Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

Background: Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6].

Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.

Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.

Household Clustering of Sequence Type 131 Clinical and Fecal Isolates According to Whole Genome Sequence Analysis.

 Within-household sharing of strains from the resistance-associated 30R1 and 30Rx subclones of sequence type 131 (ST131) has been inferred based on conventional typing data, but it has been assessed minimally using whole genome sequence (WGS) analysis.  Thirty-three clinical and fecal isolates of ST131-30R1 and ST131-30Rx, from 20 humans and pets in 6 households, underwent WGS analysis for comparison with 52 published ST131 genomes. Phylogenetic relationships were inferred using a bootstrapped maximum likelihood tree based on core genome sequence polymorphisms.

A Review of Atypical Femoral Fractures From a Tertiary Care Teaching Hospital: An Alarming Trend?

Objective: To evaluate the experience of a single tertiary care teaching hospital with the association between use of bisphosphonates and atypical femoral fractures, and to identify potential risk factors and chronologic incidence.

Design: Retrospective review.

Setting: Tertiary-care teaching hospital.

Practical Approaches to Immunotherapy in the Clinic.

The development of immunotherapy using checkpoint blockade has altered the treatment landscape for patients who had but few options only several years ago. Currently, approved anti-checkpoint agents include ipilimumab, the first approved treatment aimed against the cytotoxic T-lymphocyte antigen-4 (CTLA-4) pathway, and pembrolizumab and nivolumab, which inhibit the programmed death-1 (PD-1) pathway. Careful monitoring and early intervention for immune-mediated side effects is important to mitigate toxicity.

Scleroderma renal crisis or thrombotic thrombocytopenic purpura: seeing through the masquerade.

SCLERODERMA: renal crisis (SRC), a somewhat rare but serious complication of systemic scleroderma, is one of only a few known rheumatologic emergencies; it presents in as many as 10% of patients with scleroderma. Before the use of angiotensin converting enzyme (ACE) inhibitors to treat SRC, the mortality rate for SRC was extremely high-as much as 90% after 1 year. However, the mortality rate has significantly improved with the early and aggressive use of ACE inhibitors.

Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Melanoma.

Purpose: Talimogene laherparepvec (T-VEC) is a herpes simplex virus type 1-derived oncolytic immunotherapy designed to selectively replicate within tumors and produce granulocyte macrophage colony-stimulating factor (GM-CSF) to enhance systemic antitumor immune responses. T-VEC was compared with GM-CSF in patients with unresected stage IIIB to IV melanoma in a randomized open-label phase III trial.

Patients And Methods: Patients with injectable melanoma that was not surgically resectable were randomly assigned at a two-to-one ratio to intralesional T-VEC or subcutaneous GM-CSF.

RECORD-2: phase II randomized study of everolimus and bevacizumab versus interferon α-2a and bevacizumab as first-line therapy in patients with metastatic renal cell carcinoma.

Background: The open-label, phase II RECORD-2 trial compared efficacy and safety of first-line everolimus plus bevacizumab (EVE/BEV) with interferon plus bevacizumab (IFN/BEV) in patients with metastatic renal cell carcinoma.

Patients And Methods: Previously untreated patients were randomized 1:1 to bevacizumab 10 mg/kg every 2 weeks with either everolimus 10 mg/day (EVE/BEV) or interferon (9 MIU 3 times/week, if tolerated) (IFN/BEV). Tumor assessments occurred every 12 weeks.

Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a single center experience with 2 years follow-up.

Background: Laparoscopic Sleeve Gastrectomy (LSG) is a relatively new procedure that is gaining wide acceptance. However, laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains one of the most commonly performed bariatric procedures with the best long-term results. There are few studies comparing LSG with LRYGB.

Characteristics of elderly fall patients with baseline mental status: high-risk features for intracranial injury.

Background: Falls are a major cause of morbidity in the elderly.

Objectives: We describe the low-acuity elderly fall population and study which historical and clinical features predict traumatic intracranial injuries (ICIs).

Methods: This is a prospective observational study of patients at least 65 years old presenting with fall to a tertiary care facility.

Delayed presentation of deep sternal wound infection.

Deep sternal wound infections (DSWI) are infections of the sternum, mediastinum, or the muscle, fascia and soft tissue that overlie the sternum, typically occurring within a month of cardiac surgery. They are infrequent though severe complications of cardiac surgery. Diagnosis is made by the clinical presentation of fever, chest pain, or sternal instability in the setting of wound drainage, positive wound cultures, or chest radiographic findings.

Improving outcome of bariatric surgery: best practices in an accredited surgical center.

The number of laparoscopic bariatric procedures being performed in the USA has increased dramatically in the past decade. Because of limited health-care resources, hospital administrators and insurance carriers are placing emphasis on length of stay and patient outcomes. The goal of this study was to evaluate the feasibility and safety of a clinical pathway in managing patients undergoing bariatric surgery in a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited center.

Mid-level Providers Working in a Low-acuity Area are More Productive than in a High-acuity Area.

Introduction: Mid-level providers (MLP) are extensively used in staffing emergency departments (ED). We sought to compare the productivity of MLPs staffing a low-acuity and high-acuity area of a community ED.

Methods: This is a retrospective review of MLP productivity at a single center 42,000-volume community ED from July 2009 to September 2010.

The impact of working with medical students on resident productivity in the emergency department.

Introduction: Academic emergency departments (ED) strive to balance educational needs of residents and medical students with service requirements that optimize patient care. No study to date has evaluated whether resident precepting of medical students affects residents' clinical productivity. Understanding the interplay of these variables may allow for ED staffing that maximizes productivity.

Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

Objective: To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures.

Design: Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator.

Setting: Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory.

Intratympanic hemorrhage and concussion in a football offensive lineman.

Background: A 26-year-old arena football lineman participating in a "bull in the ring" blocking and tackling drill was blindsided by an opposing teammate. He sustained a direct helmet-to-helmet blow to the right temporal area.

Objectives: This case describes a unique mechanism of ear barotrauma (intratympanic hemorrhage) and concussion caused by helmet-to-helmet contact in American football.

Babesia microti infection, eastern Pennsylvania, USA.

Infection with Babesia microti has not been well-described in eastern Pennsylvania, USA, despite the vector of this organism being prevalent. We report 3 cases of babesiosis in eastern Pennsylvania in persons without recent travel outside the region or history of blood transfusions, suggesting emergence of this infection.

Aerodigestive tract burn from ingestion of microwaved food.

Aerodigestive tract burns represent a rare but potentially devastating injury pattern throughout the world. Although the majority of these injuries do not require intervention, these burns have the potential for poor outcomes. Traditionally this disease has been caused by superheated gases found in explosions or fire-related injury.

Communication gaps in nursing home transfers to the ED: impact on turnaround time, disposition, and diagnostic testing.

Introduction: This study aims to determine the source of communication gaps in history of present illness (HPI), medical history, and advanced directives in nursing home (NH) patients transferred to the emergency department (ED). We also attempt to determine if these gaps create differences in patient turnaround time (TAT), disposition decision, or diagnostic testing.

Methods: A convenience sample of patients transferred from NHs to a level 1 community trauma center was enrolled by the physicians caring for them.

Comparison of resident and mid-level provider productivity in a high-acuity emergency department setting.

Introduction: Mid-level providers (MLPs) are used in many emergency departments (EDs) to provide care in a low-acuity, high-volume setting, and are able to see more patients and generate more relative value units (RVUs) than residents in this setting. It is unknown if MLPs are as productive as emergency medicine residents in a high-acuity setting.

Objective: To determine if there are productivity differences between residents and MLPs, as defined by patients seen (pt/h) and RVUs generated per hour (RVU/h), in a high-acuity area of the ED.