Incentivizing environmental sustainability for surgical healthcare at a systems level.

The healthcare sector contributes up to 4.6% of global greenhouse gas emissions. The surgical system contributes predominantly.

Could the R2C2 Feedback and Coaching Model Enhance Feedback Literacy Behaviors: A Qualitative Study Exploring Learner-Preceptor Feedback Conversations.

Introduction: Feedback literacy (FBL) is a critical skill for learners encompassing four behaviors: appreciating feedback, making judgements, managing affect, and taking action. Little guidance has been available for clinical preceptors to promote FBL. The R2C2 feedback and coaching model that guides teachers through building Relationships, exploring Reactions and Reflections, discussing Content and Coaching to co-develop an action plan for follow-up may support FBL.

Electroconvulsive therapy in the treatment of catatonia in a patient with Budd Chiari syndrome: a case report.

Catatonia may manifest as an independent entity or as a feature of a neuropsychiatric or medical illness. While electroconvulsive therapy (ECT) is the gold standard treatment for catatonia, it is typically administered if the patient's symptoms fail to respond to benzodiazepines. We describe the case of a 22-year-old male with Budd Chiari induced cirrhosis and no prior psychiatric history, who presented with symptoms of psychosis and hepatic encephalopathy, was treated in the ICU for multi-factorial delirium, developed symptoms of catatonia that failed to respond to lorazepam, ultimately requiring ECT with a favorable response.

Stress Management Program for Scanxiety in People With Advanced Lung Cancer: Intervention Adaptation and Stakeholder Feedback.

Background: Although scanxiety is common and impactful for people with advanced lung cancer, few interventions address this psychosocial concern.

Aims: To create a stress management program for scanxiety.

Methods: We conducted a structured intervention adaptation process guided by the ADAPT-ITT framework.

Engineered Mycobacterium tuberculosis triple-kill-switch strain provides controlled tuberculosis infection in animal models.

Human challenge experiments could accelerate tuberculosis vaccine development. This requires a safe Mycobacterium tuberculosis (Mtb) strain that can both replicate in the host and be reliably cleared. Here we genetically engineered Mtb strains encoding up to three kill switches: two mycobacteriophage lysin operons negatively regulated by tetracycline and a degron domain-NadE fusion, which induces ClpC1-dependent degradation of the essential enzyme NadE, negatively regulated by trimethoprim.

Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study.

Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy.

Algorithm-informed treatment from EEG patterns improves outcomes for patients with major depressive disorder.

Objective: Selecting the right medication for major depressive disorder (MDD) is challenging, and patients are often on several medications before an effective one is found. Using patient EEG patterns with computer models to select medications is a potential solution, however, it is not widely performed. Therefore, we evaluated a commercially available EEG data analysis system to help guide medication selection in a clinical setting.

An Elusive Diagnosis of Castleman Disease.

We present the case of a 41-year-old man with an anterior mediastinal mass and constellation of clinical symptoms, including dyspnea, pleural effusions, pericardial effusions, renal insufficiency, and pancytopenia. After inconclusive results on several laboratory tests and a nondiagnostic surgical biopsy specimen, a specimen from a second surgical biopsy identified the patient's condition as Castleman disease associated with TAFRO (thrombocytopenia, anasarca, fevers, reticulin myelofibrosis, organomegaly) syndrome. This case highlights the importance of obtaining large tissue biopsy samples, interval follow-up, and acknowledging cognitive biases.

Variations in Perioperative Thromboprophylaxis Practices: Do the Guidelines Need a Closer Look?

Background: In 2022, the American Association for Thoracic Surgery (AATS) and the European Society of Thoracic Surgeons (ESTS) published joint guidelines regarding the timing, duration, and choice of agent for perioperative venous thromboembolism prophylaxis for thoracic cancer patients. Now, 1 year after their release, we looked to assess practices and general adherence to these recommendations.

Methods: We conducted a survey among board-certified/board-eligible thoracic surgeons in the United States, between July and October 2023.

High- versus Low-dose Oxytocin Regimens for Labor Augmentation: A Systematic Review and Meta-analysis.

Objective: To assess whether high- versus low-dose oxytocin regimens for labor augmentation are associated with differential risk for low Apgar score, neonatal acidosis, and other adverse labor outcomes.

Data Sources: We searched electronic databases (MEDLINE, EMBASE, the Cochrane Library, CINAHL, Scopus, ClinicalTrials.gov) from inception up to March 2024 using combinations of the following keywords: "oxytocin," "oxytocin regimen," "oxytocin protocol," "oxytocin dosage," "active management," "high dose protocol," "low dose protocol," "augmentation of labor.

Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders.

Objective: To examine the prevalence and severity of postcesarean residual niche, evaluated using saline infusion sonohysterography, in an expanded cohort of women with one prior cesarean delivery and to assess the effect of uterine closure technique on the risk of placenta accreta spectrum (PAS) disorders.

Methods: This secondary analysis includes 70 patients who underwent saline infusion sonohysterography after one prior cesarean delivery. Patients were grouped according to hysterotomy closure technique: two-layer endometrium-free closure (technique A), and two- or one-layer routine closures (technique B).

Children's executive functioning and health behaviors across pediatric life stages and ecological contexts.

Executive functioning (EF) has been linked to chronic disease risk in children. Health behaviors are thought to partially explain this association. The current cross-sectional study evaluated specific domains of EF and varied health behaviors in three pediatric life stages.

Demographic Correlates of Autism: How Do Associations Compare Between Diagnosis and a Quantitative Trait Measure?

Prevalence of autism diagnosis has historically differed by demographic factors. Using data from 8224 participants drawn from the Environmental influences on Child Health Outcomes (ECHO) Program, we examined relationships between demographic factors and parent-reported autism-related traits as captured by the Social Responsiveness Scale (SRS; T score > 65) and compared these to relations with parent-reported clinician diagnosis of ASD, in generalized linear mixed effects regression analyses. Results suggested lower odds of autism diagnosis, but not of SRS T > 65, for non-Hispanic Black children (adjusted odds ratio [OR] = 0.

Association Between Chronic Kidney Disease Risk Categories and Abdominal Aortic Calcification: Insights From the National Health and Nutrition Examination Survey.

Background: Abdominal aortic calcification (AAC) is a critical indicator of cardiovascular risk, particularly in patients with chronic kidney disease (CKD). Traditional classification systems may underestimate the risk in those with moderate CKD. This study aimed to evaluate the association between CKD risk categories - defined by both estimated glomerular filtration rate (eGFR) and albuminuria - and the prevalence of severe AAC.

Coronary Intervention Outcomes in Patients with Liver Cirrhosis.

Purpose Of Review: This review assesses the outcomes of coronary interventions in patients with liver cirrhosis and coronary artery disease (CAD), focusing on the clinical challenges posed by cirrhosis-related hemodynamic and coagulopathic changes. It highlights essential considerations for managing these patients, who have an increased risk of adverse events during coronary procedures.

Recent Findings: Recent studies have shown that patients with liver cirrhosis undergoing PCI experience significantly higher mortality rates compared to non-cirrhotic patients, particularly in the context of STEMI and NSTEMI.

Development of a rapid screener to elicit patient preferences for antiseizure medication discontinuation.

Objective: While guidelines encourage individualized discussions of the risks and benefits of antiseizure medication (ASM) withdrawal after a period of seizure-freedom, no formal methods exist for assessing patient preferences. We report the initial development of a rapid patient preferences screener.

Methods: We conducted a mixed-methods study of adults who were ≥1 year seizure-free and seen for epilepsy across three institutions.

Scrolling to Success: Leveraging Social Media to Highlight Wellness Culture in Orthopedic Surgery Residency Programs.

Background Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, profoundly affects interprofessional collaboration. Despite rising burnout rates, there is a paucity of research regarding the use of social media to support wellness culture, particularly among orthopedic surgery residents. Methods A list of all US orthopedic surgery residency programs was compiled through the Accreditation Council for Graduate Medical Education (ACGME) and associated social media accounts were identified.

Delayed postoperative impedance issues in patients treated with deep brain stimulation: A single-center retrospective study.

Background: In rare circumstances, an implanted deep brain stimulation device will develop impedance issues across its contacts. Even more rare is the resultant inability to program a patient effectively, or that the patients' prior programming settings become unusable.

Objective: In this study we investigate this occurrence across the device manufacturers implanted, and whether this could be resolved.

Understanding the development of tuberculous granulomas: insights into host protection and pathogenesis, a review in humans and animals.

Granulomas, organized aggregates of immune cells which form in response to (), are characteristic but not exclusive of tuberculosis (TB). Despite existing investigations on TB granulomas, the determinants that differentiate host-protective granulomas from granulomas that contribute to TB pathogenesis are often disputed. Thus, the goal of this narrative review is to help clarify the existing literature on such determinants.

To Acquire or Not to Acquire: Evaluating Compressive Sensing for Raman Spectroscopy in Biology.

Raman spectroscopy has revolutionized the field of chemical biology by providing detailed chemical and compositional information with minimal sample preparation. Despite its advantages, the technique suffers from low throughput due to the weak Raman effect, necessitating long acquisition times and expensive equipment. This limitation is particularly acute in time-sensitive applications like bioprocess monitoring and dynamic studies.

A multi-phase structured cascade model for mass training of community healthcare workers in performing clinical breast exams in remote regions.

Background: Clinical breast exam (CBE) by outreach healthcare workers (HCW) may help downstage breast cancer in resource-limited areas where mammography may not be feasible. We evaluated the effectiveness of a pilot cascade-model training programme for HCWs in remote areas of Pakistan.

Methods: The training programme comprised three phases.

Lipid-Lowering Therapy Use When Indicated and Subsequent Ischemic Stroke Severity.

Background: Elevated low-density lipoprotein cholesterol is a risk factor for atherosclerotic cardiovascular disease, including acute ischemic stroke (AIS), due to large- and small-vessel disease. Cholesterol management guidelines recommend lipid-lowering therapy (LLT) to prevent atherosclerotic cardiovascular disease events. This study assessed use of LLT at the time of AIS according to guideline recommendations and determined the association of prestroke LLT use with stroke severity.

Dysarthria and Altered Mental Status Following Electroconvulsive Therapy (ECT) in a Patient With Polycythemia Vera: A Case Report.

Although rare, neurological complications following electroconvulsive therapy (ECT) can have significant consequences. Recognizing patient populations that may be at high risk of neurological complications following ECT can reduce the likelihood of these patients developing such complications. We report a case of a patient with a history of polycythemia vera presenting with a worsening episode of depression with psychotic features who demonstrated a significant change in neurological status following ECT, suspected to be due to cerebral ischemia.