Investigating Moral Distress in Clinical Research Professionals-A Deep Dive into Troubled Waters.

Moral distress occurs when professionals are constrained from taking what they believe to be ethically appropriate actions or are forced to take actions they believe are ethically inappropriate, challenging their professional identities and representing systems-level issues within organizations. Moral distress has been recognized in a variety of health care-related fields; however, the phenomenon is still comparatively unexplored among clinical research professionals (CRPs). In this qualitative study, we interviewed ten CRPs to unearth root causes of moral distress in this ethically unique profession.

Who Should Contribute to Decisions About Health Care Space Design?

This commentary on a case considers how and by whom decisions about health care structures and spaces should be made and suggests merits and drawbacks of shared decision-making as one approach to Certificate of Need assessments.

A Wireless and Wearable Multimodal Sensor to Non-Invasively Monitor Transabdominal Placental Oxygen Saturation and Maternal Physiological Signals.

Poor placental development and placental defects can lead to adverse pregnancy outcomes such as pre-eclampsia, fetal growth restriction, and stillbirth. This study introduces two sensors, which use a near-infrared spectroscopy (NIRS) technique to measure placental oxygen saturation transabdominally. The first one, an NIRS sensor, is a wearable device consisting of multiple NIRS channels.

Lumbar Sympathetic Block for Treatment of Knee Pain From Synovial Plica Syndrome: A Case Report.

Lumbar sympathetic blocks (LSBs) are used to treat sympathetically mediated pain in the lower extremities, kidneys, ureters, and genitals. LSBs use local anesthetic to block the sympathetic system to modulate pain response. In this case report, an avid runner was diagnosed with synovial plica syndrome.

Vasoactive and Antifibrotic Properties of Cannabinoids and Applications to Vasospastic/Vaso-Occlusive Disorders: A Systematic Review.

Background: Management of vasospastic and vaso-occlusive disorders is a complex challenge, with current treatments showing varied success. Cannabinoids have demonstrated both vasodilatory and antifibrotic properties, which present potential mechanisms for therapeutic relief. No existing review examines these effects in peripheral circulation in relation to vasospastic and vaso-occlusive disorders.

The Musculoskeletal Tumor Society Clinical Practice Guideline on the Management of Metastatic Humeral Disease.

Management of Metastatic Humeral Disease is based on a systematic review of published studies surrounding the management of metastatic disease, multiple myeloma, and lymphoma limited to the humerus. This guideline contains seven action statements to assist orthopaedic surgeons, orthopaedic oncologists, physicians, and any other qualified healthcare professionals involved in the surgical management of metastatic disease of the humerus. It is also intended to serve as an information resource for decision makers, researchers, and developers of clinical practice guidelines.

Acute Respiratory Failure Complicating Endoscopic Sleeve Gastroplasty: A Case Report.

Endoscopic sleeve gastroplasty (ESG) is a safe and minimally invasive procedure for the treatment of obesity. We report the case of a patient with obesity who underwent ESG complicated by postprocedural respiratory failure. During the procedure, she developed a Pao2/fraction of inspired oxygen (Fio2) ratio that necessitated postoperative mechanical ventilation.

Membranous nephropathy in chronic lymphocytic leukemia responsive to ibrutinib: A case report.

Membranous nephropathy (MN) is an uncommon renal presentation in patients with chronic lymphocytic leukemia (CLL), and as such, there is no standard therapy for these patients. A few cases of MN in CLL have been described with varying success in MN treatment involving alkylating agents and fludarabine. Here we report the first case of MN in a patient with CLL treated with ibrutinib with complete renal response.

Tricarboxylic acid (TCA) cycle, sphingolipid, and phosphatidylcholine metabolism are dysregulated in infection-induced cachexia.

Cachexia is a life-threatening disease characterized by chronic, inflammatory muscle wasting and systemic metabolic impairment. Despite its high prevalence, there are no efficacious therapies for cachexia. Mice chronically infected with the protozoan parasite represent a novel animal model recapitulating the chronic kinetics of cachexia.

Fleeing Iraq with nothing but a dream.

Facing the harsh realities of life as a refugee in Jordan and the United States, an ambitious young man holds to a conviction: that he will, one day, get a PhD.

Utility of Regional Maxillary Nerve Blocks in Improving Cleft Palate Postoperative Outcomes.

Background: Palatoplasty procedures used to repair cleft palates are commonly associated with limiting postoperative pain. Regional anesthetic blocks have been utilized to improve pain outcomes and decrease opioid intake, yet additional data is needed to fully explore its utility in this setting.

Objective: To explore whether ultrasound-guided suprazygomatic maxillary blocks (SMB) improve postoperative pain, postoperative opioid use, time to oral feeding, and length of stay compared with a palatal field block in cleft palate repair.

Predicting anti-cancer drug combination responses with a temporal cell state network model.

Cancer chemotherapy combines multiple drugs, but predicting the effects of drug combinations on cancer cell proliferation remains challenging, even for simple in vitro systems. We hypothesized that by combining knowledge of single drug dose responses and cell state transition network dynamics, we could predict how a population of cancer cells will respond to drug combinations. We tested this hypothesis here using three targeted inhibitors of different cell cycle states in two different cell lines in vitro.

Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes.

Objective: Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes.

Intraoperative Kounis Syndrome and Fixation Errors: A Case Report.

Postinduction hypotension, though frequently due to anesthetic medications, has a variety of causes. We present a case of presumed intraoperative Kounis syndrome, or anaphylaxis-induced coronary vasospasm, in which the patient's perioperative course was initially attributed to anesthesia-induced hypotension and iatrogenic rebound hypertension leading to Takotsubo cardiomyopathy. A second anesthetic event with immediate recurrence of hypotension after the patient received levetiracetam appears to confirm the diagnosis of Kounis syndrome.

Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation.

Objective: To compare the rates of health care utilization (office messages or calls, office visits, and emergency department [ED] visits) and postoperative complications within 30 days after surgery between patients with successful voiding trials on postoperative day 0 and those with unsuccessful voiding trials on postoperative day 0 and between patients with successful and unsuccessful voiding trials on postoperative day 1. Secondary objectives were to identify risk factors for unsuccessful voiding trials on postoperative days 0 and 1 and to explore the feasibility of catheter self-discontinuation by assessing for any complications associated with at-home catheter self-discontinuation on postoperative day 1.

Methods: This study was a prospective observational cohort study of women undergoing outpatient urogynecologic or minimally invasive gynecologic surgery for benign indications at one academic practice from August 2021 to January 2022.

Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot.

In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC's 13 Core EPAs. In 2020-21, a case study was employed to describe pilot schools' implementation experiences.

Sclerodermiform Lupus Erythematosus: A Series of Five Patients.

Background: Sclerodermiform lupus erythematosus (SDLE) is a rare Type 3 overlap syndrome of morphea and cutaneous lupus diagnosed with histopathologic features of both diseases present. It was first reported in 1976 by Umbert et al with a case series of four patients. SDLE is more common in young to middle-aged female patients.

The CROWNing Event on Hair Loss in Women of Color: A Framework for Advocacy and Community Engagement (FACE) Survey Analysis.

Hair loss is a primary reason for women with skin of color to seek dermatologic care. In addition to physical disfigurement, patients with hair loss are more likely to report feelings of depression, anxiety, and low self-esteem. There is a critical gap in dermatology advocacy efforts and educational information intended for women with skin of color.

Fibrous Proliferations in Posttransplant Kaposi Sarcoma.

Kaposi sarcoma (KS) is characterized by cutaneous lesions that are often papular and present variably depending on the stage of progression. We describe a patient with a fibroma-like nodule, a lesion not commonly associated with KS. Previously observed in lymphedematous human immunodeficiency virus-associated KS, the occurrence of this nodule in the absence of chronic lymphedema suggests an alternative etiology.

Quality Improvement: Effect of Standardized Plastic Surgery Consultation Note Templates on Charge Capture.

Background: Effective medical record documentation is imperative for both patient care and reimbursement for care provided. The purpose of this study was to compare coding/billing patterns for plastic surgery consultations before and after implementation of a standardized documentation protocol.

Methods: Standardized hand, facial trauma, and general plastic surgery consult note templates were created.

Practical Review of the Management of Animal Bites.

Unlabelled: Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans.