Perspectives and Recommendations from Hospitalized Patients with Substance Use Disorders: A Qualitative Study.

Background: Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality.

Diagnostic interobserver agreement for thyroid fine-needle aspirates: Effects of reviewer experience and molecular diagnostics.

Objectives: Few cytologically indeterminate thyroid fine-needle aspirations (FNAs) harbor BRAF V600E. Here, we assess interobserver agreement for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III (atypia of undetermined significance [AUS]) FNAs harboring BRAF V600E and contrast their features with those harboring non-BRAF V600E alterations, with attention to cytopathology experience.

Methods: Seven reviewers evaluated 5 AUS thyroid FNAs harboring BRAF V600E.

Use of the Afirma Xpression Atlas for cytologically indeterminate, Afirma Genomic Sequencing Classifier suspicious thyroid nodules: Clinicopathologic analysis with postoperative molecular testing.

Objectives: Afirma has recently introduced its Xpression Atlas (XA) as an adjunct to its Genomic Sequencing Classifier (GSC) for risk stratification of cytologically indeterminate thyroid nodules. We evaluated the performance of Afirma XA and associated pathologic findings for Afirma GSC suspicious nodules.

Methods: Intradepartmental records of thyroid fine-needle aspirations (FNAs) from January 2021 to December 2022 were identified and reviewed for patient and nodule characteristics, FNA findings, molecular test results, and final surgical pathology, if available.

Extracorporeal membrane oxygenation for cardiac arrest: what, when, why, and how.

Introduction: Extracorporeal membrane oxygenation (ECMO) facilitated resuscitation was first described in the 1960s, but only recently garnered increased attention with large observational studies and randomized trials evaluating its use.

Areas Covered: In this comprehensive review of extracorporeal cardiopulmonary resuscitation (ECPR), we report the history of resuscitative ECMO, terminology, circuit configuration and cannulation considerations, complications, selection criteria, implementation and management, and important considerations for the provider. We review the relevant guidelines, different approaches to cannulation, postresuscitation management, and expected outcomes, including neurologic, cardiac, and hospital survival.

Management of Medication-Induced Weight Gain.

Several medications can contribute to weight gain. Medication-induced weight gain can have severe health consequences leading to overweight or obesity, or exacerbation of preexisting obesity and the plethora of obesity-related comorbidities. Weight gain due to medications is potentially avoidable by prescribing medications that are either weight neutral or that lead to weight loss, when appropriate.

Stability of Intertrochanteric Femur Fractures.

The stability of intertrochanteric fractures depends upon multiple factors including the fracture displacement, location and pattern, the type of fixation used for stabilization, and the loading that the fracture undergoes postfixation. Traditional classification systems are of limited utility because they typically stratify intertrochanteric fractures as stable or unstable based purely on the fracture pattern without consideration of the stability after fixation. Biomechanical studies evaluating the stability of various fixation constructs should include physiologic loading, including rotation around the axis of the femoral neck, and reproduce clinical failure modes to be clinically relevant.

Pulmonary Artery Pressures and Mortality during VA ECMO: An ELSO Registry Analysis.

Background: Systemic hemodynamics and specific ventilator settings have been shown to predict survival during venoarterial extracorporeal membrane oxygenation (VA ECMO). While these factors are intertwined with right ventricular (RV) function, the independent relationship between RV function and survival during VA ECMO is unknown.

Objectives: To identify the relationship between RV function with mortality and duration of ECMO support.

Integration of Cirrhosis Best Practices Into Electronic Medical Record Documentation Associated With Reduction in 30-Day Mortality Following Hospitalization.

Background: Hospital admissions for patients with cirrhosis continue to increase. In New York City, 25% to 30% of hospitalized cirrhotics are readmitted within 30 days. Rehospitalization is associated with increased mortality, poor quality of life, and financial burden to patients, hospitals, and payers.

Evaluating the impact of eligibility criteria in first-line clinical trials for follicular lymphoma: a MER/LEO cohort analysis.

Cancer clinical trial eligibility criteria may create patient populations studied in trials that do not reflect the patient populations treated in the real-world setting. Follicular lymphoma (FL) is an indolent lymphoma with heterogeneous presentations across a broad range of individuals, resulting in many acceptable management strategies. We evaluated how first-line clinical trial eligibility criteria impacted the demographic makeup and outcomes of patients with FL for whom systemic therapy might be considered.

Situational uncertainty interacts with anxiety sensitivity and distress intolerance to predict anticipated worry and preparation for a hurricane.

Background: There is evidence for the impact of emotional intolerance on reactivity to stressors, but it is unknown whether the level of situational uncertainty may moderate this relationship. We examined whether situational uncertainty moderated the relationship between emotional intolerance and anticipated anxious responding to hurricane forecasts, considering three aspects of emotional tolerance: anxiety sensitivity, distress intolerance, and hurricane-specific distress intolerance.

Methods: Participants (N = 358) were Florida residents who experienced Hurricane Irma.

A Spanish translation of the Hoarding Rating Scale: Differential item functioning and convergent validity.

Hoarding disorder (HD) involves extreme difficulties discarding possessions and significant clutter in living areas. Although hoarding occurs worldwide, cross-cultural research remains in nascent stages, hampered in part by a lack of validated measures in non-English languages. We aimed to validate a Spanish translation of the Hoarding Rating Scale (HRS), a widely used measure of core HD symptoms.

A longitudinal investigation of COVID-19 pandemic experiences and mental health among university students.

Objectives: Previous studies have established a link between the COVID-19 pandemic and poor mental health. They further suggest that young adults may be especially vulnerable to worsened mental health during the pandemic, but few studies have investigated which specific aspects of the COVID-19 experience affect psychological well-being over time. To better understand concrete predictors of poor mental health outcomes in this population, we identified several pandemic-related experiences and evaluated their effects on mental health symptoms (depression, anxiety, stress, alcohol, and substance use) in a sample of U.

Conventional Hepatic Volumetry May Lead to Inaccurate Segmental Yttrium-90 Radiation Dosimetry.

Objective: To compare radioembolization treatment zone volumes from mapping cone beam CT (CBCT) versus planning CT/MRI and to model their impact on dosimetry.

Methods: Y90 cases were retrospectively identified in which intra-procedural CBCT angiograms were performed. Segmental and lobar treatment zone volumes were calculated with semi-automated contouring using Couinaud venous anatomy (planning CT/MRI) or tumor angiosome enhancement (CBCT).

Dual Enkephalinase Inhibitors and Their Role in Chronic Pain Management.

Purpose Of Review: Dual enkephalinase inhibitors (DENKIs) are pain medications that indirectly activate opioid receptors and can be used as an alternative to traditional opioids. Understanding the physiology of enkephalins and their inhibitors and the pharmacology of these drugs will allow for proper clinical application for chronic pain patients in the future.

Recent Findings: DENKIs can be used as an alternative mode of analgesia for patients suffering from chronic pain by preventing the degradation of endogenous opioid ligands.

Evaluation of the prognostic utility of bone marrow biopsy in diffuse large B-Cell lymphoma in the SEER-Medicare dataset.

Positron emission tomography-computed tomography (PET-CT) has become the primary modality for staging in diffuse large B-cell lymphoma (DLBCL), whereas the role of staging bone marrow biopsy (BMB) has become less clear. In this analysis, we included 7,005 DLBCL patients in SEER-Medicare who received either PET-CT without BMB (PET-CT w/o BMB), CT with BMB (CT w/ BMB), or both PET-CT and BMB (PET-CT w/ BMB). The proportion of patients undergoing PET-CT increased across years of diagnosis, while the proportion undergoing CT or BMB decreased.

Assessing the Positive Predictive Value of Architectural Distortion Detected with Digital Breast Tomosynthesis in BI-RADS 4 Cases.

Objective: The purpose of this study was to evaluate the positive predictive value of biopsy (PPV3) of architectural distortion (AD) detected on digital breast tomosynthesis (DBT) in BI-RADS 4 cases, where suspicion for malignancy remains broad.

Methods: This Institutional Review Board-approved, retrospective study included screening and diagnostic mammograms performed from August 2015 to December 2017 with DBT and digital mammography (DM) revealing suspicious AD with a BI-RADS 4 assessment. Medical records were reviewed for clinical data, imaging, and pathology results.

Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study.

Purpose: We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.

Methods: We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses.

Do Subspecialists Ask About and Refer Families with Psychosocial Concerns? A Comparison with General Pediatricians.

Objectives Calls for pediatricians to tend to children's psychosocial concerns have existed for decades because they are known to negatively impact child health. Children with chronic illnesses frequently have child- and family-level psychosocial concerns that complicate the care provided by their pediatric subspecialists. This study compares pediatricians who exclusively practice general pediatrics with subspecialists regarding their inquiring/screening and referring for psychosocial concerns.

Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999-2001 vs 2013-2015.

Background: Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known.

Objective: To describe temporal changes in ED concordance with guidelines for the management of SIIAs.

Methods: We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015.

Relation of Exercise Capacity to Risk of Development of Diabetes in Patients on Statin Therapy (the Henry Ford Exercise Testing Project).

High exercise capacity (EC) has been associated with a lower risk of incident diabetes, whereas statin therapy has been associated with a higher risk. We sought to investigate whether the association between EC and diabetes risk is modified by statin therapy. This retrospective cohort study included 47,337 patients without diabetes or coronary artery disease at baseline (age 53 ± 13 years, 48% women, 66% white) who underwent clinical treadmill stress testing within the Henry Ford Health System from January 1, 1991, to May 31, 2009.

Life-Saving Esophageal Intubation in Neonate With Undiagnosed Tracheal Agenesis: A Case Report.

A 3-day-old, 2.2-kg former 34-week premature infant with imperforate anus required loop ileostomy surgery. At delivery, the child had respiratory distress.

Cirrhotic Patients Have Worse Bowel Preparation at Screening Colonoscopy than Chronic Liver Disease Patients without Cirrhosis.

Background: Cirrhosis has been shown in small studies to be a predictor of suboptimal bowel preparation at screening colonoscopy. It has yet to be established whether patients with chronic liver disease in the absence of cirrhosis experience equally poor colon cleansing. Intestinal dysmotility related to cirrhosis might impair bowel preparation in this population more than those with chronic liver disease without cirrhosis.