Emergency department-initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study.

Objectives: Alcohol use disorder (AUD) is the most common substance use disorder in the United States. Despite availability of four FDA-approved medications, fewer than 10% of patients are prescribed medication. This study aimed to evaluate the impact and feasibility of emergency department (ED)-initiated oral naltrexone in patients with moderate to severe AUD.

The Art of Clinical Negotiation.

The art of clinical negotiation is an important, yet underappreciated aspect of medicine. Key components of negotiation include the need to consider principles over personalities, to explore all options before deciding on the best course, to realize if consensus cannot be achieved then compromise may still be possible, to work from evidence to incorporate contextual factors, and to stay evidence based. These principles can be helpful in many settings, including contract negotiation, drug pricing, and research.

Two-Layer Retrieval-Augmented Generation Framework for Low-Resource Medical Question Answering Using Reddit Data: Proof-of-Concept Study.

Background: The increasing use of social media to share lived and living experiences of substance use presents a unique opportunity to obtain information on side effects, use patterns, and opinions on novel psychoactive substances. However, due to the large volume of data, obtaining useful insights through natural language processing technologies such as large language models is challenging.

Objective: This paper aims to develop a retrieval-augmented generation (RAG) architecture for medical question answering pertaining to clinicians' queries on emerging issues associated with health-related topics, using user-generated medical information on social media.

Clinical Impact of Pancreatic and Peripancreatic Hemorrhage Associated With Acute Pancreatitis.

Purpose: The significance of pancreatitis-associated hemorrhage outside the context of a ruptured pseudoaneurysm remains unclear. This study aims to characterize the clinical significance of pancreatic hemorrhage during acute pancreatitis (AP).

Methods: This retrospective study included adult patients diagnosed with hemorrhagic pancreatitis (HP) from 2010 to 2021.

Betacoronavirus internal protein: role in immune evasion and viral pathogenesis.

Betacoronaviruses express a small internal (I) protein that is encoded by the same subgenomic RNA (sgRNA) as the nucleocapsid (N) protein. Translation of the +1 reading frame of the N sgRNA through leaky ribosomal scanning leads to expression of the I protein. The I protein is an accessory protein reported to evade host innate immune responses during coronavirus infection.

Heightened innate immune state induced by viral vector leads to enhanced response to challenge and prolongs malaria vaccine protection.

Cytomegalovirus is a promising vaccine vector; however, mechanisms promoting CD4 T cell responses to challenge, by CMV as a vector, are unknown. The ability of MCMV to prolong immunity generated by short-lived malaria vaccine was tested. MCMV provided non-specific protection to challenge with and increased interleukin-12 (IL-12) and CD8α dendritic cell (DC) numbers through prolonged MCMV-dependent interferon gamma (IFN-γ) production.

BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial.

Background: In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.

Aims: The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.

Methods: Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group.

Nasal Septal Abscesses: A Systematic Review.

Background: Nasal septal abscesses (NSA) necessitate prompt recognition and management to prevent morbidity and long-term sequelae. To date, no comprehensive review of NSA alone has been conducted.

Objective: To conduct a systematic review of the presentation and management of NSA and determine patients at risk of sequelae.

Squamous Cell Carcinoma of the Conjunctiva: A Population-Based Study on Epidemiologic Trends, Cancer-Specific Survival Patterns, and the Risk of Second Malignant Neoplasms, 1975 to 2016.

Purpose: To analyze the national epidemiologic trends of squamous cell carcinoma of the conjunctiva (SCCC) over 4 decades, providing the largest report on disease-specific survival (DSS) outcomes and investigating the risk of developing second primary neoplasms in these patients.

Methods: This retrospective, population-based cohort study analyzed 1,172 patients diagnosed with SCCC from January 1, 1975, through December 31, 2016. Data were extracted from the US Surveillance, Epidemiology, and End Results database.

Exploring the role of the rock climbing Treadwall as a novel therapy tool in physical rehabilitation.

Background: Rock climbing offers numerous health benefits, but accessibility and safety concerns limit its therapeutic use, especially for individuals with disabilities. No prior studies have explored the potential benefits of integrating the Treadwall, a rotating climbing wall with improved accessibility and safety, into rehabilitation protocols.

Objective: To evaluate the safety and feasibility of implementing a Treadwall climbing intervention as a novel therapy tool for children with hemiplegic cerebral palsy.

Utility of ChatGPT as a preparation tool for the Orthopaedic In-Training Examination.

Purpose: Chat Generative Pre-Trained Transformer (ChatGPT) may have implications as a novel educational resource. There are differences in opinion on the best resource for the Orthopaedic In-Training Exam (OITE) as information changes from year to year. This study assesses ChatGPT's performance on the OITE for use as a potential study resource for residents.

Spinal accessory nerve transfer for shoulder abduction has no benefit over supraclavicular exploration and nerve grafting in brachial plexus birth injury: a systematic review.

Introduction: Brachial plexus birth injury (BPBI) has an incidence of 0.9 per 1,000 live births in the population. Techniques for repair classically include supraclavicular exploration and nerve grafting (SENG) and more recently nerve transfer, namely of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) to improve functional outcomes such as glenohumeral abduction and external rotation.

Trends in Antepartum, Delivery, and Postpartum Venous Thromboembolism.

Objective: To assess trends in risk for obstetric venous thromboembolism (VTE).

Methods: This retrospective cohort study analyzed data from the 2008-2019 Merative MarketScan Commercial Claims and Encounters and Medicaid Multi-State databases. Women aged 15-54 years with a delivery hospitalization and health care enrollment from 1 year before pregnancy to 60 days after delivery were identified.

Geriatric Nutritional Risk Index and Postoperative Outcomes Following Head and Neck Cancer Surgery.

Background: The geriatric nutritional risk index (GNRI) is a tool to assess preoperative nutritional status that can be calculated simply based on height, weight, and serum albumin. This study assesses the utility of GNRI in predicting postoperative complications in patients undergoing major head and neck cancer (HNC) surgery.

Methods: Retrospective review of the 2016-2020 National Surgical Quality Improvement Program database.

Robotic Laparoscopic Assisted Treatment of Inguinal Hernia Containing an Incarcerated Ectopic Pregnancy.

Introduction: It is rare for adult female patients to present with incarcerated inguinal hernias containing ovary, fallopian tube, or uterine tissue. Potential surgical treatment options for incarcerated inguinal hernias containing ovary, fallopian tube or uterine tissue include open inguinal hernia repair (IHR), laparoscopic or robotic IHR.

Case Description: Herein, we report a case of an adult female presenting with a unilateral incarcerated inguinal hernia containing ectopic pregnancy.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Changes in Medication Complexity and Post-Hospitalization Outcomes in Older Adults Hospitalized for Heart Failure.

Introduction: Medication regimen complexity may be an important risk factor for adverse outcomes in older adults with heart failure. However, increasing complexity is often necessary when prescribing guideline-directed medical therapy at the time of a heart failure hospitalization. We sought to determine whether increased medication regimen complexity following a heart failure hospitalization was associated with worse post-hospitalization outcomes.

Can We Improve Geriatrics Recruitment? An Analysis of U.S. Geriatrics Fellowship Programs on X.

Introduction: The COVID-19 pandemic accelerated the shift from in-person to virtual recruitment, prompting residency and fellowship programs to adopt innovative strategies, such as leveraging social media platforms to attract applicants and enhance visibility. Our aim was to identify and describe the presence of U.S.