Kingella kingae Induced Septic Arthritis in the Knee Revealing an Unexpected Diagnosis of Multiple Myeloma, a Case Report.

Introduction: Kingella kingae has become an increasingly significant cause of osteoarticular infection in children under the age of 4. The bacteria is infrequent in adults. Previous reports have indicated its association with infections, primarily affecting immunocompromised individuals.

Neuromodulation techniques in traumatic brain injury: a narrative review of the current state.

Traumatic brain injury (TBI) is a leading cause of death and disability throughout the world. Despite significant advances in medical care, many TBI survivors continue to have cognitive, physical, and psychological deficits that have a significant impact on their quality of life. Neuromodulation techniques, which use electrical or magnetic stimulation to modulate brain activity, have shown promise in the treatment of TBI symptoms.

Model for an International Case Sharing Program to Enhance Global Palliative Care Education.

Context: In Thailand, the field of palliative medicine is growing but access and training remain limited. We sought to expand education of resident physicians at Chiang Mai University (CMU) in Thailand through development of an international case sharing program.

Objectives: The goals of this project were to increase knowledge of core palliative care topics, to cultivate a culture of reflective clinical practice, and to create a model for collaboration in international palliative care education that can be replicated by other institutions.

The Minnesota Critical Care Working Group 1: Monitoring and coordinating statewide critical care surge response in the COVID-19 pandemic, March 2020 through July 1, 2021.

Background: In response to the COVID-19 pandemic and as part of the statewide healthcare coalition response the Minnesota Critical Care Working Group (CCWG), composed of Interprofessional leaders from the state's nine largest health systems was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July1, 2021.

Research Question: Can a statewide Critical Care Working Group develop contingency and crisis level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team?

Study Design And Methods: CCWG members (Intensivists, ethicists, nurses, MDH and MHA leaders) met by audio video conferencing as often as daily assessing COVID and non-COVID hospitalization data, developed surge indicators reflecting contingency versus crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response.

The Minnesota Critical Care Working Group 2: Crisis conditions during the COVID-19 Pandemic, July 2021 through March 2022.

Background: At the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge.

Research Question: Can a statewide Working Group collaboratively analyze real time evidence to identify crisis conditions and engage state leadership to implement care processes?

Study Design And Methods: CCWG/EWG met via video conferencing during the Fall 2021 severe surge to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions including group consensus on operating conditions; Federal Tele-Tracking data; MOCC patient placement data; and two surveys created and distributed to hospitals and healthcare professionals.

Does Trauma Center Volume Matter? An Analysis of Trauma Center Volume on Outcome Using the TQIP/NTDB Database.

Increasing trauma center admission volume is said to decrease mortality. Evidence supporting this position is dependent upon patient groups and the time period studied, and gaps remain. We evaluated the effect of annual volume of critically injured patients on hospital mortality, comparing two time periods.

Impact of Fluid Balance on the Development of Lung Injury.

Rationale: The pathophysiological relationship between fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear.

Objectives: To quantify the relative contribution of mechanical power and fluid balance in the development of lung injury.

Methods: Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (~18J/min) or low (~6J/min) mechanical power; and high (~4L) or low (~1L) targeted fluid balance.

Short-Term Postoperative Complications in Flexor Tendon Repair: A Subcategory Analysis by Surgical Specialty.

We aimed to investigate and compare the 30-day postsurgical complication rates and total operative times for hand or wrist flexor tendon injury repair procedures. We performed a retrospective cohort analysis of the American College of Surgeon National Quality Improvement Program database between 2015 and 2019. Patients were included in our study if they were 18 years or older and underwent surgical repair of a wrist or hand flexor tendon by a plastic surgeon, general surgeon, or orthopedic surgeon.

Impact of Methicillin-Resistant Nasal Polymerase Chain Reaction Screening Tests on Duration of Vancomycin Therapy for Skin and Soft Tissue Infections.

Recent literature demonstrated a 24-hour reduction in vancomycin duration of therapy (DOT) for skin and soft tissue infections (SSTIs) with a negative methicillin-resistant staphylococcus aureus (MRSA) nasal screening versus a positive nasal screening. Objective of this study was to investigate vancomycin DOT in patients with SSTIs who received MRSA nasal polymerase chain reaction (PCR) screening versus those who did not receive MRSA nasal PCR screening. A retrospective, multi-center, cohort study was completed in admitted adult patients on vancomycin for SSTI from 01/01/2020 to 09/30/2022.

Core Content, Competencies, and Accreditation in US Global Health Fellowships: A Survey of Leaders' Perspectives.

The number of global health (GH) fellowships in the United States has increased over the past two decades. However, there are currently no standard requirements, shared core content, or widespread systems of accreditation. With the growth in programs, it is appropriate to consider these issues.

Postoperative Brace Use After Hip Arthroscopy: A Systematic Review.

Background: Although hip bracing after hip arthroscopy is relatively common, it is not an evidence-based practice; no comparative studies or clinical trials exploring its effectiveness exist.

Purpose: We sought to summarize the rates of and indications for hip bracing after hip arthroscopy, surgeons' preferences on braces, and the types of braces used.

Methods: A systematic review was conducted using the PubMed, Embase, and Medline databases to identify studies that examined hip bracing following hip arthroscopy.

Local/Regional Anesthesia Versus General Anesthesia in Phalanx Fractures/Dislocations.

Traditionally, surgical repair of phalanx fractures was performed under general anesthesia. However, the emergence of regional and local anesthesia, otherwise known as Wide-awake Local Anesthesia No Tourniquet, provides an alternative approach where general anesthesia is undesirable. The choice of anesthetic approach resides with clinicians, though it is important to factor in the evidence that regional/local provides not only an alternative anesthesia approach but also potentially avoids comorbidities associated with general anesthesia.

The Dunning‒Kruger effect in resident predicted and actual performance on the American Board of Emergency Medicine in-training examination.

Objectives: The Dunning-Kruger effect (DKE) is a cognitive bias wherein individuals who are unskilled overestimate their abilities, while those who are skilled tend to underestimate their capabilities. The purpose of this investigation is to determine if the DKE exists among American Board of Emergency Medicine (ABEM) in-training examination (ITE) participants.

Methods: This is a prospective, cross-sectional survey of residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs.

Identification of patients on chronic prescription opioids at risk for opioid use disorder using pharmacy claims data.

Using pharmacy claims data from a single commercial health plan to identify opportunities for opioid use disorder (OUD) focused screening and interventions communicated via targeted prescriber messaging. Participants included members ≥18 years using more than 90 morphine milligram equivalents (MMED) daily based on all opioid claims, had >1 paid claim for an opioid product, and had ≥90 days of total opioid therapy. Members were excluded with ≥1 claims for an oral chemotherapy agent (except methotrexate).

Sedation Vacations in Neurocritical Care: Friend or Foe?

Purpose Of Review: To evaluate the role of sedation vacations in optimizing patient outcomes and enhancing the quality of care in neurological intensive care units (ICUs). We discuss the importance of sedation management in neurocritical care, considering recent research findings and clinical guidelines.

Recent Findings: Recent studies have highlighted the significance of sedation interruption protocols in improving patient outcomes in the ICU setting.

Emergency Medicine Milestones Final Ratings Are Often Subpar.

Background: The emergency medicine (EM) milestones are objective behaviors that are categorized into thematic domains called "subcompetencies" (eg, emergency stabilization). The scale for rating milestones is predicated on the assumption that a rating (level) of 1.0 corresponds to an incoming EM-1 resident and a rating of 4.