Cancellous Grafting Versus Corticocancellous Graft With Volar Locked Plating for Scaphoid Waist Fracture Nonunion: An Evaluation of Early Bony Bridging.

Background: Achieving bony union in scaphoid nonunion fractures is challenging. Various bone grafts have been studied using headless compression screws (HCS) fixation. However, the impact of bone graft choice on bone healing with volar locking plates (VLP) use is less clear.

Subcutaneous cardioverter-defibrillator implantation in an adult with congenital heart disease and left infra-mammary pacemaker.

The approach/type of an implantable cardioverter defibrillator (ICD) is determined by the underlying cardiac anatomy, venous access, and pre-existing cardiac implantable electronic devices. We describe a case of subcutaneous ICD implantation in an adult with congenital heart disease (CHD) with a pre-existing inframammary transvenous pacemaker. This was preferred over adding a defibrillator coil to existing pacing leads, extraction/replacement of pacing system, or a sternotomy/epicardial ICD placement.

Rapid resolution of catatonia secondary to post traumatic stress disorder with secondary psychotic features through scheduled zolpidem tartrate.

Catatonia is a complication of numerous psychiatric and medical conditions. The first-line treatment is typically management of the underlying primary condition as well as scheduled benzodiazepines or electroconvulsive therapy. Electroconvulsive therapy and benzodiazepines are not always tolerated or available when treating patients with catatonia.

Outpatient medications associated with protection from COVID-19 hospitalization.

The COVID-19 pandemic remains the pre-eminent global health problem, and yet after more than three years there is still no prophylactic agent against the disease aside from vaccines. The objective of this study was to evaluate whether pre-existing, outpatient medications approved by the US Food and Drug Administration (FDA) reduce the risk of hospitalization due to COVID-19. This was a retrospective cohort study of patients from across the United States infected with COVID-19 in the year 2020.

Rationale and design for the myocardial ischemia and transfusion (MINT) randomized clinical trial.

Background: Accumulating evidence from clinical trials suggests that a lower (restrictive) hemoglobin threshold (<8 g/dL) for red blood cell (RBC) transfusion, compared with a higher (liberal) threshold (≥10 g/dL) is safe. However, in anemic patients with acute myocardial infarction (MI), maintaining a higher hemoglobin level may increase oxygen delivery to vulnerable myocardium resulting in improved clinical outcomes. Conversely, RBC transfusion may result in increased blood viscosity, vascular inflammation, and reduction in available nitric oxide resulting in worse clinical outcomes.

NRG Oncology/RTOG1205: A Randomized Phase II Trial of Concurrent Bevacizumab and Reirradiation Versus Bevacizumab Alone as Treatment for Recurrent Glioblastoma.

Purpose: To assess whether reirradiation (re-RT) and concurrent bevacizumab (BEV) improve overall survival (OS) and/or progression-free survival (PFS), compared with BEV alone in recurrent glioblastoma (GBM). The primary objective was OS, and secondary objectives included PFS, response rate, and treatment adverse events (AEs) including delayed CNS toxicities.

Methods: NRG Oncology/RTOG1205 is a prospective, phase II, randomized trial of re-RT and BEV versus BEV alone.

Caring for behaviorally challenging patients in nonpsychiatric settings.

This article discusses a pilot study on the use of a behavior support plan to safely address patients who exhibit disruptive behaviors in the ED and nonpsychiatric medical settings while respecting their autonomy.

Drug-Eluting Bead, Irinotecan Therapy of Unresectable Intrahepatic Cholangiocarcinoma (DELTIC) with Concomitant Systemic Gemcitabine and Cisplatin.

Background: Unresectable intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, and currently there are moderately established chemotherapeutic [gemcitabine/cisplatin (Gem/Cis)] treatments to prolong survival. The purpose of this study was to assess the efficacy of irinotecan drug-eluting beads (DEBIRI) therapy by transarterial infusion in combination with systemic therapy in unresectable ICC.

Patients And Methods: This is a prospective, multicenter, open-label, randomized phase II study (Clin Trials: NCT01648023-DELTIC trial) of patients with ICC randomly assigned to Gem/Cis with DEBIRI or Gem/Cis alone.

Parsonage-Turner Syndrome Following COVID-19 Vaccination: Clinical and Electromyographic Findings in 6 Patients.

Parsonage-Turner syndrome (PTS) following COVID-19 infection or vaccination is rare. The pathophysiology may involve an immune-mediated inflammatory reaction against brachial plexus nerve fibers in a genetically predisposed individual. We describe the clinical and electromyographic features of 6 patients presenting with the clinical picture of PTS following COVID-19 vaccination.

The impact of COVID-19 on patient safety attendant use.

Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system.

The environment has effects on infrared temperature screening for COVID-19 infection.

Infrared temperature measurement is a common form of mass screening for febrile illnesses such as COVID-19 infection. Efficacy of infrared monitoring is debated, and external factors can affect accuracy. We determine that outside temperature, wind, and humidity can affect infrared temperature measurements and partially account for inaccurate results.

Effect of the Ductal Carcinoma In Situ Margin Consensus Guideline Implementation on Re-Excision Rates, Satisfaction, and Cost.

Introduction: The 2016 consensus guideline on margins for breast-conserving surgery (BCS) with whole-breast irradiation (WBI) for ductal carcinoma in situ (DCIS) recommended 2 mm margins to decrease local recurrence rates. We examined re-excision rates, cost, and patient satisfaction before and after guideline implementation.

Methods: From an Institutional Review Board-approved database, patients with DCIS who underwent BCS with over 1 year of follow-up at one academic institution and one community cancer center were evaluated.

Headless Compression Screw Fixation for Proximal Phalanx Fractures: A Biomechanical Study.

Proximal phalanx fractures are common injuries of the hand with multiple treatment options. Intramedullary (IM) screw fixation has become more widely used, and early outcomes are promising. However, biomechanical data regarding this type of fixation are sparse.

The Write Stuff: The Development of a Medical Writing Pharmacy Residency Elective.

The Problem: Effective medical writing requires a mastery of many skills including those of data interpretation, literature evaluation, written communication, and leadership. A number of these skills are considered educational goals and objectives for residents by the American Society of Health-System Pharmacists, yet preceptors and residents oftentimes face challenges in gaining competency, confidence, and success in medical writing.

Innovation: A structured yet individualized plan for medical writing, including idea creation, peer reviewing, manuscript preparation, and team management for post-graduate year two pharmacy residents was implemented as an elective learning experience.

Comparing the efficacy of initial percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stenting for relief of biliary obstruction in unresectable cholangiocarcinoma.

Background: In patients with cholangiocarcinoma (CC), management of biliary obstruction commonly involves either up-front percutaneous transhepatic biliary drainage (PTBD) or initial endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. The objective of the study was to compare the efficacy and of initial ERCP with stent placement with efficacy of initial PTBD in management of biliary obstruction in CC.

Methods: A single-center database of patients with unresectable CC treated between 2006 and 2017 was queried for patients with biliary obstruction who underwent either PTBD or ERCP.

Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial.

 This multicenter randomized controlled trial compared cervical pessary (CP) versus expectant management (EM) in women with placenta previa between 22.0 and 32.0 in prolonging gestation until ≥ 36.

Safety and efficacy of irreversible electroporation in the treatment of obstructive jaundice in advanced hilar cholangiocarcinoma.

Background: Irreversible electroporation (IRE) has successfully been used for palliation of pancreatic and liver cancers due to its ability to ablate tumors without destroying nearby vital structures. To date, it has not been evaluated in patients with advanced hilar cholangiocarcinoma (AHC). This study presents a single-institution experience with IRE for management of obstructive jaundice in AHC.

A Hospital-Based Neuroscience Nursing Course Designed to Improve Competence and Confidence.

After experiencing growth in a neuroscience service line, nurse leaders identified a need for increased competencies among clinical staff. This hospital met the need by developing a unique multidisciplinary neuroscience nursing course to improve the clinical competence, confidence, and professional development of bedside nurses.

Tissue Engineered Bone Differentiated From Human Adipose Derived Stem Cells Inhibit Posterolateral Fusion in an Athymic Rat Model.

Study Design: Biological augmentation spinal arthrodesis trial in athymic rats.

Objective: To assess the efficacy of tissue-engineered bone to promote L4-L5 intertransverse process fusion in an athymic rat model.

Summary Of Background Data: Each year in the United States, over 400,000 spinal fusion surgeries are performed requiring bone graft.

Cerebral amyloid angiopathy-related inflammation: A potentially reversible cause of dementia with characteristic imaging findings.

Background And Purpose: Cerebral amyloid angiopathy with inflammation (CAA-I) is a less well-recognized clinically and radiologically distinct subtype of CAA. We aim to describe the imaging manifestations of this uncommon entity.

Materials And Methods: A retrospective review of the medical records and imaging database yielded 9 patients with clinical and radiological findings compatible with CAA-I.

Snack and Relax®: A Strategy to Address Nurses' Professional Quality of Life.

Purpose And Design: Snack and Relax® (S&R), a program providing healthy snacks and holistic relaxation modalities to hospital employees, was evaluated for immediate impact. A cross-sectional survey was then conducted to assess the professional quality of life (ProQOL) in registered nurses (RNs); compare S&R participants/nonparticipants on compassion satisfaction (CS), burnout, and secondary traumatic stress (STS); and identify situations in which RNs experienced compassion fatigue or burnout and the strategies used to address these situations.

Method: Pre- and post vital signs and self-reported stress were obtained from S&R attendees (N = 210).

Nurses' perceptions of family presence during resuscitation.

Background: Although strong evidence indicates that the presence of a patient's family during resuscitation has a positive effect on the family, the practice is still controversial and is not consistently implemented.

Objectives: To explore nurses' experience with resuscitation, perceptions of the benefits and risks of having a patient's family members present, and self-confidence in having family presence at their workplace. Differences in demographic characteristics and relationships between nurses' perceptions of self-confidence and perceived risks and benefits of family presence were evaluated.

Uterine trauma with fetal loss associated with chronic perforation of the inferior vena cava by an infrarenal vena cava filter.

Gestational complications in pregnant women have been considered a theoretical sequelae of vena cava filters (VCFs) positioned in the infrarenal segment of the inferior vena cava. We describe a 32-year-old woman who became pregnant with the known existence of an asymptomatic but chronically perforated, permanent infrarenal VCF. At 24 weeks gestation, uterine trauma leading to massive intraperitoneal hemorrhage and fetal loss occurred.