An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults.

Objectives: Research supports cognitive behavioral therapies for nightmares (CBT-N) in adults. However, the nuances of implementation and unstandardized nomenclature for treatment components has created confusion in the field. To provide clarification, an expert consensus panel convened to review treatment manual components and to develop guidelines for the standardized implementation and terminology of CBT-N.

Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction.

Introduction: Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

Opioid Prescriptions for Low Back Pain among Military-Connected Older Adults Across Multiple Care Systems.

Background: Untreated low back pain (LBP) in older adults can lead to disability and development of chronicity. Due to the potential development of medical comorbidities and negative risks associated with pharmacological use, chronic LBP management for older adults requires a responsive approach.

Methods: The objective of this study is to evaluate the probability of (1) opioid prescription receipt and (2) opioid-sedative coprescription, in a sample of military-service-connected patients enrolled in the Veterans Health Administration (VHA) or TRICARE, ages 30-85 years, receiving care in three systems: VHA, Military Health System (MHS), and nonfederal (civilian) healthcare facilities.

Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial.

Background: Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current AHA guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation but do not provide guidance around intubation methods, including the choice of laryngoscope.

Research Question: Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared to use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest?

Study Design And Methods: This secondary analysis of the Direct versus Video Laryngoscope (DEVICE) trial compared video laryngoscopy versus direct laryngoscopy in the subgroup of patients who were intubated following cardiac arrest.

Experience of The National Emergency Tele-Critical Care Network.

The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity.

Treatment of focal anaplastic Wilms tumor: A report from the Children's Oncology Group AREN0321 and AREN03B2 studies.

Background: In the fifth National Wilms Tumor Study, patients received vincristine and dactinomycin (VA) without radiation for stage I focal anaplastic Wilms tumor (FAWT) and VA plus doxorubicin (DD4A) and radiation for stage II-IV FAWT. Four-year event-free survival (EFS) and overall survival (OS) for stage I FAWT were 67.5% and 88.

Evaluating Digital Rehabilitation Outcomes in Chronic Musculoskeletal Conditions Across Non-Obesity, Obesity, and Severe Obesity.

Background: Obesity is a known risk factor and aggravator of musculoskeletal (MSK) conditions. The rising prevalence of obesity calls for scalable solutions to address MSK conditions in this population, given their complex clinical profile and barriers to accessing care.

Purpose: To evaluate the engagement and clinical outcomes of a fully remote digital care program in patients with MSK conditions, focusing on those with and without comorbid obesity.

Treatment Considerations for Pyoderma Gangrenosum After Reduction Mammoplasty in an Unsuspecting Patient Demographic.

Pyoderma gangrenosum (PG) is a rare, often idiopathic, noninfectious inflammatory neutrophilic dermatitis that causes painful ulcerative cutaneous papillomatous lesions. PG often mimics surgical infection, wound dehiscence, and postoperative cellulitis, leading to high rates of misdiagnosis and mistreatment. Here, a healthy 17-year-old adolescent girl with congenital breast asymmetry, macromastia, and a history of only mild intermittent autoimmune conditions developed an open wound along her inferior left breast incision 2 weeks after reduction mammoplasty.

Recent Orthopedic Trauma Volume in the United States Military Health System.

Introduction: As illustrated by the "Walker Dip," there is growing concern regarding the lack of combat casualty care during peacetime. Surgical volume and case complexity are paramount for training and skill sustainment. We sought to quantify the recent orthopedic trauma surgical case load of all military orthopedic surgeons across the Military Health System (MHS).

Patterns and Predictors of COVID-19 Vaccine Uptake Among U.S. Active Duty Service Members, 2020-2022: Implications for Future Pandemics.

Introduction: Vaccine mandates have been used to minimize the duty days lost and deaths attributable to infectious disease among active duty Service members (ADSMs). In response to the global COVID-19 pandemic, in August 2021, the U.S.

Best Practice Recommendations for Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia in the Military Health System.

Endometrial cancer is the most prevalent gynecologic cancer in the United States and has rising incidence and mortality. Endometrial intraepithelial neoplasia or atypical endometrial hyperplasia (EIN-AEH), a precancerous neoplasm, is surgically managed with hysterectomy in patients who have completed childbearing because of risk of progression to cancer. Concurrent endometrial carcinoma (EC) is also present on hysterectomy specimens in up to 50% of cases.

Viability assessment of Chlamydia trachomatis in men who have sex with men using molecular and culture methods.

Objectives: Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection (STI) worldwide. Diagnosis relies on nucleic acid amplification techniques, such as PCR, which does not distinguish between viable pathogens and residual bacterial DNA, leading to potential overdiagnosis and overtreatment. PCR with confirmation of pathogen viability has not been widely explored in the STI field.

FRESH extrusion 3D printing of type-1 collagen hydrogels photocrosslinked using ruthenium.

The extrusion bioprinting of collagen material has many applications relevant to tissue engineering and regenerative medicine. Freeform Reversible Embedding of Suspended Hydrogels (FRESH) technology is capable of 3D printing collagen material with the specifications and details needed for precise tissue guidance, a crucial requirement for effective tissue repair. While FRESH has shown repeated success and reliability for extrusion printing, the mechanical properties of completed collagen prints can be improved further by post-print crosslinking methodologies.

What is the Surgical Burden of Treatment for High-Energy Lower Extremity Trauma? A Secondary Analysis of the OUTLET Study.

Objectives: To describe and enumerate surgeries for patients who underwent reconstruction or amputation after severe distal tibia, ankle, and mid to hindfoot injuries.

Methods: Design: Secondary analysis of a multicenter prospective observational study.

Setting: 31 U.

Understanding the Medical Education Experiences of Low-Income Students Through a Maslow's Hierarchy of Needs Lens: An Exploratory Qualitative Study.

Background: Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences.

Objective: To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow's Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework.

Pharmacokinetic and Metabolomic Studies with BBT-059 in Nonhuman Primates Exposed to Total-Body Gamma Radiation.

BBT-059 is a long-acting PEGylated interleukin-11 analog that has been shown to have hematopoiesis-promoting and anti-apoptotic attributes, and is being studied as a radiation countermeasure for the hematopoietic acute radiation syndrome (H-ARS). This potential countermeasure has been demonstrated to enhance survival in irradiated mice. To investigate the toxicity and safety profile of this agent, 14 nonhuman primates (NHPs, rhesus macaques) were administered two different doses of BBT-059 subcutaneously 24 h after 4 Gy total-body irradiation and were monitored for the next 60 days postirradiation.

Utility of Candidate Genes From an Algorithm Designed to Predict Genetic Risk for Opioid Use Disorder.

Importance: Recently, the US Food and Drug Administration gave premarketing approval to an algorithm based on its purported ability to identify individuals at genetic risk for opioid use disorder (OUD). However, the clinical utility of the candidate genetic variants included in the algorithm has not been independently demonstrated.

Objective: To assess the utility of 15 genetic variants from an algorithm intended to predict OUD risk.

Losartan May Prevent Clinically Significant Postoperative Fibrosis, But Large Database Studies May Not Provide an Answer.

Losartan and other modulators of the Renin-Angiotensin System (RAS) have been used for their anti-fibrotic effects by non-surgeons for decades where suppression of maladaptive scar deposition is helpful, such as heart failure and chronic kidney disease. Only recently have orthopaedic surgeons begun to explore whether these medications might reduce or prevent post-operative joint stiffness. The relationship between orthopaedic surgeons and fibrosis is a more complicated.

Navigating Communication in Racially Concordant Care: Considerations for Medical Education.

Background And Objectives: Black/African American medical professionals and students engage in patient-centered communication in ways that are not yet described in medical education literature. The purpose of this paper is to explore the ways in which Black/African American attending physicians, residents, and medical students enact patient-centered communication while interacting with their Black/African American patients.

Methods: Forty-one Black/African American attending physicians, residents, and medical students were recruited through a snowball sample of the authors' personal and professional networks.

Biodiversity of the Bacterial and Fungal Microbiome and Associated Inflammatory Cytokine Profile in Chronic Rhinosinusitis.

Background: Dysbiosis of the bacterial and fungal microbiome has been increasingly implicated in the pathogenesis of chronic rhinosinusitis (CRS). This study explores the relationship between microbiome and mycobiome biodiversity and type 2 (T2) versus non-type 2 (NT2) inflammation.

Methods: Mucosal tissues from the ethmoid sinus were collected during endoscopic sinus (CRS) and skull base (controls) surgery between January 2020 and July 2021.

An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome.

Objectives: To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients.

Design: Retrospective cohort study.

Setting: American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021.

On context specificity and management reasoning: moving beyond diagnosis.

Objectives: Diagnostic error is a global emergency. Context specificity is likely a source of the alarming rate of error and refers to the vexing phenomenon whereby a physician can see two patients with the same presenting complaint, identical history and examination findings, but due to the presence of contextual factors, decides on two different diagnoses. Studies have not empirically addressed the potential role of context specificity in management reasoning and errors with a diagnosis may not consistently translate to actual patient care.