Instruments evaluating the duration and pace of clinical encounters: A scoping review.

Objective: Hurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters.

Methods: We searched multiple databases from inception through July 2023.

Unhurried Conversations in Health Care Are More Important Than Ever: Identifying Key Communication Practices for Careful and Kind Care.

Unhurried conversations are necessary for careful and kind care that is responsive and responsible to both patients and clinicians. Adequate conceptual development is an important first step in being able to assess and measure this important domain of quality of care. In this article, we expand on a preliminary model to identify the key microlevel communication practices that support an unhurried conversation, defined as an ongoing, mutual accomplishment between patient and clinician that proceeds through a range of verbal and nonverbal communication practices wherein one or more participants (mutually) regulate the sequence, spacing (temporal and spatial), and speed of interaction to make themselves available to the other and remove or suspend distractions from the environment in order to improve care.

Treatment of Early Gastric Cancer.

Gastric cancer is a highly prevalent malignancy in Asia; however, its incidence is rising in the United States. Traditionally, methods of treatment include surgery and chemotherapy. Endoscopy has become an alternative method with a low recurrence rate when used to treat early gastric cancers.

A Rare Case of Acute Bacterial Native Valve Endocarditis Caused by Streptococcus thoraltensis.

This report presents a rare case of acute bacterial native valve endocarditis caused by in a 57-year-old male with a history of intravenous drug use. The patient presented with chest pain, productive cough, and diarrhea, with clinical evaluation revealing atrial flutter, pulmonary embolism, and a large tricuspid valve vegetation. Blood cultures confirmed , an organism rarely implicated in human infections.

The Upper Limit of Normal Rate of Lung Function Decline in Healthy Adults in the Framingham Heart Study.

Background: Lung function declines over the course of adulthood; however, a consensus on the normal range of decline in an individual's lung function is lacking.

Research Question: What is the normal range and the upper limit of normal (ULN) decline in lung function in adults without prior tobacco use, occupational dust exposure, or a known diagnosis or symptoms of cardiopulmonary disease?

Study Design And Methods: A retrospective analysis of healthy individuals who have never smoked (N = 1,305) from the Framingham Heart Study with repeated lung function meeting standards for acceptability and reproducibility was conducted. Longitudinal change was derived using a linear mixed effects model and estimated to a 6-year interval.

Impact of a New Preoperative Stratification Based on Cardiac Structural Compromise in Patients with Severe Aortic Stenosis Undergoing Valve Replacement Surgery.

Aortic valve replacement surgery (SAVR) remains a recommended indication, though its pre-surgical stratification is an ongoing challenge. Despite the widespread use of scores like the STS and EuroSCORE II, they have a number of limitations, while often neglecting structural parameters like left ventricular hypertrophy or left atrium volume. This study aimed to evaluate whether a new adaptation of the Généreux classification in the preoperative risk stratification of severe aortic stenosis (AS) is associated with the primary outcome, and to compare it with the original classification versus the traditional scores in short- and long-term follow-up.

Orogastric Tube Fracture and Ingestion in a Patient With Hyperacute Delirium: A Unique and Potentially Catastrophic Complication.

Orogastric tubes (OGTs) are frequently used to administer feeds and medications to critically ill patients. They are inserted blindly, with a low first-pass success rate and frequent benign complications. OGT fractures and ingestion are exceedingly rare, with only two cases reported to date.

Long COVID diagnostic with differentiation from chronic lyme disease using machine learning and cytokine hubs.

The absence of a long COVID (LC) or post-acute sequelae of COVID-19 (PASC) diagnostic has profound implications for research and potential therapeutics given the lack of specificity with symptom-based identification of LC and the overlap of symptoms with other chronic inflammatory conditions. Here, we report a machine-learning approach to LC/PASC diagnosis on 347 individuals using cytokine hubs that are also capable of differentiating LC from chronic lyme disease (CLD). We derived decision tree, random forest, and gradient-boosting machine (GBM) classifiers and compared their diagnostic capabilities on a dataset partitioned into training (178 individuals) and evaluation (45 individuals) sets.

Ewing sarcoma of the uterus: A case report.

A case is described of Ewing sarcoma of the uterus, an atypical presentation of an already rare cancer. A 55-year-old woman presented with abdominal pain, abnormal uterine bleeding and a uterine mass that measured 11 × 10 × 14.5 cm and demonstrated heterogeneous enhancement with possible areas of central necrosis, concerning for sarcoma.

Unforeseen and Immediate: A Case of a Post-Watchman Device-Related Thrombus.

Atrial fibrillation (AFib) is recognized as a risk factor linked to arterial thromboembolism stemming from blood clot formation in the left atrium, associated with increased morbidity and mortality. Most of these thrombi originate in the left atrial appendage (LAA). Oral anticoagulation (OAC) therapy can help mitigate this risk.

Wide Spectrum of Flecainide Toxicity: A Case Report and Literature Review.

Flecainide toxicity is a rare but serious condition that can present with a wide range of clinical symptoms. We report the case of a 79-year-old female with paroxysmal atrial fibrillation on flecainide therapy who developed altered mental status, visual hallucinations, and bradycardia. Laboratory results revealed an acute kidney injury, which contributed to elevated flecainide levels.

Adjectives in the Summary Paragraph of the MSPE: Are They Telling Us Something?

Rationale And Objectives: Many US medical schools do not provide a summative, comparative assessment of students (class rank), instead utilizing descriptive adjectives in the summary paragraph of the Medical Student Performance Evaluation (MSPE). The objective of this study was to determine whether those adjectives correlate with student performance.

Materials And Methods: Applications from all US allopathic medical schools received by a single diagnostic radiology program in the 2023-24 cycle were reviewed.

Crossroads of Care: Navigating Injection Drug Use-Associated Endocarditis.

Infective endocarditis (IE), with its high morbidity and mortality, is a frequent complication of injection drug use (IDU). We present a case highlighting the complexities in the management of IDU-associated IE (IDU-IE) in a 46-year-old male with active IDU who presented with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and a large tricuspid valve vegetation. Urgent tricuspid valve surgery was indicated due to the size of the vegetation measuring up to 4 cm, along with recurrent pulmonary septic emboli.

A rare case of giant cell tumor of the anterior rib presenting as a breast mass.

Initial diagnostic ultrasound of a 22-year-old female patient presenting with a palpable breast mass revealed a suspicious mass initially thought to arise from the breast. However, follow-up diagnostic mammography was normal without evidence of the 5 cm mass seen on ultrasound, and pathology results from ultrasound-guided core needle biopsy raised suspicion for giant cell tumor, making chest wall origin of the mass more likely. Further CT and MRI imaging indeed revealed a locally invasive mass arising from the anterior fifth rib.

Clinical risk factors and blood protein biomarkers of 10-year pneumonia risk.

Background: Chronic inflammation may increase susceptibility to pneumonia.

Research Question: To explore associations between clinical comorbidities, serum protein immunoassays, and long-term pneumonia risk.

Methods: Framingham Heart Study Offspring Cohort participants ≥65 years were linked to their Centers for Medicare Services claims data.

Intravenous Immunoglobulin-Induced Aseptic Meningitis in a Dermatomyositis Patient.

Aseptic meningitis is a rare but serious complication of treatment with intravenous immunoglobulin (IVIG) and often mimics meningitis of infectious etiology which poses a challenge for timely diagnosis. Although there are published recommendations on the management of IVIG-induced complications, there are no clear guidelines on the continuation of IVIG use after resolution of aseptic meningitis. We present a case of IVIG-induced aseptic meningitis in a patient with a history of refractory dermatomyositis who had been treated with immunosuppressive therapy and IVIG infusions for over a year.

The role of time in involving patients with cancer in treatment decision making: A scoping review.

Background: Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized.

Objective: This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers.

Diagnostic performance of immunohistochemistry markers for malignant pleural mesothelioma diagnosis and subtypes. A systematic review and meta-analysis.

Background: Malignant pleural mesothelioma (MPM) poses diagnostic challenges due to its resemblance to benign pleural pathologies and different histological subtypes. Several immunohistochemistry markers have been employed to aid in accurate diagnosis.

Methods: The present systematic review and meta-analysis aimed to assess the diagnostic performance of various immunohistochemistry markers in malignant pleural mesothelioma diagnosis and its histological subtypes.

Mitapivat-Associated Rib Fracture in a Hemolytic Anemia Patient.

Hereditary hemolytic anemia associated with pyruvate kinase deficiency is a rare hematological disorder that affects the glycolic pathway within red blood cells. The standard of care includes splenectomy, transfusions, and hematopoietic stem cell transplantation. However, these treatments can lead to common iatrogenic side effects such as infections, surgical complications, and iron overload.

Catecholaminergic Polymorphic Ventricular Tachycardia: Clinical Characteristics, Diagnostic Evaluation and Therapeutic Strategies.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary arrhythmia syndrome predominantly affecting children and young adults. It manifests through bidirectional or polymorphic ventricular arrhythmia, often culminating in syncope triggered by physical exertion or emotional stress which can lead to sudden cardiac death. Most cases stem from mutations in the gene responsible for encoding the cardiac ryanodine receptor (), or in the Calsequestrin 2 gene (), disrupting the handling of calcium ions within the cardiac myocyte sarcoplasmic reticulum.