Complete Heart Block in a Patient Declining Pacemaker Implantation: A Discussion on Patient-Centered Care and Shared Decision-Making.

Permanent pacemaker (PPM) implantation is the standard of care in patients with complete heart block (CHB) and second-degree type II atrioventricular (AV) block irrespective of patient symptoms when the conduction abnormality is irreversible. CHB generally constitutes a medical emergency that can be fatal if not urgently treated. This is in contrast to first-degree AV block and second-degree type I AV block, which require PPM implantation only in very special circumstances.

Teaching Preclinical Medical Students Lifestyle Counseling Skills for Patients' Health Behavior Change.

Introduction: Physicians face barriers to counseling patients regarding lifestyle, specifically, low perceived importance of and confidence in counseling, leading to underuse. There is a dearth in the literature evaluating educational interventions for counseling skills among preclinical medical students. Closing this gap is crucial to taking advantage of critical opportunities early in training.

A 24% Decline in the Utilization of Epidural Procedure Visits for Chronic Spinal Pain Management in the Medicare Population from 2019 to 2022: Updated Analysis of the Effect of Multiple Factors.

Background: The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020.

Escalating Growth to Rapid Decline of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in the Medicare Population: Updated Analysis of the Effect of Multiple Factors from 2000 To 2022.

Background: The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.

Immunomodulatory Effects of Modified Colostrum, Whey, and Their Combination With Other Natural Products: Effects on Natural Killer Cells.

Objectives: Natural killer (NK) cells are important immune system effector cells providing innate defenses against intracellular infections, including viral infections, immune surveillance, and cancer immunoediting. The primary purpose of this study was to investigate whether modified ultra-filtrated colostrum (UC) and hydrolyzed whey (W) products or their combinations with other natural products with reported immunomodulatory properties will stimulate NK cell cytotoxic activity by activation of granzyme B and IFN-γ production.

Methods: The ability of study products to stimulate the cytotoxic activity of human-purified CD56 NK cells and the production of granzyme B and IFN-γ by activated NK cells was evaluated in the cytotoxic assay.

A Moving Target: Firearm Deaths, Mental Health, and the Role of Physicians.

Purpose Of Review: This review aims to provide an updated overview of trends in firearm- related deaths, the mental health impact on communities, and clinical and legislative interventions. We examine existing interventions and highlight lesser-known yet impactful strategies, such as incorporating appropriate training in medical education on firearm safety. Additionally, we explore the broader impacts of firearm violence on community mental health and address the disputed topic of whether mental illness is a driving factor behind mass shootings.

Batteries Included: A Case of Multiple Self-Inflicted Foreign Bodies in the Lower Genitourinary Tract.

Self-insertion of foreign objects into the lower urinary tract is an uncommon presentation with diverse underlying motivations, including psychiatric illness, sexual gratification, intoxication, and perceived contraception. A wide variety of objects may be inserted, leading to varied symptom presentations. We report the case of a 51-year-old male with a history of post-traumatic stress disorder, antisocial personality disorder, and prior self-mutilation, who presented to the ED following self-insertion of multiple foreign objects into the lower urinary tract.

Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties.

Background: In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.

Methods: The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report.

Resident Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Academic Curriculum.

Background The goals of the annual Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) are to provide residents with an assessment of their knowledge and program directors an assessment of their residency programs. Research has shown that a score greater than 200 is correlated with passing the qualifying board examination. We observed a substantial number of our residents were not performing well on the exam, which prompted the implementation of a new academic program aimed at determining the impact of an academic curriculum addition on CREOG-ITE scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program.

Novel Injectable Nerve Stimulation Electrode Placed on the Dorsal Root Ganglion Using an Extravertebral Approach: A Feasibility Study in Cadavers.

Background: Dorsal root ganglion stimulation (DRGS) is an established method for treating persistent and severe pain conditions. However, performing DRGS has significant challenges. Current DRGS systems are expensive, hindering accessibility for many patients and health care systems.

Exponential Decline of 28.9% in Utilization of Interventional Pain Management Techniques Among Medicare Beneficiaries From 2019 to 2022: Updated Analysis on the Ongoing Effects of COVID-19, Economic Decline, the Affordable Care Act (ACA), and Medical Policies.

Background: Numerous studies have highlighted the escalating costs associated with managing low back and neck pain, as well as other musculoskeletal disorders. In the past, there was a notable increase in the use of interventional techniques to address these disorders. However, the COVID-19 pandemic disrupted various chronic pain treatment approaches, including interventional procedures and opioid use, following a broader trend of reduced healthcare services.

Socioeconomic deprivation is predictive of incomplete postoperative follow-up in patients with tibial shaft fractures.

Introduction: Patients who sustain tibial shaft fractures are at risk for delayed recognition of complications with inadequate postoperative follow-up. Area Deprivation Index (ADI) is a surrogate which may be used to analyze the effects of socioeconomic deprivation on postoperative follow-up rates. The purpose of this study was to determine if ADI is associated with incomplete postoperative follow-up after intramedullary (IM) nailing for fractures of the tibial diaphysis.

Key Insights for the Ethical and Appropriate Use of Artificial Intelligence by Medical Learners.

Introduction: The rapid advancement and adoption of large language models (LLMs) in various academic domains necessitate an examination of their role in scholarly works by medical learners.This paper seeks to discern the implications of LLM use by medical learners when preparing works for publication. While LLMs possess great potential to revolutionize the academic writing process, they can detract from the learning process when used by students and residents who are still learning how to research, formulate ideas, and write cohesive arguments.

Comprehensive Evidence-Based Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain: From the American Society Of Interventional Pain Physicians (ASIPP).

Background: Peripheral nerve stimulation (PNS) has been used for over 50 years to treat chronic pain by delivering electrical pulses through small electrodes placed near targeted peripheral nerves those outside the brain and spinal cord. Early PNS systems often required invasive neurosurgical procedures. However, since 2015, the Food and Drug Administration (FDA) approved percutaneously implanted PNS leads and neurostimulators  offering a much less invasive, non-opioid option for managing recalcitrant chronic pain.

Lifestyle Medicine Implementation in Family Medicine Clinic.

Lifestyle medicine, a patient-centered approach promoting healthy lifestyle behaviors, is an evidence-based tool for preventing and treating chronic diseases. It has been shown to reduce the burden of physical and psychological diseases. Despite this, clinical implementation is lagging, with physicians facing barriers effectively encouraging lifestyle change.

Synergistic Epistasis and Systems Biology Approaches to Uncover a Pharmacogenomic Map Linked to Pain, Anti-Inflammatory and Immunomodulating Agents (PAIma) in a Healthy Cohort.

The global public health addiction crisis has been stark, with over 932,400 deaths in the USA and Canada from opioid overdose since 1999-2020, surpassing the mortality rates at the top of the HIV/AIDS epidemic. Both nations exhibit opioid consumption rates significantly above the norm for developed countries. Analgesic type of opioids present both therapeutic benefits and substantial health risks, necessitating balanced drug regulation, careful prescribing, and dedicated opioid stewardship.

2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Management of Headache.

Description: Headache medicine and therapeutics evidence have been rapidly expanding and evolving since the 2020 U.S. Department of Veterans Affairs (VA) and U.