Epidemics and the healthcare professional's duty to care: Students' attitudes about work requirements before and during Covid-19 (2017-2021).

Context: The Covid-19 pandemic has added a new chapter to discussions about the professional duty to care. To understand how Covid-19 may have changed medical students' ethical attitudes towards this duty, we analysed policies written before and during the pandemic by first-year students completing a yearly educational exercise focused on work requirement expectations for healthcare professionals during a hypothetical epidemic.

Methods: Within a repeated cross-sectional design, consensus coding was performed on policies written over 5 years (2017-2021) using a codebook based on eight questions from the educational exercise for summative content analysis.

Synchronous Bilateral Breast Cancer: A Case Report Piloting and Evaluating the Implementation of the AI-Powered Large Language Model (LLM) ChatGPT.

Primary breast carcinoma is the most common cancer type in women, and although bilateral synchronous breast cancers (s-BBC) remain quite rare, the reported incidence may increase with the adoption of more sensitive imaging modalities. Here, we present a case of histomorphological and clinically distinct s-BBC, together with a discussion of clinical management decisions, prognosis, and treatment standards and how these relate to outcomes vis-à-vis more established standards in unifocal breast carcinoma. The case report also constitutes a pilot and formal evaluation of a large language model (LLM) of ChatGPT as a tool to aid in generating a single patient case report.

Changes in Pediatric Intensive Care Admissions in Wisconsin During the 2020 COVID-19 Pandemic.

Background: We perceived changes in the frequency of and reasons for admissions to Wisconsin pediatric intensive care units (PICU) during the advent of the COVID-19 pandemic, and we hypothesized that the rates of total, scheduled, and respiratory viral admissions were lower during the first calendar year of the pandemic than would have been predicted by historical admission data. Such findings would reflect important changes in PICU utilization paradigms during the pandemic. There are no descriptions of PICU admission changes in a single American state during the pandemic.

A Review of Concurrent Chemo/Radiation, Immunotherapy, Radiation Planning, and Biomarkers for Locally Advanced Non-small Cell Lung Cancer and Their Role in the Development of ECOG-ACRIN EA5181.

ECOG-ACRIN EA5181 is a current prospective, randomized trial that is investigating whether the addition of concomitant durvalumab to standard chemo/radiation followed by 1 year of consolidative durvalumab results in an overall survival benefit over standard chemo/radiation alone followed by 1 year of consolidative durvalumab in patients with locally advanced, unresectable non-small cell lung cancer (NSCLC). Because multiple phase I/II trials have shown the relative safety of adding immunotherapy to chemo/radiation and due to the known synergism between chemotherapy and immunotherapy, it is hoped that concomitant durvalumab can reduce the relatively high incidence of local failure (38%-46%) as seen in recent prospective, randomized trials of standard chemo/radiation in this patient population. We will review the history of radiation for LA-NSCLC and discuss the role of induction, concurrent and consolidative chemotherapy as well as the concerns for late cardiac and pulmonary toxicities associated with treatment.

Diagnostic Stewardship: Appropriate Testing and Judicious Treatments.

Diagnostic stewardship encompasses the entire diagnosis-to-treatment paradigm in the intensive care unit (ICU). Initially born of the antimicrobial stewardship movement, contemporary diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions. In the stewardship framework, excessive diagnostic testing in low probability cases is discouraged due to its tendency to generate false-positive results, which have their own downstream consequences.

Diagnostic Error in the Critically Ill: A Hidden Epidemic?

Epidemiologic studies of diagnostic error in the intensive care unit (ICU) consist mostly of descriptive autopsy series. In these studies, rates of diagnostic errors are approximately 5% to 10%. Recently validated methods for retrospectively measuring error have expanded our understanding of the scope of the problem.

The Risks of Reflexive Refilling.

Introduction: The electronic health record and electronic prescribing have transformed the practice of medicine. Both have led to improved efficacy and safety in medication management. However, dangers may arise when electronic prescription requests are filled by default and when electronic health record medication lists are presumed accurate.

A Review of Immunotherapy for Stage III and Metastatic Non-Small Cell Lung Cancer and the Rationale for the ECOG-ACRIN EA5181 Study.

ECOG-ACRIN EA5181 is a phase III prospective, randomized trial that randomizes patients undergoing chemo/radiation for locally advanced non-small cell lung cancer (LA-NSCLC) to concomitant durvalumab or no additional therapy, with both arms receiving 1 year of consolidative durvalumab. Radiation dose escalation failed to improve overall survival in RTOG 0617. However, conventionally fractionated radiation to 60 Gy with concomitant chemotherapy is associated with a high risk of local failure (38%-46%).

Current understanding and future implications of sepsis-induced thrombocytopenia.

Sepsis is a global health burden that needs intensive medical care. Thrombocytopenia in sepsis is well known to increase morbidity as well as mortality. Several studies have been performed both in animal models and in humans to understand the mechanism by which sepsis causes thrombocytopenia.

Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: The MIST trial.

Rationale: Minimally invasive cardiac surgery has emerged as a safe alternative to standard cardiac surgery. Minimally invasive coronary surgery (MICS CABG) was developed to allow adequate exposure and complete revascularization in CABG from a small thoracotomy incision without cardiopulmonary bypass. Multiple studies have reported significant shorter length of hospital stay and earlier postoperative physical recovery for MICS CABG patients when compared to sternotomy CABG patients.

Role of Echocardiography in the Diagnosis of Aorto-Right Ventricular Fistula: A Rare Complication of Surgical Aortic Valve Replacement Successfully Closed by Bovine Pericardial Patch.

• AoRV fistula is a rare complication of prosthetic aortic valve replacement. • A high index of suspicion is required for detection. • Postprocedural follow-up with echocardiography is key to early diagnosis.

A Systematic Review of Arthroscopic Versus Open Tenotomy of Iliopsoas Tendonitis After Total Hip Replacement.

Purpose: To conduct a systematic review of the literature comparing patient outcomes following arthroscopic and open operative management of iliopsoas tendonitis (IPT) following total hip replacement (THR).

Methods: This review study was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Inclusion criteria were as follows: outcome studies following open or arthroscopic iliopsoas tendon release after THR with at least 6 months of follow-up, English language, and human studies.

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

Objective: To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR).

Background: Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation.

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting.

Background: We examined the efficacy of olanzapine for the prevention of nausea and vomiting in patients receiving highly emetogenic chemotherapy.

Methods: In a randomized, double-blind, phase 3 trial, we compared olanzapine with placebo, in combination with dexamethasone, aprepitant or fosaprepitant, and a 5-hydroxytryptamine type 3-receptor antagonist, in patients with no previous chemotherapy who were receiving cisplatin (≥70 mg per square meter of body-surface area) or cyclophosphamide-doxorubicin. The doses of the three concomitant drugs administered before and after chemotherapy were similar in the two groups.

Total Hip Arthroplasty With an Uncemented Tapered Femoral Component in Patients Younger Than 50 Years of Age: A Minimum 20-Year Follow-Up Study.

Background: Previously, we reported the mean 16-year results of primary uncemented total hip arthroplasty using a tapered femoral component in patients <50 years. The purpose of this study was to update our previous report using the Taperloc femoral component in young patients who had been followed for a minimum of 20 years postoperatively.

Methods: Between 1983 and 1990, 108 consecutive uncemented total hip arthroplasties were performed in 91 patients of age <50 years, with use of the Taperloc femoral component.

Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients.

Background: The long-term outcome of patients with pyogenic vertebral osteomyelitis (PVO) has not been fully assessed.

Methods: We conducted a retrospective cohort study to describe the long-term outcome of PVO and to assess risk factors for treatment failure in patients evaluated at our institution between 1994 and 2002. Patients were observed until July 1, 2013.

Translation of incremental talk test responses to steady-state exercise training intensity.

Purpose: The Talk Test (TT) is a submaximal, incremental exercise test that has been shown to be useful in prescribing exercise training intensity. It is based on a subject's ability to speak comfortably during exercise. This study defined the amount of reduction in absolute workload intensity from an incremental exercise test using the TT to give appropriate absolute training intensity for cardiac rehabilitation patients.

Gunshot wounds and blast injuries to the face are associated with significant morbidity and mortality: results of an 11-year multi-institutional study of 720 patients.

Background: Gunshot wounds and blast injuries to the face (GSWBIFs) produce complex wounds requiring management by multiple surgical specialties. Previous work is limited to single institution reports with little information on processes of care or outcome. We sought to determine those factors associated with hospital complications and mortality.

Recovery education: a tool for psychiatric nurses.

Patient teaching is vital for nursing care of psychiatric patients. This paper describes the process of developing Recovery Education as a tool for nurses who lead daily patient education groups. Gundersen Lutheran's Recovery Model developed for the Inpatient Psychiatric Unit includes seven Elements of Recovery--Hope, Security, Support/Managing Symptoms, Empowerment, Relationships, Coping and Finding Meaning.

Incidence of nonunion after isolated arthroscopic ankle arthrodesis.

Purpose: To determine the incidence of nonunion after isolated arthroscopic ankle arthrodesis.

Methods: Electronic databases and relevant peer-reviewed sources, including OvidSP/Medline (http://ovidsp.tx.