Primary Neuroendocrine Tumor of the Breast: A Case Report and Review of Current Guidelines.

Primary neuroendocrine tumor of the breast is a rare subtype of breast carcinoma that most commonly affects postmenopausal women in their sixth or seventh decade of life. We report a case of a 52-year-old female who presented to our clinic with concerns about a self-palpable mass involving her left breast that had not been detected on a routine mammogram five months prior. Upon clinical exam and diagnostic workup comprising imaging, a tissue biopsy, and immunostaining, she was found to have primary high-grade neuroendocrine carcinoma of the breast with necrosis.

Association of the COVID-19 Pandemic With Outcomes After Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study Examining Changes in Health Care Access, Delivery, and Functional Outcomes.

Background: Structured rehabilitation optimizes outcomes and reduces reinjury risk after anterior cruciate ligament reconstruction (ACLR). The coronavirus 2019 (COVID-19) pandemic interrupted standard rehabilitation, possibly affecting ACLR outcomes.

Purpose: To characterize changes to ACLR functional outcomes related to the COVID-19 pandemic.

Simultaneous Pancreas-Kidney Transplant Outcomes Stratified by Autoantibodies Status and Pretransplant Fasting C-peptide.

Backgrounds: Pancreatic beta cell function and islet autoantibodies classically distinguish types of diabetes (type 1 diabetes mellitus [DM] or type 2 DM). Here, we sought to evaluate simultaneous pancreas-kidney (SPK) transplant outcomes stratified by the presence or absence of beta cell function and autoantibodies.

Methods: SPK recipients were eligible if pretransplant autoantibodies were measured against insulin, islet cell, or glutamic acid decarboxylase 65-kD isoform.

Association of complicated appendicitis with geographic and socioeconomic measures in children.

Background: Complicated appendicitis, considered a marker of delay in accessing surgical care among children, has been inconsistently associated with race, socioeconomic status, insurance type, rurality, and distance to care. This statewide assessment measured factors associated with complicated appendicitis while overcoming limitations of prior work, namely, selection bias and use of inexact socioeconomic status measures.

Methods: Children (<18 years) undergoing appendectomy for appendicitis in Wisconsin from 2018 to 2021 were identified in the Wisconsin Hospital Association database.

Prompt engineering with a large language model to assist providers in responding to patient inquiries: a real-time implementation in the electronic health record.

Background: Large language models (LLMs) can assist providers in drafting responses to patient inquiries. We examined a prompt engineering strategy to draft responses for providers in the electronic health record. The aim was to evaluate the change in usability after prompt engineering.

Venous Thromboembolism Prophylaxis in High-Risk Pediatric Trauma Patients.

Importance: The indications, safety, and efficacy of chemical venous thromboembolism prophylaxis (cVTE) in pediatric trauma patients remain unclear. A set of high-risk criteria to guide cVTE use was recently recommended; however, these criteria have not been evaluated prospectively.

Objective: To examine high-risk criteria and cVTE use in a prospective multi-institutional study of pediatric trauma patients.

Telemedicine for Prescribing Nirmatrelvir/Ritonavir: Safety, Logistics, and Challenges.

Nirmatrelvir/ritonavir can be a useful COVID-19 treatment but is challenging to prescribe safely because of drug-drug interactions. This study describes our experience prescribing nirmatrelvir/ritonavir within a small interdisciplinary team with a specific focus on management of drug-drug interactions. Ascertaining and communicating modifications of concomitant medications is a key safety element.

Integrative Group Visits for Sleep Disturbance: A Brief Report.

Background: There is limited research on the efficacy of group visits using integrative treatment modalities and for people whose chief concern is sleep disturbance. This quality improvement project delivered integrative health content in group visits for people with self-reported sleep disturbance.

Objective: To describe an integrative group visit for sleep disturbance, explore the evaluation process for several outcomes, and report on lessons learned.

Rehabilitation Following ACL Repair with Internal Brace Ligament Augmentation in Female Gymnast: A Resident's Case Report.

Introduction: Anterior Cruciate Ligament (ACL) injuries continue to be a major source of morbidity in gymnastics. The gold standard is to perform an ACL Reconstruction (ACLR). However, injuries to the proximal femoral attachment of the ACL have demonstrated an ability to regenerate.

Validation of the motivated strategies for learning questionnaire and instructional materials motivation survey.

Purpose: To validate the Motivated Strategies for Learning Questionnaire (MSLQ), which measures learner motivations; and the Instructional Materials Motivation Survey (IMMS), which measures the motivational properties of educational activities.

Methods: Participants (333 pharmacists, physicians, and advanced practice providers) completed the MSLQ, IMMS, Congruence-Personalization Questionnaire (CPQ), and a knowledge test immediately following an online learning module (April 2021). We randomly divided data for split-sample analysis using confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and the multitrait-multimethod matrix.

Evaluation of Gram Stain-Guided Antibiotic Therapy for Methicillin-Resistant Pneumonia in Intensive Care Unit Patients.

Despite high negative predictive values (NPVs) seen with methicillin-resistant (MRSA) nares polymerase chain reaction (PCR) assays, utilization of both respiratory sample Gram stain and MRSA nares PCR in patients with pneumonia may contribute to overuse of laboratory resources. The purpose of this study was to evaluate if a Gram stain demonstrating no Gram-positive organisms from a respiratory sample is sufficient to allow for de-escalation of vancomycin therapy. This single center study retrospectively identified intensive care unit (ICU) patients started on vancomycin for presumed pneumonia at University of Wisconsin (UW) Health in Madison, WI between August 2022 and March 2023.

Health-related quality of life in patients with triple-class exposed relapsed and refractory multiple myeloma treated with idecabtagene vicleucel or standard regimens: patient-reported outcomes from the phase 3, randomised, open-label KarMMa-3 clinical trial.

Background: Chimeric antigen receptor T-cell therapy idecabtagene vicleucel (ide-cel) showed significantly improved progression-free survival compared with standard regimens in adults with relapsed and refractory multiple myeloma who had received two to four previous regimens in the ongoing phase 3 KarMMa-3 trial (NCT03651128). This study analysed patient-reported outcomes (PROs), a KarMMa-3 secondary endpoint.

Methods: In the randomised, open-label, phase 3 KarMMa-3 trial, 386 patients in hospitals (≥18 years of age, with measurable disease and an Eastern Cooperative Oncology Group performance status score of 0 or 1, who had received two to four previous regimens-including an immunomodulatory agent, a proteasome inhibitor, and daratumumab-and had documented disease progression after receiving their last dose of the last therapy) were randomly assigned to ide-cel (n=254) or standard regimens (daratumumab, pomalidomide, and dexamethasone; daratumumab, bortezomib, and dexamethasone; ixazomib, lenalidomide, and dexamethasone; carfilzomib and dexamethasone; or elotuzumab, pomalidomide, and dexamethasone; n=132).

Neuromodulation Techniques for Headache Management.

This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic.

Ketamine for Primary Analgosedation in Critically Ill Surgery and Trauma Patients Requiring Mechanical Ventilation.

Objectives: Evaluate effectiveness and safety outcomes associated with the use of ketamine for primary analgosedation in the surgical/trauma ICU setting.

Design: Retrospective cohort study.

Setting: Academic medical center in Minnesota.

Behavioral Management of Respiratory/Phonatory Dysfunction for Dysarthria Associated With Neurodegenerative Disease: A Systematic Review.

Purpose: This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease.

Method: Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

Results: The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators.

A severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial cluster with inter-facility spread: Lessons learned.

Background: Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest.

Setting: This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital.

Diagnostic testing and antibiotic utilization among inpatients evaluated for coronavirus disease 2019 (COVID-19) pneumonia.

We evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2-positive patients and even higher among those who underwent procalcitonin testing (68%).

Radical hysterectomy case volume and cervical cancer treatment in the era of COVID-19: A multi-site analysis of National Cancer Institute-designated Comprehensive Cancer Centers.

Objective: To compare radical hysterectomy case volume, cancer stage, and biopsy-to-treatment time of invasive cervical cancer diagnosed before and after onset of the COVID-19 pandemic.

Methods: In a multi-institution retrospective cohort study conducted at 6 large, geographically diverse National Cancer Institute-designated cancer centers, patients treated for newly diagnosed invasive cervical cancer were classified into 2 temporal cohorts based on date of first gynecologic oncology encounter: (1) Pre-Pandemic: 3/1/2018-2/28/2020; (2) Pandemic & Recovery: 4/1/2020-12/31/2021. The primary outcome was total monthly radical hysterectomy case volume.

Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.

Purpose: The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role.

Intraoperative neural monitoring during head and neck surgery in patients with concern for cervical spine instability.

Cervical and craniocervical instability are associated with catastrophic procedural outcomes. We discuss three individuals who required otolaryngologic surgical intervention: two with symptomatic spinal instability and one in whom spinal stability was unable to be assessed. Two cases were managed with procedural positioning precautions and evoked potential monitoring, and the other with procedural positioning precautions alone.

Personalisation and embodiment in e-Learning for health professionals: A randomised controlled trial.

Purpose: Mayer's theory of multimedia learning proposes that personalisation and embodiment (P/E) can improve outcomes in e-Learning. The authors hypothesised that an e-Learning module enhanced by P/E principles would lead to higher knowledge, perceived P/E and motivation among health care professionals, compared with an unenhanced module.

Methods: The authors conducted a randomised trial comparing two versions of a 30-minute multimedia e-Learning module addressing the antibiotic management of pneumonia.