Direct Induction of Buprenorphine Extended-Release: A Case Report.

Buprenorphine has superior safety in opioid use disorder compared with alternatives due to its action as a partial opioid agonist, which limits its ability to cause respiratory depression. There is a risk of precipitated opioid withdrawal after buprenorphine exposure in someone using full opioid agonists. Buprenorphine induction strategies that avoid precipitated withdrawal remain a crucial component for starting buprenorphine in individuals actively using opioids.

Enhancing Lung Ultrasound Diagnostics: A Clinical Study on an Artificial Intelligence Tool for the Detection and Quantification of A-Lines and B-Lines.

A-lines and B-lines are key ultrasound markers that differentiate normal from abnormal lung conditions. A-lines are horizontal lines usually seen in normal aerated lungs, while B-lines are linear vertical artifacts associated with lung abnormalities such as pulmonary edema, infection, and COVID-19, where a higher number of B-lines indicates more severe pathology. This paper aimed to evaluate the effectiveness of a newly released lung ultrasound AI tool (ExoLungAI) in the detection of A-lines and quantification/detection of B-lines to help clinicians in assessing pulmonary conditions.

Assessment of an Artificial Intelligence Tool for Estimating Left Ventricular Ejection Fraction in Echocardiograms from Apical and Parasternal Long-Axis Views.

This work aims to evaluate the performance of a new artificial intelligence tool (ExoAI) to compute the left ventricular ejection fraction (LVEF) in echocardiograms of the apical and parasternal long axis (PLAX) views. We retrospectively gathered echocardiograms from 441 individual patients (70% male, age: 67.3 ± 15.

Extended-Release 7-Day Injectable Buprenorphine for Patients With Minimal to Mild Opioid Withdrawal.

Importance: Buprenorphine is an effective yet underused treatment for opioid use disorder (OUD).

Objective: To evaluate the feasibility (acceptability, tolerability, and safety) of 7-day injectable extended-release buprenorphine in patients with minimal to mild opioid withdrawal.

Design, Setting, And Participants: This nonrandomized trial comprising 4 emergency departments in the Northeast, mid-Atlantic, and Pacific geographic areas of the US included adults aged 18 years or older with moderate to severe OUD and Clinical Opiate Withdrawal Scale (COWS) scores less than 8 (minimal to mild), in which scores range from 0 to 7, with higher scores indicating increasing withdrawal.

Emergency Department Access to Buprenorphine for Opioid Use Disorder.

Importance: Although substantial evidence supports buprenorphine for treatment of opioid use disorder (OUD) in controlled trials, prospective study of patient outcomes in clinical implementation of emergency department (ED) buprenorphine treatment is lacking.

Objective: To examine the association between buprenorphine treatment in the ED and follow-up engagement in OUD treatment 1 month later.

Design, Setting, And Participants: This multisite cohort study was conducted in 7 California EDs participating in a statewide implementation project to improve access to buprenorphine treatment.

Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite).

Background: Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts.

A descriptive analysis of predoctoral surgical requirements in US dental schools in 2020.

Objectives: This study aims to describe surgical graduation requirements in US dental schools in 2020, including changes made due to the COVID-19 pandemic.

Methods: Representatives of Commission on Dental Accreditation-approved predoctoral dental programs in the US (n = 66) received a 13-item questionnaire about operative and observational surgical requirements. Responses were assigned values to tabulate a surgical score (zero- to eight-point scale) as a proxy for required surgical experience, and statistical analyses were performed to explore for predictors.

Defining an Ultrasound-guided Regional Anesthesia Curriculum for Emergency Medicine.

Objectives: Ultrasound-guided regional anesthesia (UGRA) can be a powerful tool in the treatment of painful conditions commonly encountered in emergency medicine (EM) practice. UGRA can benefit patients while avoiding the risks of procedural sedation and opioid-based systemic analgesia. Despite these advantages, many EM trainees do not receive focused education in UGRA and there is no published curriculum specifically for EM physicians.

"I wanted to participate in my own care": Evaluation of a Patient Navigation Program.

Introduction: Patient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users.

Case Report: Bilateral Ultrasound-guided Serratus Anterior Plane Blocks for a Chest Wall Burn.

Introduction: The serratus anterior plane block (SAPB) has been shown to effectively treat pain following breast surgery, thoracotomies, and rib fractures. We present the first reported case of a bilateral ultrasound-guided SAPB in a multimodal analgesic regimen after an acute large, thoracic, deep partial-thickness burn.

Case Report: A 72-year-old male presented in severe pain two days after sustaining a deep partial- thickness burn to his anterior chest wall after his shirt caught on fire while cooking.

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic.

Background: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside.

Oral manifestations and clinical progression of a rare double-hit B-cell lymphoma: a case report and review of the literature.

Double-hit (DH) lymphoma is a rare subtype of B-cell lymphoma characterized by the chromosomal rearrangement of c-Myc and Bcl-2, and/or Bcl-6. c-Myc is an oncogene that keeps cells proliferative. Bcl-2 and Bcl-6 grant cells antiapoptotic features.

Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department.

We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41 year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. The AC joint was located by US, and bupivacaine was injected into the joint effusion under US guidance, yielding near complete resolution of pain.

A Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block.

Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.

Principles of safety for ultrasound-guided single injection blocks in the emergency department.

Ultrasound-guided nerve blocks (UGNBs) allow emergency physicians an opportunity to provide optimal pain management for acute traumatic conditions. Over the past decade, a growing body of literature has detailed the novel ways clinicians have incorporated UGNBs for analgesia and an alternative to procedural sedation. UGNBs are considered a relatively safe procedure, and have been shown to increase rates of success and reduce complications (as compared to older techniques).

Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control.

The ultrasound-guided transversus abdominis plane (TAP) block or TAP block is a well-established regional anesthetic block used by anesthesiologists for peri-operative pain control of the anterior abdominal wall. Multiple studies have demonstrated its utility to control pain for a range of procedures from inguinal hernia repair, laparoscopic cholecystectomies to cesarean sections [1-3]. There are no cases describing the efficacy of the ultrasound-guided TAP block in the emergency department as a part of a multimodal pain pathway for patients diagnosed with acute appendicitis.

Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician.

We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture.

Syphilis and vision loss: A role for point-of-care ultrasound.

Vision loss in young adults is relatively rare. In patients with suspected HIV or syphilis, the risk of developing vision loss is increased, and should alert the emergency physician of specific retinal pathologies. We present a case of a 33-year-old man with recently identified syphilis and HIV, who was diagnosed with bilateral retinal detachments (RDs) with the help of point-of-care ultrasound (POCUS) in the setting of panuveitis (preventing visualization with direct fundoscopy).

Fibromodulin reduces scar formation in adult cutaneous wounds by eliciting a fetal-like phenotype.

Blocking transforming growth factor (TGF)β1 signal transduction has been a central strategy for scar reduction; however, this approach appears to be minimally effective. Here, we show that fibromodulin (FMOD), a 59-kD small leucine-rich proteoglycan critical for normal collagen fibrillogenesis, significantly reduces scar formation while simultaneously increasing scar strength in both adult rodent models and porcine wounds, which simulate human cutaneous scar repair. Mechanistically, FMOD uncouples pro-migration/contraction cellular signals from pro-fibrotic signaling by selectively enhancing SMAD3-mediated signal transduction, while reducing AP-1-mediated TGFβ1 auto-induction and fibrotic extracellular matrix accumulation.

Using Social Media to Characterize Public Sentiment Toward Medical Interventions Commonly Used for Cancer Screening: An Observational Study.

Background: Although cancer screening reduces morbidity and mortality, millions of people worldwide remain unscreened. Social media provide a unique platform to understand public sentiment toward tools that are commonly used for cancer screening.

Objective: The objective of our study was to examine public sentiment toward colonoscopy, mammography, and Pap smear and how this sentiment spreads by analyzing discourse on Twitter.

Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital.

Objectives: To explore the feasibility and acceptability of providing acupuncture treatment to relieve pain and nausea symptoms in intensive care unit (ICU) patients.

Design: Prospective feasibility study.

Settings/location: Public safety net hospital with a 20-bed mixed medical/surgical ICU.

Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate in Asian Subjects with Human Immunodeficiency Virus 1 Infection: A Sub-Analysis of Phase 3 Clinical Trials.

The efficacy and safety of a single tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF) were analyzed in Phase 3 clinical trials in antiretroviral therapy (ART)-naïve and ART-experienced Asian subjects infected with human immunodeficiency virus (HIV)-1. Studies GS-US-236-102 and GS-US-236-103 were randomized, double-blind, placebo-controlled, 144-week studies conducted in ART-naïve subjects, comparing E/C/F/TDF versus efavirenz (EFV)/F/TDF or ritonavir-boosted atazanavir (ATV+RTV) plus emtricitabine/tenofovir DF (F/TDF), respectively. Studies GS-US-236-115 and GS-US-236-121 were randomized, open-label, 96-week long conducted in ART-experienced subjects, who switched to E/C/F/TDF from ritonavir-boosted protease inhibitors (PI+RTV)+F/TDF, or non-nucleoside reverse transcriptase inhibitors (NNRTI)+F/TDF regimens.