Decision-Making About Potentially Non-Beneficial Intensive Care Unit Treatments: Interviews of Family Members from an Academic Public Hospital.

ObjectiveDeveloping effective strategies to improve shared decision-making (SDM) about potentially non-beneficial intensive care unit (ICU) treatments for patients with advanced medical illness requires understanding patients' and family members' perspectives. This study explores family members' experiences in discussing potentially non-beneficial treatments with ICU clinicians to identify factors that influenced their decision-making.MethodsSemi-structured interviews of pre-dominantly non-White family members making decisions about potentially non-beneficial ICU treatments were conducted in the medical ICU of an academic public hospital in Los Angeles County.

Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.

Introduction: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.

Patients And Methods: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.

An Age-Friendly Approach to Medication Optimization.

This is the second in a series of Age-Friendly case studies developed as a function of the John A. Hartford Foundation grant to the American Society of Consultant Pharmacists and the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy to Leverage Pharmacists as Age-Friendly 4Ms Champions. This series presents a case for each of the 4Ms: What Matters, Medication, Mentation, and Mobility, and examines how these elements interrelate to optimize care for older patients.

Cholecysto-biliary fistula mimicking type 1 Mirizzi syndrome: A case report.

Background: Mirizzi syndrome is a rare complication of chronic gallstone disease in which an impacted stone causes compression or erosion of the common hepatic duct. Accurate preoperative diagnosis is crucial but often challenging. We report a case that was preoperatively diagnosed as type 1 Mirizzi syndrome but was found intraoperatively to be type 4, involving a cholecysto-biliary fistula and complete erosion of the common hepatic duct.

A giant fecaloma causing stercoral colitis secondary to aripiprazole and benztropine: A case report.

Background: Fecaloma is a mass of hardened feces impacted in the rectum and sigmoid. When the colonic mucosal wall and vasculature are compressed, stercoral colitis, a rare type of inflammatory colitis, may occur. Despite being connected to psychiatric patients and antipsychotic medications in the literature, fecaloma remains a significant, yet often overlooked, cause of morbidity and mortality in this population.

Carvedilol vs. Metoprolol Effectiveness in Patients With Left Ventricular Assist Devices: A TriNetX Analysis.

Background: Beta-blockers are a cornerstone of heart failure management, but comparative effectiveness data for different beta-blockers in patients with mechanical circulatory support remain limited. This study aimed to compare clinical outcomes between carvedilol and metoprolol in patients with left ventricular assist devices (LVADs).

Methods: We performed a retrospective cohort study using the TriNetX Research Network (Cambridge, MA: TriNetX, LLC), a global federated health research platform providing access to electronic medical records across 104 healthcare organizations.

Enhanced Instructions for Inpatients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Introduction: Colonoscopy is the gold standard test for detecting colorectal cancer. Its accuracy relies on adequate bowel preparation (BP), but the current literature shows that hospitalized patients have high rates of inadequate BP. Data about strategies to improve BP in the inpatient population are limited and controversial.

Ethics of deceased organ donation and normothermic regional perfusion: donors are 'dead enough'.

Purpose Of Review: Normothermic regional perfusion (NRP) for the donation after circulatory death (DCD) increases the supply and function of organs. However, the procedures used have led to significant ethical controversies. Despite the numerous studies on the subject, moral issues are seldom analyzed comparatively.

Ethics of managed care in renal transplantation: the principal approach and alignment of incentives create an ethical system.

Purpose Of Review: Organ transplantation is a vital medical procedure that saves and extends lives. However, it requires a careful balance of resources, which are often limited by managed care constraints. Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD).

Characterizing the General Surgery Experience of Future Breast Surgeons: A Multi-institutional Study from the US ROPE Consortium.

Background: Breast cancer care has become increasingly complex, lending itself to fellowship-based specialization. However, breast surgery expertise remains central to general surgery training. We hypothesized that residents entering breast surgical oncology (BSO) fellowship have more exposure to breast surgery and log a higher number of breast cases compared with all other graduating residents.

Associations Between Adverse Childhood Experiences, Depressive Symptoms, and Nicotine Dependence Among Tobacco Users With Mental Illnesses.

BackgroundAdverse childhood experiences (ACEs) are associated with both increased depressive symptomatology and nicotine dependence (ND) in the general population. However, the relationship between ACEs, depressive symptoms, and ND among people with mental illness (MI) remains unexplored.AimsIn this study, we examined (a) depressive symptoms mediating the relationship between ACEs and ND and (b) ND severity mediating the relationship between ACEs and depressive symptoms.

Improving Scholarship in a Community Hospital Residency Program With a Curriculum Featuring a Structured Roadmap, Individual Accountability, and Measurement of Outcomes.

Introduction: The Accreditation Council of Graduate Medical Education requires all Graduate Medical Education programs to show evidence of scholarly activity. Fulfilling this obligation remains a challenge for residency programs and remains a common citation by the specialty Residency Review Committees, especially in community hospital settings with limited academic resources. This study evaluated the impact of implementing a bundled intervention on resident scholarly activity within a family medicine residency program in a community hospital.

Comparison Between Adalimumab and Infliximab in Perianal Crohn's Disease: A Systematic Review and Meta-Analysis.

Background And Aims: Anti-tumor necrosis factor therapy has been a mainstay of medical management of perianal Crohn's disease (CD). This systematic review and meta-analysis aimed to compare the efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of perianal fistulizing CD.

Methods: We searched PubMed, Embase, and Web of Science databases for studies that compared the efficacy of ADA with IFX for treatment of patients with perianal fistulizing CD.

Improving Family Medicine Residency Training in Women's Health-Related Procedures at a Community Hospital.

Introduction: The Accreditation Council for Graduate Medical Education requires family medicine (FM) residents to be trained in outpatient procedures. The Society of Teachers of Family Medicine (STFM) group on hospital and procedural training compiled a core list of procedures that all FM residents should perform by graduation. We implemented a quality improvement project using a bundled intervention to enhance resident training in outpatient gynecological procedures.

The Surgical Management of Cutaneous Melanoma.

Cutaneous melanoma is a highly aggressive malignancy originating from melanocytes. It frequently occurs on the head/neck where it is often diagnosed at advanced stages and associated with poorer outcomes compared to the trunk and extremities. Wide local excision remains the standard-of-care for localized disease; however, Mohs micrographic surgery offers superior local control for melanomas in cosmetically sensitive areas.

A Rare Case of Tension Empyema Unveiling the Diagnostic Pitfalls of Pneumococcal Rapid Urinary Antigen.

Tension empyema is a rare, life-threatening condition characterized by infected pleural effusion leading to significant respiratory distress, mediastinal shift, and hemodynamic instability. We present a unique case of a 55-year-old male with a history of alcohol use disorder who presented with productive cough, hemoptysis, shortness of breath, and left-sided back pain persisting for over one month. Imaging demonstrated a unilocular fluid collection in the left upper anterior pleural space and a large loculated left-sided hydropneumothorax causing mediastinal shift, raising concern for tension empyema.

Five-year pivotal trial outcomes of the Gore Excluder conformable endoprosthesis implanted in abdominal aortic aneurysms with short non-angulated infrarenal seal zones.

Objective: The GORE EXCLUDER Conformable Abdominal Aortic Aneurysm Endoprosthesis with Active Control System (EXCC) is approved in the United States (U.S.) for treatment of AAAs and highly angulated (≤90°) and short (≥10 mm) infrarenal aortic proximal seal zones (necks).

Accidental Carbon Monoxide Poisoning Leading to Devastating Cardiovascular Consequences.

We report a case of a young male patient presenting with accidental carbon monoxide poisoning leading to pulmonary embolism, acute myocardial infarction, right and left ventricular thromboses, acute limb ischemia, and acute renal failure. We review clinical aspects of carbon monoxide poisoning with a specific focus on cardiovascular and systemic thrombotic complications.

Achalasia or Pseudoachalasia: Incidental Esophagogastric Junction Submucosal Leiomyoma During Peroral Endoscopic Myotomy.

The concomitant presence of esophageal achalasia and esophagogastric junction submucosal leiomyoma is extremely rare. Peroral endoscopic myotomy has been endorsed as one of the primary interventions to manage esophageal achalasia. We present a 49-year-old woman who had initial endoscopic evaluation and diagnosis of achalasia type II then underwent peroral endoscopic myotomy and found to have incidental submucosal leiomyoma at 1 cm distal to esophagogastric junction.

Ascaris Peritonitis in a Pediatric Patient With Typhoid Fever.

Intestinal infestation with ascaris worms is very common worldwide and usually causes minimal or no abdominal symptoms. Severe abdominal complications such as bowel obstruction may occur, but bowel perforation from ascariasis is rare. We present a case of a seven-year-old boy who initially presented with typhoid fever and then developed ascaris peritonitis requiring emergent surgery.

Hearts apart: exploring sex disparity in the global and regional burden of ischemic heart disease; a systematic analysis from the global burden of disease study 1990-2021.

Background: Worldwide, ischemic heart disease is less prevalent in women than in men, but this gap has narrowed in recent decades. This study aims to evaluate trends and gender differences in the global burden of ischemic heart disease (IHD) across demographics and regions from 1990 to 2021.

Methods: We utilized the data of the Global Burden of Disease Study from 1990 to 2021.

Antidepressant Use in New-Onset Depression After Total Joint Arthroplasty Is Not Associated With Reduced Arthroplasty-Related Complications.

Background and objective Some patients without pre-existing depression develop new-onset depression (NOD) following total joint arthroplasty (TJA), potentially impacting recovery and quality of life. New-onset depression has been associated with increased TJA complications (i.e.