Distinguishing Pseudosubluxation From True Injury: A Case of C2-3 and C3-4 Subluxation in a Pediatric Patient.

A 6-year-old girl presented with a one-week history of neck pain after a trampoline accident. Cervical radiographs interpreted as pseudosubluxation of C2 on C3. CT demonstrated the reversal of lordosis with anterolisthesis of C2-C3 and C3-C4.

Prospective Study of Outcomes in Adults with Nonalcoholic Fatty Liver Disease.

Background: The prognoses with respect to mortality and hepatic and nonhepatic outcomes across the histologic spectrum of nonalcoholic fatty liver disease (NAFLD) are not well defined.

Methods: We prospectively followed a multicenter patient population that included the full histologic spectrum of NAFLD. The incidences of death and other outcomes were compared across baseline histologic characteristics.

Influence of Psychological Safety and Organizational Support on the Impact of Humiliation on Trainee Well-Being.

Objectives: To develop physicians who can practice safely, we need better understanding of how the clinical learning environment affects trainee well-being. Two psychosocial constructs may help us understand the context: psychological safety (belief one can speak up without concerns) and perceived organizational support (degree to which members feel that their organization cares for them and values their contributions). The objective of this study is to test a moderated mediation model to determine how humiliation (X) impacts trainees' well-being (Y) while taking into account psychological safety (mediator) and organizational support (moderator).

Chyle Leak After Robotic Living Donor Nephrectomy: Literature Review And Management.

Chyle leak after living donor nephrectomy is a rare complication and is associated with a significant postoperative burden. To the best of our knowledge, only 1 case of chyle leak after robotic living donor nephrectomy has been reported in the literature. In this study, we present our experience with 2 cases of chyle leak: 1 after and 1 during robotic donor nephrectomy.

DNAgenie: accurate prediction of DNA-type-specific binding residues in protein sequences.

Efforts to elucidate protein-DNA interactions at the molecular level rely in part on accurate predictions of DNA-binding residues in protein sequences. While there are over a dozen computational predictors of the DNA-binding residues, they are DNA-type agnostic and significantly cross-predict residues that interact with other ligands as DNA binding. We leverage a custom-designed machine learning architecture to introduce DNAgenie, first-of-its-kind predictor of residues that interact with A-DNA, B-DNA and single-stranded DNA.

Analysis of Pediatric Dog Bite Injuries at a Level 1 Trauma Center Over 10 Years.

Background: Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center.

Methods: This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries.

Hip and Knee Bracing: Categorization, Treatment Algorithm, and Systematic Review.

Hip and knee braces or orthoses are often used to provide support after surgery and to prevent or reduce the severity of injuries. The braces are used for stabilization, immobilization, mechanical correction, and rehabilitation. Hip braces consist of stabilization and unloader variations, whereas knee braces are composed of knee sleeves and patellofemoral, prophylactic, unloader, and functional braces.

The Role for Simulation in Professional Identity Formation in Medical Students.

Introduction: Authentic clinical experiences and reflection are critical for medical student professional identity formation (PIF). Individualized learning plans and competency-based education accelerate time to graduation, thus creating more demand for students to gain PIF experiences early in medical education. This pilot study investigated student professional identity experiences related to participation in a clinical simulation during the first week of medical school.

Brain State Monitoring: Current Research and Future Possibilities.

Processed electroencephalography (pEEG) devices have been used as depth of anesthesia monitors for over two decades to monitor anesthetic depth and reduce the incidence of awareness with recall (AWR). Each device has unique strengths and weaknesses. A growing body of evidence questions the ability of a pEEG-derived numerical indices to consistently, rapidly, and reliably quantify consciousness and prevent AWR in patients under general anesthesia.

Group B streptococcal colonization: Prevalence and impact of smoking in women delivering term or near term neonates in a large tertiary care hospital in the southern United States.

Background And Hypothesis: The role of smoking as a risk factor for group B streptococcal (GBS) colonization in women during pregnancy has not been previously adequately explored. We hypothesized that women of term or near term neonates who smoked during pregnancy were more likely to have GBS colonization than their non-smoking counterparts.

Methods: The electronic health records (EHRs) of a convenience sample of women delivering in an inner-city university tertiary care center were reviewed.

Primary Care Physician Characteristics Associated with Prescribing Potentially Inappropriate Medication for Elderly Patients: Medicare Part D Data.

Background: Despite the high risk of adverse drug events associated with potentially inappropriate medications (PIMs), primary care physicians (PCPs) continue to prescribe them for the elderly. The objective of this study was to explore PIM prescribing behavior in relation to characteristics among PCPs practicing in the United States.

Methods: We conducted a retrospective cohort study of PCPs in the 2013 to 2015 Medicare Part D Public Use File.

Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey.

Background: Little is known about specialist-specific variations in guideline agreement and adoption.

Objective: To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report.

Methods: Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n = 134) and pulmonologists (n = 99) in the 2012 National Asthma Survey of Physicians.

Preventable Closed Claims in the AANA Foundation Closed Malpractice Claims Database.

Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. This study used thematic analysis to examine anesthesia closed claims that were associated with preventable morbidity and mortality.

Providers' Guidance to Parents and Service Use for Latino Children With Developmental Disabilities.

To better understand disparities between Latino and White children with autism or other developmental disabilities (ASD/DD), we examined whether Latino ethnicity predicted the number of specialty care services received by children with severe functional limitations depending on medical providers' responses to parents' initial concerns about their child's development. Through linkage of the Pathways and NS-CSHCN datasets, we found ethnic disparities in the receipt of specialty services associated with providers' responsiveness to parent-reported concerns among children with ASD/DD. Among children with significant functional limitations, Latino children whose parents received passive/reassuring responses from their providers were less likely to receive specialty services than White children with ASD/DD.

Tobacco smoke exposure as a risk factor for human papillomavirus infections in women 18-26 years old in the United States.

Background: Although tobacco smoke has been associated with many infections, little is known of its association with human papillomavirus (HPV) infections among young adult women. The aim of the study was to explore the association of tobacco smoke exposure on HPV infections in young adult women in the United States. It was hypothesized that tobacco smoke exposure (both active and passive) as objectively measured by cotinine levels was associated with increased HPV infection in a national sample of 18 and 26 year-old women in the United States.

Basics of continuous renal replacement therapy in pediatrics.

In the last three decades, significant advances have been made in the care of children requiring renal replacement therapy (RRT). The move from the use of only hemodialysis and peritoneal dialysis to continuous venovenous hemofiltration with or without dialysis (continuous renal replacement therapy, CRRT) has become a mainstay in many intensive care units. The move to CRRT is the result of greater clinical experience as well as advances in equipment, solutions, vascular access, and anticoagulation.

It's Never Just a Block: An Analysis of Regional Anesthesia Closed Claims.

Anesthesia care increasingly includes use of regional anesthesia techniques, either as a primary anesthetic or to reduce the patient's postoperative pain. Both neuraxial anesthesia and peripheral nerve blockade have several noteworthy functions. These functions include diminishing sensory sensation to pain and potentially producing a motor blockade, both of which may facilitate the surgical procedure.

How Should Mechanical Circulatory Support Be Deactivated for Patients With Depression at the End of Life?

Mechanical circulatory support (MCS) is an increasingly frequent treatment option for managing end-stage heart failure. Devices are implanted either as destination therapy or as bridge to transplant. Patients undergoing this treatment can experience significant symptoms of depression in addition to stresses associated with chronic illness.

Educating Resident and Fellow Physicians on the Ethics of Mechanical Circulatory Support.

Mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation, left ventricular assist devices and total artificial hearts have altered the natural history of heart failure, and specialists in the fields of cardiology and cardiothoracic surgery are faced with more complex ethical considerations than ever before. Residency and fellowship training programs, however, do not have formal curricula in medical ethics as it applies to MCS. In response, this article proposes that ethics be integrated into graduate medical education with a focus on the following 6 constructs: patient best interest, respect for autonomy, informed consent, shared decision making, surrogate decision making, and end-of-life care.