Bilateral Proximal Humerus Lesser Tuberosity Avulsions in an Adolescent Patient: A Case Report.

Case: Fourteen-year-old boy presented with bilateral proximal humerus lesser tuberosity avulsions after swinging between 2 desks. Injuries were not visualized on radiographs but identified on magnetic resonance imaging. He underwent bilateral open reduction and internal fixation of the bony avulsions.

Building a research-focused academic practice partnership: A stepwise approach.

The 20th century began a period of reform in nursing education and practice, with more nurses receiving advanced degrees and serving in key leadership roles throughout healthcare organizations. During this period, the transformation of the healthcare delivery system encouraged innovation and collaboration between academic nursing programs and other healthcare entities to develop partnerships based on a shared vision and goals. As a result, nurses are negotiating academic-practice partnership agreements and leading interprofessional teams to meet the needs of collaborating organizations.

Academic-Practice Partnership to Prevent and Manage Pressure Injuries: An Evidence-Based Quality Improvement Initiative.

Purpose: This evidence-based quality improvement (EBQI) initiative examined the effect of an academic-practice (A-P) partnership on improvement in quality measures in an acute care setting, specifically hospital-acquired pressure injury (HAPI) prevention and management.

Design: A pre-/postdescriptive design was conducted using the practice-informed active learning program to guide the project.

Participants And Setting: The EBQI initiative was conducted at a Southern Gulf-Coast university college of nursing and clinical nursing practice leaders at its affiliated 406-bed academic health center/level I trauma center, regional burn center, and comprehensive stroke center.

Massive Myelomatous Pleural Effusion With Contralateral Mediastinal Shift: A Unique Presentation of Extramedullary Myeloma.

Multiple myeloma (MM) is a relatively common malignancy that primarily affects the bone marrow, while extramedullary disease (EMD) occurs in the skin and muscle, lung pleura, lymph nodes, liver, and CNS. Myelomatous pleural effusion (MPE) is a rare extramedullary manifestation of MM in which pleural fluid is composed almost entirely of abnormal plasma cells. MPE and other types of EMD are associated with poor prognosis, and MPE can present emergently due to tension physiology.

Defining Pathogen and Susceptibility Patterns for Early Versus Late Ventilator Associated Pneumonia in Trauma Patients to Guide Empiric Treatment Decisions.

Introduction: Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant (MRSA) and infections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP.

Methods: This retrospective cohort study included adult trauma patients with the diagnosis of VAP.

An exploration of the perspectives of individuals and their caregivers on pressure ulcer/injury prevention and management to inform the development of a clinical guideline.

Background: Consumer engagement is a requirement of high quality clinical guidelines. Developing strategies to engage consumers and incorporate the perspectives of individuals with or at risk of pressure ulcers/injuries and their informal caregivers was one priority in the recent update of the EPUAP/NPIAP/PPPIA's Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline.

Aims: The aims were to determine the goals of individuals and caregivers for pressure ulcer/injury care, priorities for pressure ulcer/injury education and biggest problems related to pressure ulcers/injuries.

A unique presentation of a rare renal cancer: Appearance of bone metaplasia in tubulocystic renal cell carcinoma.

Tubulocystic renal cell carcinoma is a rare cancer that was not defined as a distinct entity until the early 2000s. Due to the recency of its classification, it remains poorly understood and leaves much room for future research. This report looks at a unique case of this rare subtype of renal cancer.

Immune Microenvironment in Gallbladder Adenocarcinomas.

Programmed death-1 (PD1) expression has not been reported in gallbladder adenocarcinoma. In this study we examined PD1 expression in gallbladder cancer to explore the correlation between PD1 expression and the clinicopathologic parameters. We found that 98% (46/47) cases expressed programmed death-ligand 1 (PD-L1) with 85% cases being PD-L1 3+.

An Unusual Case of Retroperitoneal Plexiform Neurofibromas Found in a Trauma Patient.

The spectrum of presentation for patients who have neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is very diverse due to a phenomenon known as variable expressivity. Patients may or may not present with cutaneous lesions or central nervous system (CNS) manifestations. However, multiple neurofibromas are the pathognomonic hallmark of NF1.

Miraculous Recovery After Penetrating Trauma to the Mediastinum.

Traumatic injury to the mediastinum can damage critical surrounding structures, including the pericardium, aorta, and bronchial tree. We highlight a miraculous case of a 13-year-old female with no past medical history who presented to the emergency department after being impaled in the chest by a metal fence post. After median sternotomy, the foreign object was removed, and the patient fortunately recovered with no permanent sequelae.

Mitigating disparity in children with acute appendicitis: Impact of patient-driven protocols.

Purpose: Previous reports in the literature demonstrate racial and ethnic disparities for children diagnosed with acute appendicitis, with minorities experiencing worse outcomes. At our institution, we have developed an evidence based patient driven protocol for children following laparoscopic appendectomy. However, the influence of such protocol on mitigating racial and ethnic disparities in outcomes remains unknown.

Protecting Restricted Extremities: The Implementation of a Pink Wristband.

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods.