Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline.

Objective: The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition.

Methods: This was a retrospective cohort study. Patients less than 18 years old presenting to a single academic children's hospital ED between 2010 and 2020 with a chief complaint of heavy menstrual bleeding were included.

Impact of Fatigue on Work Productivity, Activity Impairment, and Healthcare Resource Utilization in Inflammatory Bowel Disease.

Objectives: Fatigue is commonly reported in patients with Crohn's disease (CD) and ulcerative colitis (UC), including patients with inactive disease. We explored the impact of fatigue on healthcare utilization (HCU) and work productivity and activity impairment (WPAI).

Methods: Data collected between 2017 and 2022 were analyzed from the CorEvitas IBD Registry.

Higher rates of delay in starting advanced inflammatory bowel disease therapies linked to insurance delays, intravenous infusions, and lack of pharmacy support.

Background: Because biologic and small molecule therapy is expensive, payors have mandated pre-authorizations for these medications, often resulting in a lengthy approval process. The aims of this study are to assess the frequency of and risk factors for delays in starting advanced therapies assessing insurance, care team, and patient-related factors.

Methods: Retrospective, multi-center study of adult inflammatory bowel disease patients with prescriptions for an advanced therapy in two geographically distinct academic gastroenterology practices; one with and the other without a dedicated pharmacist.

Perfusion Showdown: Comparison of Multiple MRI Perfusion Techniques in the Grading of Pediatric Brain Tumors.

Background And Purpose: There are multiple MRI perfusion techniques, with limited available literature comparing these techniques in the grading of pediatric brain tumors. For efficiency and limiting scan time, ideally only one MRI perfusion technique can be used in initial imaging. We compared DSC, DCE, and IVIM along with ADC from DWI for differentiating high versus low grade pediatric brain tumors.

Proactive Approaches for a Wheelchair User in Pediatric Residency: A Case Study for Disability Inclusion.

Objective: Despite encountering many barriers to inclusion, people with disabilities are entering residency training in increasing numbers. However, the increase in representation among people with physical disabilities remains low and published case studies and accommodations processes for wheelchair users in pediatric residency are absent in the literature. To support the inclusion of residents with physical disabilities in residency, we outline a proactive approach to the accommodations process and inclusion of a resident with a physical disability in pediatric residency.

Transforming the Medical School Admissions Process: Prioritizing Team-Based Skills and Patient-Centered Values.

This article examines the need for reform in medical school admissions to better align with the collaborative and patient-centered nature of contemporary healthcare. Traditional admissions processes prioritize academic excellence, often neglecting essential interpersonal and team-based skills. We advocate for several strategies to address this gap.

Long Head of Biceps Tendinopathy Is Associated With Age and Cuff Tendinopathy on MRI Obtained for Evaluation of Shoulder Pain.

Background: Shoulder pain-mostly related to rotator cuff tendinopathy-is the most common reason adults seek upper limb specialty care. Tendinopathy of the long head of the biceps may be part of rotator cuff tendinopathy, which most of us develop as we age. Evidence that these processes are related and that both are part of human shoulder senescence could contribute to a reconceptualization of shoulder tendinopathy as a single set of age-related changes, which are often well-accommodated, sometimes misinterpreted as an injury, and associated with notable nonspecific treatment effects, thus meriting caution regarding the potential for overtreatment.

Words of advice: how to write the story of a patient for a problem-based learning session in a healthcare education program.

Medical education is in the process of a pedagogical revolution. Traditional lectures are playing a progressively smaller role, with more of the content being delivered through student-centered small-group sessions. Problem-based learning (PBL) has become a centerpiece of education for many medical schools, in large part because of its focus on the learners identifying their own knowledge gaps.

Intracranial findings associated with low odds of retinal hemorrhage among children under 2 years of age at a single pediatric trauma center.

Background: Evaluation by a pediatric ophthalmologist to look for retinal hemorrhages (RH) is often part of screening for occult injury among young children with intracranial hemorrhage (ICH) presenting to a trauma center. While important, this examination may lengthen the time a child and family remain at the hospital.

Objective: We sought to identify injury patterns associated with a low likelihood of RH, which may help streamline child abuse screening protocols for very young children with ICH.

Why so slow? The advancement of females in neurosurgery: a 30-year analysis.

Objective: As gender parity in medicine improves, neurosurgery lags behind. In pediatric neurosurgery, considered the most "female-friendly" subspecialty, determining the extent to which gender disparity has evolved over time, and how it compares to other subspecialties, can serve as an important benchmark for neurosurgery altogether. This study analyzed gender parity across different neurosurgical and subspecialty training stages to understand how female representation varies with training level and leadership positions.

Associations of linear growth and weight gain in the first 2 years with bone mass at 4 years of age in children in Dhaka, Bangladesh.

Objective: Growth faltering is widespread in many low- and middle-income countries, but its effects on childhood bone mass accrual are unknown. The objective of this study was to estimate associations between length (conditional length-for-age -scores, cLAZ) and weight (conditional weight-for-age -scores, cWAZ) gain in three age intervals (ages 0-6, 6-12 and 12-24 months) with dual-energy X-ray absorptiometry-derived measures of bone mass (total body less head (TBLH) bone mineral content (BMC), areal bone mineral density (aBMD) and bone area) at 4 years of age.

Design: Associations between interval-specific growth parameters (cLAZ and cWAZ) and bone outcomes were estimated using linear regression models, adjusted for maternal, child and household characteristics.

Are Levels of Loneliness Associated With Levels of Comfort and Capability in Musculoskeletal Illness?

Background: Variation in levels of pain intensity and incapability among patients with musculoskeletal conditions is associated with measures of mindset (unhelpful thoughts [such as hurt equals harm] and feelings of distress [overwhelm, rumination] regarding bodily sensations) and circumstances (social health as well as security in finances, roles, home, and support) as much or more so than pathophysiology severity. Loneliness is an important aspect of social health, it is associated with worse mental health, and it has been identified as worthy of attention and intervention by health authorities in several countries. It is estimated that up to one-third of adults older than 45 years of age experience loneliness.

Navigating life with single-ventricle CHD: psychosocial needs across adulthood.

Objective: The population of adults with single-ventricle congenital heart disease (CHD) is growing. This study explores their lived experiences through an adult developmental psychology framework.

Methods: Individuals aged 18 and older with single-ventricle CHD participated in Experience Group sessions and 1:1 interviews.

Variation Across Organ Procurement Organizations in Deceased-Donor Kidney Offer Notification Practices.

Introduction: How offer notifications are distributed early in the kidney allocation timeline, including how widely they are offered, is unclear. A better understanding of offer notification practices across organ procurement organizations (OPOs) may identify opportunities for more efficient allocation.

Methods: We merged the Scientific Registry of Transplant Recipients potential transplant recipient file with additional offer notification time stamps to identify 54 631 deceased-donor kidney match runs from 2017 to 2023.

Multidisciplinary Surgical Care for a Cervical Esophageal Duplication Cyst.

We present a case of a three-month-old male who presented with a cervical esophageal duplication cyst requiring early surgical intervention. The patient presented with feeding difficulties, poor weight gain, and respiratory distress. Due to the position of the cervical esophageal duplication cyst and airway compression, this unique case required a multidisciplinary surgical approach involving both otolaryngology and cardiothoracic surgery.

Visual recovery in a patient with optic neuropathy secondary to copper deficiency.

Purpose: To highlight the utility of ganglion cell layer (GCL) analysis in early diagnosis of optic neuropathy secondary to copper deficiency and emphasize the importance of timely repletion for visual recovery.

Observations: A 67-year-old woman presented with four months of gradually decreasing vision bilaterally. Medical history was significant for Stage I duodenal and Stage III colon cancer treated with Whipple surgery and hemicolectomy.