Hybrid repair of type A aortic dissection after infrarenal endovascular aortic repair and bilateral iliac branched grafts.

Type A dissection is infrequently reported after infrarenal endovascular aortic repair (EVAR). Here, we present a case of an EVAR with iliac branch endoprosthesis complicated by type A dissection requiring ascending arch repair. After hemiarch repair, the patient was noted to have residual type B dissection, malperfusion of the left renal artery, and compression of the EVAR with left external iliac limb occlusion.

Sequential Dual Guide Catheter Technique for Chronic Total Occlusion Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery.

Triple arterial access is sometimes necessary for complete visualization of the collateral circulation and distal vessel anatomy, and to facilitate the retrograde approach in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass surgery (CABG) and multiple sources of collaterals. We present two CTO PCI cases in prior CABG patients with complex occlusions supplied by multiple sources of collaterals for which a "sequential dual guide technique" was used, reducing the number of necessary arterial access points from three to two.

Immediate postinjury extracorporeal carbon dioxide removal reduces ventilator requirements and mitigates acute respiratory distress syndrome in swine.

Background: Awareness of ventilator-induced lung injury contributed to increased use of extracorporeal interventions, but not immediately after injury, before acute respiratory distress syndrome (ARDS) ensues. Our objective was to evaluate the role of venovenous extracorporeal carbon dioxide removal (ECCO2R) in management of mechanically ventilated swine with smoke inhalation injury and 40% body surface area burns.

Methods: Yorkshire swine (n = 29, 43.

Real world virologic outcomes in patients with elevated body mass index receiving long acting cabotegravir/rilpivirine.

Background: The first long-acting injectable antiretroviral, cabotegravir/rilpivirine (LA-CAB/RPV), was FDA approved in January 2021 for persons with HIV suppressed on their current regimen. Body mass index (BMI) ≥30 kg/m2 has been identified as a risk factor for virologic failure, however data is limited due to small sample sizes. The aim of this study was to evaluate the impact of BMI on the efficacy of LA-CAB/RPV in a real-world setting.

Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial.

Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health.

Legal Risk to the Emergency Medicine Resident in Training and Attending Supervisors.

Medical malpractice is an inevitable truth of being a practicing provider. Despite awareness of malpractice risk, education on understanding the legal landscape and protecting oneself from being named in a malpractice claim is sorely underrepresented in medical school and residency curricula. This review summarizes what is known about the legal risks to the resident in training and the attending physician supervisor.

The Expanding Role of United States Healthcare Chaplains in Clinical Ethics.

Healthcare chaplains in the United States increasingly report being tasked by their organizations to participate in the formal work of clinical ethics, by serving on ethics committees, performing clinical ethics consultations, or leading clinical ethics programs. This mapping study documents that professionally-trained chaplains possess a number of skills and attributes that enhance their capability for this work; however, they often lack certain knowledge specific to the discipline of clinical ethics that is needed for roles they are being asked to perform. The professional associations of both chaplaincy and clinical ethics are encouraged to address this educational gap for the benefit of both disciplines.

Expanding Treatment Opportunities: Reviewing the Current State of Injectable Antiretrovirals for Treatment of HIV.

Antiretroviral therapy has evolved significantly over the last 20-30 years, from requiring multiple tablets multiple times per day to single-tablet regimens and most recently, in 2021, long-acting injectable antiretrovirals. These long-acting antiretrovirals have expanded the treatment options for individuals with HIV who may have difficulty adhering to daily oral medications, difficulty taking oral medications, and/or individuals with multidrug-resistant HIV. This article reviews the currently available long-acting injectable antiretrovirals, including cabotegravir/rilpivirine, lenacapavir, and ibalizumab.

Characterization of Interchanging Incretin Analogs in Clinical Practice: A Descriptive Report.

Objective: To characterize the tolerability associated with incretin analog interchanges to equipotent or higher strengths based on an interchange process in an adult outpatient setting.

Methods: This was a retrospective chart review of adult patients receiving care through a participating family medicine or endocrinology clinic between January 1, 2022, and November 30, 2022 at a major academic medical center. An incretin analog equivalency table and protocol for interchange was created in response to ongoing shortages and need for therapy adjustments to different medications within the same class.

Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts.

Importance: Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications.

Objective: To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts.

Impact of Non-Alcoholic Fatty Liver Disease on Sepsis Inpatient Outcomes: A Nationwide Sample Analysis (2000-2019).

Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) are reported to have an increased risk of developing severe infections, leading to hospitalizations with sepsis. However, data regarding the impact of comorbid NAFLD on in-hospital outcomes of patients with sepsis is scarce. This nationwide retrospective observational study using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality included 21,057,911 adult patients who were admitted to hospitals in the United States between 2000 and 2019 with a primary discharge diagnosis of sepsis.

Peri-operative strategy in resuscitation of unstable injured surgical patients: a primer.

Background: Trauma remains a leading cause of death, both for individuals under 40 in North America, and globally, where it contributes to ~10% of deaths annually. Thoughtful, timely, balanced resuscitation, especially in the peri-operative period for unstable injured surgical patients, is vital for optimizing outcomes. The advanced trauma life support protocol plays a pivotal role in early evaluation and management, emphasizing hemorrhage control and resuscitation strategies.

Improvements in Transitional Care Among Medicaid-Insured Patients With Serious Mental Illness.

Background: The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients.

Purpose: To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI.

Evaluating Operation Good Food & Beverages, a Black Youth-Driven Public Advocacy Campaign.

Background: Food and beverage (F&B) marketing practices that contradict health guidelines are particularly concerning for children and adolescents, who are developmentally more susceptible than adults to persuasive advertising and to Black communities, due to ethnically-targeted marketing, contributing to higher rates of obesity and other diet-related chronic diseases. Accordingly, here we evaluated Operation Good Food and Beverages (OGF&B), an online social marketing campaign calling for shifting toward more marketing of healthier F&B to Black youth and Black communities.

Methods: OGF&B was developed and implemented by a multidisciplinary team of academic, advocacy, and advertising partners and active for four months in 2022 during the COVID-19 pandemic.

Endocarditis in a Patient With Severe Mitral Annular Calcification.

This report presents the case of a 76-year-old woman from Honduras with severe mitral annular calcification and severe aortic stenosis who presented with chest pain and presyncope. She was found to have infective endocarditis with a large abscess on the posterior mitral leaflet secondary to bacteremia.

Pneumococcal Vaccination Rates and Associated Meningitis Events in Patients With Acute Cerebrospinal Fluid Leak.

Objective: To characterize the institutional utilization of pneumococcal vaccination during an index hospital admission for acute cerebrospinal fluid (CSF) leakage and associated infectious and clinical outcomes.

Methods: This retrospective cohort study included patients hospitalized and treated for an acute CSF leak from January 2017 to June 2022. The primary outcome evaluated the incidence of pneumococcal vaccination during the index admission in patients without prior vaccination.

Cost-Comparison of Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Intermediate-Risk Pulmonary Embolism.

Background: Catheter-directed thrombolysis (CDT) and large-bore mechanical thrombectomy (MT) are the leading percutaneous-based therapies for the management of intermediate-risk pulmonary embolism (PE). While previous studies have demonstrated their procedural safety and efficacy, the cost implications of these interventions remain unclear. This study aims to conduct a cost-benefit analysis to evaluate the economic advantages associated with CDT and MT from the perspective of the treating hospital.

Association between statin intensity and femoropopliteal stent primary patency in peripheral arterial disease.

Background: Statins are widely used in coronary and peripheral arterial disease, but their impact on patency of stents placed for peripheral arterial disease is not well-studied. The purpose of this study was to evaluate femoropopliteal stent primary patency according to statin intensity at the time of stent placement and compare this effect to other covariates that may influence stent patency.

Materials And Methods: A retrospective review identified 278 discrete femoropopliteal stent constructs placed in 216 patients over a 10-year period; Rutherford categories were 2 (3.

Real-time performance improvement optimizes damage control resuscitation best practice adherence: Results of a pilot prospective observational study.

Background: Maintaining balanced blood product ratios during damage control resuscitation (DCR) is independently associated with improved survival. We hypothesized that real-time performance improvement (RT-PI) would increase adherence to DCR best practice.

Study Design And Methods: From December 2020-August 2021, we prospectively used a bedside RT-PI tool to guide DCR in severely injured patients surviving at least 30 min.