Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill Patients.

Background: Delirium and agitation are common syndromes in critically ill patients. Valproic acid (VPA) has shown benefit in intensive care unit (ICU)-associated delirium and agitation, but further evaluation is needed.

Objective: The purpose of this study was to evaluate the effectiveness and safety of VPA for hyperactive delirium and agitation in critically ill adult patients.

Implementing a Labor and Delivery Cell Salvage Protocol in Patients at Increased Risk of Hemorrhage: A Pilot Study.

Background: Postpartum hemorrhage (PPH) contributes significantly to maternal morbidity and mortality. The use of cell salvage has been implemented in operating rooms across the world, but only a limited number of institutions have protocols for use of cell salvage during vaginal hemorrhage at the time of vaginal delivery. Observations suggest that blood salvaged from vaginal delivery is comparable to blood salvaged during cesarean delivery.

The performance of 11 fingertip pulse oximeters during hypoxemia in healthy human participants with varied, quantified skin pigment.

Background: Fingertip pulse oximeters are widely available, inexpensive, and commonly used to make clinical decisions in many settings. Device performance is largely unregulated and poorly characterised, especially in people with dark skin pigmentation.

Methods: Eleven popular fingertip pulse oximeters were evaluated using the US Food and Drug Administration (FDA) Guidance (2013) and International Organization for Standardization Standards (ISO, 2017) in 34 healthy humans with diverse skin pigmentation utilising a controlled desaturation study with arterial oxygen saturation (SaO 2) plateaus between 70% and 100%.

Impact of Urinary Antigen Testing in Patients With Community-Acquired Pneumonia Admitted Within a Large Academic Health System.

Background: Limited data support use of pneumococcal urinary antigen testing (PUAT) for patients with community-acquired pneumonia (CAP) as an antimicrobial stewardship tool. At our institution, CAP guidelines and admission order set were standardized to include universal PUAT.

Methods: This was a retrospective study of adults hospitalized in 2019 who had PUAT performed.

Esophagopharyngeal perforation and prevertebral abscess after anterior cervical discectomy and fusion: a case report.

Anterior cervical discectomy and fusion (ACDF) represents one of the most commonly performed spine surgeries. Dysphagia secondary to esophageal injury during retraction is one of the most common complications, and usually leads to self-limiting dysphagia. However, actual perforation and violation of the esophageal tissue is much rarer and can lead to delayed deep infections.

Improving Birth Dose Hepatitis B Vaccination Rates: A Quality Improvement Intervention.

Background: There are 43 000 new cases of hepatitis B virus infection and 1000 cases of perinatally acquired infection each year in the United States. National recommendations are to administer hepatitis B (HepB) vaccine to all stable newborns >2000 g within 24 hours of birth. Our primary objective was to increase institutional vaccination rates from a baseline of 52% to goal >85% before hospital discharge.

Anterior knee schwannoma.

Peripheral nerve tumors are relatively uncommon with schwannomas being the most common type. Schwannomas are usually benign encapsulated tumors composed of neoplastic Schwann cells that generally do not transform to malignancy. Many are discovered incidentally as solitary tumors.

Intrathoracic Myxoid Spindle Cell Lipoma: A Rare Presentation of a Myxoid Neoplasm.

Here we present the case of a 38-year-old man with an incidentally found right upper lobe lung mass. The patient underwent thoracoscopic resection of the mass, which revealed a myxoid spindle cell lipoma. That is an exceedingly rare location for this tumor biology, and here we discuss its pathologic features and treatment options.

Interfacility Transfer is Associated With Lower Mortality in Undertriaged Gunshot Wound Patients.

Background: Treatment at a Level I trauma center yields better outcomes for patients with moderate-to-severe injury as compared with treatment in nontrauma centers. We examined the association between interfacility transfer to a level I or II trauma center and mortality for gunshot wound patients, among patients initially transported to a lower level or undesignated facility.

Materials And Methods: This retrospective cohort study included all patients from the National Trauma Data Bank (2010-2015) with firearm as the external cause of injury, who met CDC criteria for emergency medical services triage to a higher level (American College of Surgeons [ACS] Level II or above) trauma center.

The Charlson Index Is Insufficient to Control for Comorbidities in a National Trauma Registry.

Background: The Charlson Comorbidity Index (CCI) is frequently used to control for confounding by comorbidities in observational studies, but its performance as such has not been studied. We evaluated the performance of CCI and an alternative summary method, logistic principal component analysis (LPCA), to adjust for comorbidities, using as an example the association between insurance and mortality.

Materials And Methods: Using all admissions in the National Trauma Data Bank 2010-2015, we extracted mortality, payment method, and 36 International Classification of Disease, Ninth Revision-derived comorbidities.

Esophageal Ulcers in Primary Biliary Cholangitis: A Rare Cause of Hematemesis in the Setting of Portal Hypertension and Esophageal Varices.

Our patient with primary biliary cholangitis, previously termed as primary biliary cirrhosis, presented with an unexpected and unusual cause of hematemesis in the form of multiple esophageal ulcers in-between variceal columns. Given that upon endoscopic examination, the esophageal ulcers were found to bleeding instead of the varices; they should be considered in the differential in the etiology of hematemesis in primary biliary cholangitis and thoroughly searched for during an endoscopic procedure for early treatment and subsequent secondary prevention.

Differences in trauma mortality between ACS-verified and state-designated trauma centers in the US.

Background: Traumatic injury is a leading cause of deaths worldwide, and designated trauma centers are crucial to preventing these. In the US, trauma centers can be designated as level I-IV by states and/or the American College of Surgeons (ACS), reflecting the resources available for care. We examined whether state- and ACS-verified facilities of the same level (I-IV) had differences in mortality, complications, and disposition, and whether differences varied by center level.

Clearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial.

Background: Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries.

The Institutional Learning Curve of Magnetic Resonance Imaging-Ultrasound Fusion Targeted Prostate Biopsy: Temporal Improvements in Cancer Detection in 4 Years.

Purpose: While magnetic resonance imaging-ultrasound fusion targeted biopsy allows for improved detection of clinically significant prostate cancer, a concerning amount of clinically significant disease is still missed. We hypothesized that a number of these misses are due to the learning curve associated with magnetic resonance imaging-ultrasound fusion targeted biopsy. We report the results of repeat magnetic resonance imaging-ultrasound fusion targeted biopsy in men with continued suspicion for cancer and the institutional learning curve in the detection of clinically significant prostate cancer with time.

Prediagnostic Risk Assessment with Prostate MRI and MRI-Targeted Biopsy.

Prostate MRI is commonly used in the detection of prostate cancer to reduce the detection of clinically insignificant disease; maximize the detection of clinically significant cancer; and better assess disease size, grade, and location. The clinical utility of MRI seems to apply to men with no prior biopsy, who have had a previous negative biopsy, and men who are candidate for active surveillance. In conjunction with traditional clinical parameters and secondary biomarkers, MRI may allow more accurate risk stratification and assessment of need for prostate biopsy.