Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.

Importance: The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.

Objective: To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.

Design, Setting, And Participants: Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%.

Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis.

Background: Computed tomography (CT) scans are widely used for evaluating children with acute atraumatic altered mental status (AMS) despite concerns about radiation exposure and limited diagnostic yield. This study aims to assess the efficacy of CT scans in this population and provide evidence-based recommendations.

Methods: A systematic review was conducted according to PRISMA guidelines.

Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique.

Background: Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.

Objectives: Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.

Short- and Mid-Term Outcomes Following ALIF and TLIF in L5-S1 Isthmic Spondylolisthesis Patients.

Background: A limited number of studies have compared the outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF) for the treatment of isthmic spondylolisthesis. This study aims to compare postoperative complications between these two surgical approaches.

Methods: A retrospective review was performed using a large national database.

An optimized plasmalogen modulating dietary supplement provides greater protection in a male than female mouse model of dilated cardiomyopathy.

We previously reported that plasmalogens, a class of phospholipids, were decreased in a setting of dilated cardiomyopathy (DCM). Plasmalogen levels can be modulated via a dietary supplement called alkylglycerols (AG) which has demonstrated benefits in some disease settings. However, its therapeutic potential in DCM remained unknown.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Prevalence and Associated Risk Factors in a Large Cohort of US Children.

Background: Household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may play a key role in times of increased infection, particularly among children. We aimed to determine the prevalence of SARS-CoV-2 antibodies and identify risk factors associated with SARS-CoV-2 antibody positivity in children.

Methods: Unvaccinated children aged 18 months to 11 years between August 2022 and June 2023 underwent oral fluid testing for SARS-CoV-2 antibodies.

Safety, efficacy, and mechanism of action of the temporo-masseteric nerve block.

The objective of the study was to assess the utility and safety of Temporo-masseteric Nerve Block (TMNB), and to explore the mechanism for its apparent sustained pain relief. This manuscript describes, (1) a retrospective study evaluating pain reduction in patients who received the TMNB injection for the management of masticatory myogeneous pain (myalgia, per Diagnostic Criteria for Temporomandibular Disorders (DC/TMD criteria)), and (2) a motor nerve conduction study (NCS) of the temporalis and masseter, performed in the absence of signs or symptoms of TMD, before and after the TMNB injection. The results were as follows.

Arteriovenous Fistula Creation and Care in an Office-Based Practice Compared to Hospital Based Care.

Objectives: This study evaluates and compares outcomes of arteriovenous fistulas (AVFs) created in a dialysis access dedicated office-based laboratory (OBL) and outpatient hospital setting.

Methods: All consecutive outpatient surgical autologous AVFs created at an academic hospital, community hospital, and an OBL from 2016-2020 were reviewed. Demographics, comorbidities, surgical procedure, complications, maturation, patency, and procedures for maintenance were assessed from time of surgical evaluation to latest available documentation.

Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents.

Background: Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses.

Objective: To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain.

Rotational Atherectomy Followed by Modified (Cutting or Scoring) Balloon Versus Plain Balloon Before Drug‑Eluting Stent Implantation for Calcified Coronary Lesions: A Meta-Analysis.

Coronary calcification is a major factor leading to stent under-expansion, and subsequent adverse events. This meta-analysis aimed to evaluate the short and long‑term outcomes of rotational atherectomy (RA), followed by modified balloon (cutting or scoring) (MB) versus plain balloon before drug‑eluting stent implantation for calcified coronary lesions. We searched PubMed, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL), from inception until 30 January 2024.

Epidemiology of Consumer Product-Related Ocular Injuries in the Incarcerated Population.

Purpose: To characterize the epidemiology of consumer product-related ocular injury in the United States (US) incarcerated population, and identify preventable causes.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for cases of eye injury from 2014 to 2023. Incarcerated cases were identified using the keywords "prison", "jail", "inmate", and "incarcerate".

Inpatient total thyroidectomy costs and outcomes vary regionally: A nationwide study.

Objectives: While it is known that surgical costs continue to rise in the United States, there is little information about the specific underlying factors for this variation in many common procedures. This study investigates the influence of geographic location and hospital demographics on hospital cost and postoperative outcomes in adult patients undergoing total thyroidectomy (TT).

Methods: The National Inpatient Sample was queried for patients who underwent primary TT between 2016 and 2017.

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.

Stool processing methods for Xpert Ultra testing in childhood tuberculosis: A prospective, multi-country accuracy study.

Background: Centrifuge-free processing methods support stool Xpert Ultra testing for childhood tuberculosis (TB), but there are limited data on their accuracy, acceptability and usability.

Methods: We conducted a prospective evaluation of stool Xpert Ultra in India, South Africa, and Uganda with three methods: Stool Processing Kit (SPK), Simple One-Step (SOS), and Optimized Sucrose Flotation (OSF). Children <15 years old with presumptive TB had respiratory specimen testing with Xpert Ultra and culture.

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.