Addressing Diabetes in Primary Care: Hybrid Effectiveness-Implementation Study of Lifestyle Redesign Occupational Therapy.

Importance: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings.

Objective: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic.

Are You Applying to More Than One Specialty?

Although the majority of U.S. medical students predominantly apply to only one specialty, some apply to more than one.

Inhibition of Cathepsin S Reduces Lacrimal Gland Inflammation and Increases Tear Flow in a Mouse Model of Sjögren's Syndrome.

Cathepsin S (CTSS) is highly increased in Sjögren's syndrome (SS) patients tears and in tears and lacrimal glands (LG) of male non-obese diabetic (NOD) mice, a murine model of SS. To explore CTSS's utility as a therapeutic target for mitigating ocular manifestations of SS in sites where CTSS is increased in disease, the tears and the LG (systemically), the peptide-based inhibitor, Z-FL-COCHO (Z-FL), was administered to 14-15 week male NOD mice. Systemic intraperitoneal (i.

Two synchronous malignancies: nodular melanoma and renal cell carcinoma in a patient with an underlying germline mutation.

Modernised genetic testing among patients with cancer has led to an increasing wealth of knowledge regarding cancer biology and aetiology. Furthermore, some germline mutations have the potential to direct therapeutic approaches as well. While mutations are well-established risk factors for breast and ovarian cancers, their impact on other cancers is less understood.

Elevated serum globulin gap as a highly reliable marker of elevated erythrocyte sedimentation rate in patients with systemic rheumatic diseases.

Objective: Serum C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) are the two most commonly used markers of inflammation in clinical practice. Reducing the need for these tests could lead to considerable cost savings without sacrificing the quality of patient care.

Methods: The electronic medical records of patients with systemic rheumatic diseases seen between May 2015 and June 2017 in the rheumatology clinics at a single academic medical center were retrospectively reviewed.

Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma.

Purpose: To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma.

Design: Multicenter, retrospective case series and literature review.

Cutaneous gummatous tuberculosis in a kidney transplant patient.

Cutaneous gummatous tuberculosis (TB) is an uncommon subtype of cutaneous TB that can be seen in notably immunocompromised individuals. We report a case of cutaneous gummatous TB in an immunosuppressed kidney transplant patient. A 60-year-old Cambodian woman presented with fever attributed to recurrent pyelonephritis while on immunosuppressive medications 7 months after kidney transplant.

Current Burden of Gunshot Wound Injuries at Two Los Angeles County Level I Trauma Centers.

Background: Gunshot wound (GSW) injuries present a unique surgical challenge. This study explored the financial and clinical burdens of GSW patients across 2 Los Angeles County Level I trauma centers over the last 12 years, and compared them with other forms of interpersonal injury (OIPI).

Study Design: This was a retrospective study of patients presenting as those with GSW and OIPI (defined as combined stab wound or blunt assault), between January 1, 2006 and March 30, 2018, at LAC+USC Medical Center (LAC+USC) and Harbor UCLA Medical Center (HUCLA).

Functional outcomes of traumatic lower extremity reconstruction.

Background: Lower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear.

Hypothesis: This study investigates functional outcomes following soft tissue reconstruction for open tibial fractures.

The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study.

Background: Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality.

More than meets the eye: Point-of-care ultrasound diagnosis of acute optic neuritis in the emergency department.

Optic neuritis (ON) is an inflammatory condition that causes demyelination and thickening of the optic nerve leading to acute/subacute vision loss. It is frequently associated with other conditions like multiple sclerosis, but is often misdiagnosed, which can lead to a suboptimal prognosis. Ultrasound is rarely utilized to help make this diagnosis, even though it can easily detect a thickened retrobulbar optic nerve sheath diameter.

Increased Cathepsin S activity associated with decreased protease inhibitory capacity contributes to altered tear proteins in Sjögren's Syndrome patients.

Cathepsin S (CTSS) activity is elevated in Sjögren's Syndrome (SS) patient tears. Here we tested whether protease inhibition and cystatin C (Cys C) levels are reduced in SS tears, which could lead to enhanced CTSS-driven degradation of tear proteins. CTSS activity against Cys C, LF and sIgA was tested in SS or healthy control tears.

Has Rheumatology Become a More Attractive Career Choice? Comparison of Trends in the Rheumatology Fellowship Match From 2008 to 2013 With Those From 2014 to 2017.

Objective: Rheumatology has previously been a less attractive career choice than other internal medicine (IM) subspecialties. Recent fellowship data from the National Resident Matching Program (NRMP) has suggested that this may have changed. Therefore, we evaluated the current attractiveness of rheumatology as a career choice and compared it with other medical subspecialties.

How the pathologist can aid in the assessment of gastroesophageal reflux disease.

Purpose Of Review: To provide new concepts regarding the early pathologic changes of gastroesophageal reflux disease (GERD) that are associated with damage to the lower esophageal sphincter (LES).

Recent Findings: A body of evidence exists that cardiac mucosa is a metaplastic esophageal epithelium rather than a normal gastric epithelium. Recent studies in asymptomatic volunteers suggest a potential mechanism for cardiac metaplasia in the squamous epithelium of the esophagus.

Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry.

Background: Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma.

Methods: Registry data from March 2013 to December 2016 were reviewed.

Traumatic Lingual Hematoma Resulting in Bilateral Temporal Mandibular Joint Dislocations.

Background: Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.

Case Report: Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure.

How Can I Get This Bone to Heal?

A nonunion is a reconstructive challenge that may have a devastating effect on a patient's quality of life. To develop an individualized treatment plan, surgeons must carefully assess several factors related to the nonunion, including the involved bone, the existing implants, the presence of infection, the soft-tissue envelope, and the function of the involved extremity, as well as the status of the patient. Essential components of an individualized treatment plan for a patient with a nonunion include management of infection (if present); optimization of the systemic and local biologic environment via management of nutritional and metabolic deficiencies, systemic disease, tobacco use, and medications that interfere with bone healing as well as via supplemental procedures, such as use of biologics or bone grafting; and achievement of mechanical stability via internal or external fixation that allows for early functional active range of motion and weight bearing.

Flipping the Classroom in Medical Student Education: Does Priming Work?

Introduction: The emergency medicine (EM) clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by "priming" the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing).

Busting the Myth of "Static vs Cidal": A Systemic Literature Review.

We sought to determine if clinical data validate the dogma that bactericidal antibiotics are more clinically effective than bacteriostatic agents. We performed a systematic literature review of published, randomized, controlled trials (RCTs) that compared a bacteriostatic agent to a bactericidal agent in the treatment of clinical, bacterial infections. Of 56 identified trials published since 1985, 49 found no significant difference in efficacy between bacteriostatic and bactericidal agents.