Microinjection Technique: A Novel and Comprehensive Approach for Nose Reshaping with Hyaluronic Acid Fillers.

Introduction: Nose reshaping with hyaluronic acid (HA) fillers, also known as medical rhinoplasty, is an increasingly popular, minimally invasive aesthetic procedure. As the demand for nasal reshaping continues to rise, it is essential to develop safe and efficient injection techniques and assess satisfaction to ensure optimal outcomes and patient-centered care.

Objective: This study aims to evaluate patient and physician satisfaction with hyaluronic acid filler applications using microinjection technique for nasal reshaping.

The Effects of Oral Isotretinoin on Atrophic Acne Scars Measured by Shear-wave Elastography: An Observational, Single-center Study.

Background: Although the effects of oral isotretinoin (OI) on acne vulgaris and preventing further acne scars have been well-documented, the specific impact of OI alone on pre-existing atrophic acne scars (AAS) remains unclear. No clinical study has objectively evaluated the effect of OI on AAS yet.

Objective: We sought to investigate the OI effect on AAS quantitatively and reliably by shear-wave elastography (SWE).

Virtual Anesthesiology Medical Student Learning Program Pilot Designed in Response to COVID-19.

Background: This learning opportunity was designed to provide an interactive, virtual, educational anesthesiology program for interested medical students and to offer an opportunity to learn more about an institutional culture through a question and answer (Q&A) with program faculty preceptors for the 2020-2021 anesthesiology residency application cycle. We sought to identify if this virtual learning program was a valuable educational tool through a survey.

Methods: A short Likert-scale survey was sent to medical students before and after participation in a session using REDCap electronic data capture tool.

How Should Health Professions Educators and Organizations Desegregate Teaching and Learning Environments?

Motivating health equity requires taking deliberate steps toward desegregating health care, especially in academic health centers. One step should incorporate rigorous measurement and assessment of patients' access to health services and ongoing collection and review of patients' health outcomes data. Another step should develop, fund, incorporate and administer initiatives with community members that address social determinants of community and individual health, including academic health centers' inpatient and outpatient service delivery sites, insurance programs, and federal policy.

How Should US Health Care Meet Latinx Community Health Needs?

This commentary responds to a case about a Latino grocery worker who begins experiencing symptoms but is reluctant to be tested for SARS-CoV-2 and be treated for COVID-19 out of fear of losing his livelihood. The case reveals key weaknesses in US health care system capacity to mount evidence-based responses to mitigate, if not contain, spread of a deadly contagion in vulnerable populations and to care equitably for everyone at risk.

How Should Clinicians Help Homeless Trauma Survivors Make Irreversible Surgical Care Decisions?

Important but frequently overlooked childhood trauma outcomes can manifest later in patients' lives and include neurophysiological influences on language perception and expression, memory, attention, abstract reasoning, emotional regulation, and executive functioning. Therefore, when interacting with patients experiencing homelessness, mental illnesses, and substance use disorders, clinicians should adopt a trauma-informed approach to generating deeper understandings of patients' neurobiological makeup and psychosocial histories, especially when discussing interventions and during informed consent.

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Noncurative surgeries intended to relieve suffering during serious illness or near end of life have been analyzed across palliative settings. Yet sparse guidance is available to inform clinical management decisions about whether, when, and which interventions should be offered when ischemic stroke and other neurological complications occur in patients whose survival is extended by other novel disease-modifying interventions. This case commentary examines key ethical and clinical considerations in palliative neuroendovascular care of patients with acute stroke.

Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome.

Objective: To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs.

Methods: The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics.

Pharmacist and Prescriber Responsibilities for Avoiding Prescription Drug Misuse.

Pharmacists have the same duty as prescribers to prevent inappropriate use of dangerous drugs. Loperamide, for example, is an over-the-counter medication that has been reported to be potentially misused for euphoric effects. Pharmacists and prescribers alike face challenges in providing optimal care for patients and protecting communities from drug misuse.

Can Indian Health Service Referrals for Nonemergent Care Be Allocated Equitably?

The Indian Health Service (IHS) administers health care services to American Indians and Alaska Natives (AI/ANs) in the United States. The agency funds referral care services through the Purchased/Referred Care (PRC) Program, which prioritizes its budget to pay for emergent care. This commentary responds to a case about a physician's disappointment that a referral for nonemergent care is deferred for payment by the PRC Program.

Left Ventricular Compression and Hypotension Due to Acute Colonic Pseudo-Obstruction.

Acute colonic pseudo-obstruction is a postsurgical dilatation of the colon that presents with abdominal distension, pain, nausea, vomiting, constipation, or diarrhea and may lead to colonic ischemia and bowel perforation.

Effects of Substance Use Disorder Criminalization on American Indian Pregnant Individuals.

Individuals with substance use disorders (SUDs) are at markedly elevated risk of involvement in the criminal legal system. Over the past 30 years, substance use during pregnancy has been criminalized through laws on the federal, state, and tribal level. American Indian (AI) individuals are disproportionately affected by these laws due to their race, socioeconomic status, and limited access to SUD treatment.

Original Research: Understanding Nursing Home Staff Attitudes Toward Death and Dying: A Survey.

Background: Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care.

Methods: We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes.

Factors Associated with Requesting Magnetic Resonance Imaging during the Management of Glomus Tumors.

Background: The characteristic clinical presentation of glomus tumors and the low negative predictive value of the magnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this study aimed to investigate whether MRI improved the management of glomus tumors.

Methods: In total, 87 patients with a histologically confirmed glomus tumor were treated over a 25-year period and analyzed retrospectively.

Who Should Make Decisions for Unrepresented Patients Who Are Incarcerated?

The United States has a high incarceration rate. Incarceration is associated with increased risk for cancer, chronic illness, serious mental illness, and substance use disorder. People who are incarcerated are less likely to be offered or participate in advance care planning, less likely to document their treatment preferences, and might not have a surrogate if one is needed.

Influence of Environmental Factors in the Development and Outcomes of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD), which mainly comprises Crohn's disease (CD) and ulcerative colitis (UC), is a term for chronic inflammatory diseases of the gut arising due to a dysregulated immune response to a dysbiotic gut microbiome on a background of genetic predisposition. However, genetics explains a small fraction of risk, and the external environment plays a large and important role in disease pathogenesis and natural history. Cigarette smoking, one of the earliest- and most-studied risk factors, increases the risk of CD onset and is associated with severe disease.

His Wonderful Life.

A nurse is reminded that quality of life is in the eye of the beholder.

Stop Posturing and Start Problem Solving: A Call for Research to Prevent Gun Violence.

Gun violence is a major cause of preventable injury and death in the United States, leading to more than 33,000 deaths each year. However, gun violence prevention is an understudied and underfunded area of research. We review the barriers to research in the field, including restrictions on federal funding.

A Mission for Graduate Medical Education at VA.

Chief medical residents from the 3 affiliate residency training programs at VA Boston Healthcare System developed a mission statement for the educational experience of all medical trainees rotating through VA medical centers.

How Should a Health Care Professional Respond to an Incarcerated Patient's Request for a Particular Treatment?

Incarceration complicates the ethical provision of clinical care through reduction in access to treatment modalities and institutional cultures that value order over autonomy. Correctional care clinicians should expand their guiding principles to consider autonomy and health justice for their patients, which in turn should prompt development of processes and care plans that are patient-centered and account for the inherent restrictions of the setting.

How to Talk with Patients about Incarceration and Health.

The United States has the highest incarceration rate of any nation in the world-more than 700 people per 100,000. For this reason alone, clinicians practicing in the US should be aware of the numerous ways in which incarceration adversely affects the health of individuals, their families, and communities. While we clinicians are taught how to discuss ways that culture, religion, or sexuality can affect health outcomes, we are not instructed on how to talk about incarceration history with patients when it might be affecting their health, as highlighted in the case scenario.