The Other Aortic Syndrome-Intramural Hematoma and Neurological Deficit: Case Report.

Introduction: Acute thoracic aortic syndromes are among the most concerning presentations in emergency medicine and are associated with significant morbidity and mortality. Thoracic aortic dissection is most common, followed by penetrating aortic ulcer and, least commonly, intramural hematoma.

Case Report: A 67-year-old woman presented to the emergency department with chest and back pain, and sudden onset of paraparesis.

Efficacy and safety of PCSK9 inhibitors for stroke prevention: Systematic review and meta-analysis.

Objective: Investigate the efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) on stroke prevention.

Background: PCSK9i reduce low-density lipoprotein cholesterol (LDL-C) and lipoprotein a (LpA) levels. Their efficacy in reducing the risk of major cardiovascular events has been shown in multiple randomized clinical trials (RCT).

Breakthrough invasive fungal infections on isavuconazole prophylaxis in hematologic malignancy & hematopoietic stem cell transplant patients.

Background: Isavuconazole (ISA) is a newer antifungal used in patients with history of hematologic malignancies and hematopoietic transplant and cellular therapies (HM/TCT). Although it has a more favorable side-effect profile, breakthrough invasive fungal infections (bIFIs) while on ISA have been reported.

Methods: In this single-center retrospective study evaluating HM/TCT patients who received prophylactic ISA for ≥7 days, we evaluated the incidence and potential risk factors for bIFIs.

In-Hospital Versus Out-of-Hospital Stroke Onset Comparison of Process Metrics in a Community Primary Stroke Center.

Objective: To examine in-hospital stroke onset metrics and outcomes, quality of care, and mortality compared with out-of-hospital stroke in a single community-based primary stroke center.

Patients And Methods: Medical records of in-hospital stroke onset were compared with out-of-hospital stroke onset alert data between January 1, 2013 and December 31, 2019. Time-sensitive stroke process metric data were collected for each incident stroke alert.

Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators.

Unlabelled: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes.

Objectives: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices.

Design Setting And Participants: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care.

Clinical outcomes of COVID-19 treated with remdesivir across the continuum of care.

Introduction: During the early phase of the coronavirus disease 2019 (COVID-19), remdesivir was only approved for hospitalized patients. Our institution developed hospital-based, outpatient infusion centers for selected hospitalized patients with COVID-19 who had clinical improvement to allow for early dismissal. The outcomes of patients who transitioned to complete remdesivir in the outpatient setting were examined.

Real-world Clinical Outcomes of Bebtelovimab and Sotrovimab Treatment of High-risk Persons With Coronavirus Disease 2019 During the Omicron Epoch.

Background: Antispike monoclonal antibodies are recommended for early treatment of high-risk persons with mild to moderate coronavirus disease 2019 (COVID-19). However, clinical outcomes of their use during the severe acute respiratory syndrome coronavirus 2 Omicron wave are limited.

Methods: This is a descriptive retrospective study of high-risk adult patients who received treatment with sotrovimab (January 1-March 20, 2022) or bebtelovimab (March 21-April 30, 2022).

Comparable Outcomes for Bebtelovimab and Ritonavir-Boosted Nirmatrelvir Treatment in High-Risk Patients With Coronavirus Disease-2019 During Severe Acute Respiratory Syndrome Coronavirus 2 BA.2 Omicron Epoch.

The effectiveness of bebtelovimab in real-world settings has not been assessed. In this retrospective cohort study of 3607 high-risk patients, bebtelovimab was used more commonly than nirmatrelvir-ritonavir for treatment of coronavirus disease 2019 (COVID-19) among older patients, immunosuppressed patients, and those with multiple comorbid conditions. Despite its use in patients with multiple comorbid conditions, the rate of progression to severe disease after bebtelovimab (1.

[Clinicopathological profile of patients with hepatobiliary cancers at two main referral hospitals in Lima, Peru].

Objective: The aim of the study was to describe the clinicopathological profile of patients diagnosed with liver, bile ducts or gallbladder cancer.

Materials And Methods: Between 2006 and 2017, 89 patients (57% female; mean age: 62 years-old) with these cancers were diagnosed at two national hospitals in Lima, Peru.

Results: Most patients (64%) had advanced stages of disease.

ABCD-GENE Score and Clinical Outcomes Following Percutaneous Coronary Intervention: Insights from the TAILOR-PCI Trial.

Background In TAILOR-PCI, genotype-guided selection of P2Y inhibitors after percutaneous coronary intervention did not significantly reduce the risk of ischemic events at 12 months. The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) score identifies patients with high platelet reactivity on clopidogrel at increased risk of ischemic events. The aim of this study was to investigate the value of the ABCD-GENE score for tailoring P2Y inhibitor selection after percutaneous coronary intervention.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience.

Background And Purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied.

Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019.

The who, what, where, how, and why of endoscopic submucosal dissection in Canada: A survey among Canadian endoscopists.

Background And Aim: Endoscopic submucosal dissection (ESD) is an internationally accepted technique for the resection of superficial gastrointestinal neoplasia. ESD allows for en-bloc removal when endoscopic mucosal resection (EMR) is unsuitable due to the size or depth of the lesion. The aim of this survey was to examine Canadian clinicians' experience and perceptions of ESD as its prevalence increases across the country.

Changing Medical Education When Change Is Hard: Implementing an Interdepartmental Entrustable Professional Activity.

Background: Entrustable professional activities (EPAs) are a new tool for assessing learners that represents a significant movement in graduate medical education (GME) toward competency-based assessment and serves as a bridge between milestones and clinical practice. Whenever a major change is implemented to any system, resistance to change is expected. Many change management models have been proposed to overcome this resistance; a newer model is outlined in the book .

Complete lung collapse as a rare complication of sarcoidosis-associated mediastinal lymphadenopathy.

Complete lung collapse associated with sarcoidosis is exceedingly rare. Although lymphoma should be ruled out when patients with mediastinal lymphadenopathy develop lung collapse, sarcoidosis should be considered in the differential, especially when associated with fibrosing mediastinitis.

Hemodynamic Effects of Propofol and Dexmedetomidine in Septic Patients Without Shock.

Use of nonbenzodiazepine agents propofol and dexmedetomidine are first line for sedation in the intensive care unit (ICU). These agents have been implicated in the development of bradycardia and hypotension in critical illness. To compare the development of clinically significant hypotension and/or bradycardia (ie, negative hemodynamic event) in adults with sepsis yet to require vasopressors receiving either propofol or dexmedetomidine for continuous sedation.

Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals.

Purpose Of Study: The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting.

The Double-Cup Construct: A Novel Treatment Strategy for the Management of Paprosky IIIA and IIIB Acetabular Defects.

Background: Treatment of massive acetabular bone loss in revision total hip arthroplasty is complex, and various treatment strategies have been described. We describe a novel technique of using a Trabecular Metal Revision Shell as a buttress augment creating a "double-cup" construct rather than the use of custom triflanges or cup-cage constructs for Paprosky types IIIA and IIIB acetabular defects.

Methods: We retrospectively reviewed 20 double-cup cases at a mean of 2.

Sci-Hub: What Librarians Should Know and Do about Article Piracy.

The high cost of journal articles has driven many researchers to turn to a new way of getting access: "pirate" article sites. Sci-Hub, the largest and best known of these sites, currently offers instant access to more than 58 million journal articles. Users attracted by the ease of use and breadth of the collection may not realize that these articles are often obtained using stolen credentials and downloading them may be illegal.

Ebstein Anomaly: An Overview for Nursing.

Ebstein anomaly is a rare congenital heart defect. Many nurses have probably never encountered this anomaly, with very few able to accurately depict the pathological anatomy of the condition. As technology further develops, providers are better equipped to recognize and manage Ebstein anomaly.

If this then that: an introduction to automated task services.

This article explores automated task services, a type of website that allows users to create rules that are triggered by activity on one website and perform a task on another site. The most well-known automated task service is If This Then That (IFTTT), but recently a large number of these services have sprung up. These services can be used to connect websites, apps, business services, and even devices such as phones and home automation equipment.

A summary and critical assessment of the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: filling the gaps.

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets.

Big data: an introduction for librarians.

Modern life produces data at an astounding rate and shows no signs of slowing. This has lead to new advances in data storage and analysis and the concept of "big data," that is, massive data sets that can yield surprising insights when analyzed. This column will briefly describe what big data is and why it is important.