Improving Procedural Pain Management for Newborns in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Introduction:  Neonatal pain has been associated with numerous adverse outcomes, making pain management essential in the neonatal intensive care unit (NICU). Our specific, measurable, actionable, realistic, and timely (SMART) aim was to increase the proportion of neonates receiving pain management interventions during painful procedures from a baseline of less than 30% to above 50% within six months.

Methods: The Plan-Do-Study-Act (PDSA) model for improvement methodology was employed to improve pain management in the NICU between August 2022 and July 2023.

Effectiveness and Safety of Pharmacologic Therapies for Migraine in the Emergency Department: A Systematic Review and Bayesian Network Meta-analysis.

Study Objective: We performed a systematic review and Bayesian network meta-analysis to determine which pharmacologic therapies are relatively more effective and safer for migraine in adult patients who present to the emergency department (ED).

Methods: We searched MEDLINE, Embase, and Web of Science from inception to February 9, 2024. Eligible studies were randomized controlled trials that enrolled adult participants presenting to ED with migraine and compared one pharmacologic therapy to another or placebo.

Hurricane Ida - Mitigation and Preparedness for Flash-Flooding in New York City.

Objectives: Hurricane Ida delivered record rainfall to the northeast, resulting in 11 deaths in New York City. We review these deaths, identify risk factors, and discuss solutions to prevent recurrence.

Methods: Deaths were confirmed by multiple sources.

Risk-stratification tools for emergency department patients with syncope: A systematic review and meta-analysis of direct evidence for SAEM GRACE.

Objectives: Approximately 10% of patients with syncope have serious or life-threatening causes that may not be apparent during the initial emergency department (ED) assessment. Consequently, researchers have developed clinical decision rules (CDRs) to predict adverse outcomes and risk stratify ED syncope patients. This systematic review and meta-analysis (SRMA) aims to cohere and synthesize the best current evidence regarding the methodological quality and predictive accuracy of CDRs for developing an evidence-based ED syncope management guideline.

Do hybrid closed loop insulin pump systems improve glycemic control and reduce hospitalizations in poorly controlled type 1 diabetes?

Objectives: Hybrid closed-loop (HCL) systems improve glycemic control in type 1 diabetes mellitus (T1D), but their effectiveness in young, poorly controlled populations is not established and requires study.

Methods: A pre-post study was performed using electronic health records of patients 3-24 years with baseline HbA≥9 % prescribed HCL within the New York City Health+Hospitals System assessing HbA levels and hospitalizations before and after HCL initiation and factors associated with achieving HbA<9 % after HCL initiation.

Results: Of 47 children and adolescents who met inclusion criteria, 4.

Partial Reconstruction of the Auricle With the Tubed Postauricular Flap: A Case Report and Proposed Innovation for Flap Conditioning.

The authors present a case of a partial auricular deformity acquired from a human bite that was reconstructed using a 3-stage posterior auricular tubed flap. Helical rim avulsions may be ideally reconstructed with a tubed flap created from lax postauricular soft tissue. During the third stage, division and inset of the inferior pedicle of the flap were complicated by venous congestion.

Rethinking Prehospital Response to Mass Casualty Events: Move, Treat, and Transport.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world.

Jewish women in dermatology.

We highlight the contribution of notable Jewish women in American dermatology. Although not intended to be a thorough listing, we selected nine representatives as examples of early pioneer women in American dermatology and research and those who were political leaders, authors and journal editors, and teachers and role models. All struggled to overcome professional barriers to women in medicine; many experienced antisemitism, especially those who were forced to flee Nazi Germany.

Granulomatous Mastitis: An Initial Presentation of Undiagnosed Prolactinoma.

Granulomatous lobular mastitis (GLM) is a rare, benign inflammatory disease of the breast that shares some physical diagnostic features with breast cancer. GLM has been rarely reported to be associated with prolactinoma. In this report, we present a case of undiagnosed prolactinoma in a 37-year-old woman with its initial presentation as GLM.

Limitations of Triage in Military Mass Casualty Response: A Case Series.

Introduction: Mass casualty events (MASCALs) in the combat environment, which involve large numbers of casualties that overwhelm immediately available resources, are fundamentally chaotic and dynamic and inherently dangerous. Formal triage systems use diagnostic algorithms, colored markers, and four or more named categories. We hypothesized that formal triage systems are inadequately trained and practiced and too complex to successfully implement in true MASCAL events.

A Novel Approach to Noncompressible Torso Hemorrhage Using a Silicone-Based Polymer Universal Combat Matrix.

Introduction: Battlefield trauma necessitates prompt hemostatic intervention to mitigate fatalities resulting from critical blood loss. Insights from Operation Enduring Freedom and Operation Iraqi Freedom emphasize the limitations of conventional methods, such as tourniquets, especially in noncompressible torso hemorrhage. Despite advancements in hemostatic agents, the evolving dynamics of multidomain operations necessitate novel, lightweight strategies for hemorrhage control.

Treatment of Type 2 Diabetes Mellitus in Advanced Chronic Kidney Disease for the Primary Care Physician.

Diabetes mellitus (DM) is a common cause of chronic kidney disease (CKD), leading to the need for renal replacement therapy (RRT). RRT includes hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT), and medical management. As CKD advances, the management of DM may change as medication clearance, effectiveness, and side effects can be altered due to decreasing renal clearance.

Gastroesophageal Junction Adenocarcinoma With Skeletal Muscle Metastases: A Case Report and Literature Review.

Esophageal and gastroesophageal junction (GEJ) malignancies are aggressive, and survival is poor once metastasis occurs. The most common sites of metastatic involvement include the liver, lymph nodes, lung, peritoneum, adrenal glands, bone, and brain, while skeletal muscle (SM) involvement is rare. We report a case of a 68-year-old female who presented with intractable emesis for one month and was found to have a primary GEJ adenocarcinoma measuring up to 6.

Dysfunction of motor cortices in Parkinson's disease.

The cerebral cortex has long been thought to be involved in the pathophysiology of motor symptoms of Parkinson's disease. The impaired cortical function is believed to be a direct and immediate effect of pathologically patterned basal ganglia output, mediated to the cerebral cortex by way of the ventral motor thalamus. However, recent studies in humans with Parkinson's disease and in animal models of the disease have provided strong evidence suggesting that the involvement of the cerebral cortex is much broader than merely serving as a passive conduit for subcortical disturbances.

Fatal Cardiac Tamponade: The Lethal Progression of Acute-on-Chronic Pericardial Effusion.

Cardiac tamponade is a life-threatening occurrence with an incidence rate of about two out of 1,000 people. It is caused by the rapid accumulation of fluid in the pericardial sac. This can lead to the physical examination findings of tachycardia, hypotension, and elevated jugular venous pressure.

A Rare Encounter With Unusual Metastasis: Metastatic Right Ventricular Tumor Secondary to Cervical Cancer.

Metastasis of cervical cancer to the heart is rare. Cervical carcinoma typically spreads to the lungs, liver, bones, and lymph nodes via hematogenous, lymphatic, transvenous, or direct extension. Cardiac metastasis from cervical carcinoma is uncommon and portends a dismal prognosis, with mean survival under six months post-diagnosis.

A scoping review of geriatric emergency medicine research transparency in diversity, equity, and inclusion reporting.

Introduction: The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research.

Methods: We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department-based research focused on falls, delirium/dementia, medication safety, and elder abuse.