent Findings: Major findings include the use of POCUS to assess volume status of trauma patients upon arrival to measure the major vasculature.

Utilization of submandibular ultrasound to measure oral cavity changes with interventions in routine airway management.

Ultrasound is a quick, noninvasive, inexpensive tool that can provide an accurate airway assessment. Tongue thickness, oral cavity height, and their relationship were measured using submandibular ultrasonography with and without oral airway interventions during intubation in 26 patients. The mean tongue thickness to oral cavity height ratio was 0.