Outcomes and Safety of Catheter Ablation in the Elderly.

Catheter ablation has emerged as a first-line therapy for many arrhythmias. However, data on the safety and outcomes of catheter ablation in the elderly population remain limited. Here, we aimed to study the outcomes of catheter ablation in octogenarians.

Surgical synergy: Assessing care coordination in pediatric surgical referral programs.

Background: Specialized pediatric surgical referral programs (PSPs) for complex conditions are increasing across the United States, resulting in care rendered geographically distant from patients' homes. We explored care coordination gaps across differing stakeholder perspectives to identify opportunities to optimize post-discharge practices in this evolving landscape.

Methods: We reviewed published literature for guidelines and consensus statements on ideal care coordination practices.

Abnormal Nuclear Membranous Staining Pattern by MLH1 Immunohistochemistry in Endometrial Cancer: A Diagnostic Pitfall and Clone-dependent Artifact.

Immunohistochemistry (IHC) for mismatch repair (MMR) proteins is routinely performed for endometrial cancer (EC). Loss of nuclear staining for MLH1/PMS2 triggers reflex testing for MLH1 promoter hypermethylation, while loss of MSH2/MSH6 or isolated loss of MSH6 and PMS2 prompts germline testing for Lynch syndrome. We observed an unusual nuclear membranous staining pattern of MLH1 (clone G168-15).

Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature.

Objectives: Spinal motion restriction (SMR), requiring the use of a cervical collar and allowing for use of a vacuum splint or ambulance cot, and spinal immobilization, requiring the use of a backboard and a cervical collar, have long been established as the standard of care in the prehospital management of trauma. Both techniques are based on the hypothesis that post-injury movement of the spinal column may lead to the development of delayed neurological deficits. However, these techniques, which have the potential for significant patient harm, are without definitive evidence of clinical benefit.

Safety and outcomes of pulsed field ablation in the management of supraventricular arrhythmia: A systematic review.

Introduction: Pulsed field ablation (PFA) is an emerging non-thermal ablative technology that induces irreversible electroporation to selectively target cardiac tissue while minimizing damage to adjacent structures. While widely studied for atrial fibrillation, its role in managing supraventricular tachycardia (SVT) remains unclear. This systematic review aims to consolidate existing data on the safety and efficacy of PFA for SVT ablation.

Perspective: Are Grapes Worthy of the Moniker Superfood?

Superfood, an word in the American vernacular, refers to mainstream foods that are basically individual components of the Mediterranean diet, i.e., berries, fish, olive oil, cruciferous vegetables, legumes, etc.

Adapting an Anxiety Sensitivity Intervention for Perinatal Mental Health: Development of a Digital Intervention.

Introduction: The goal of this study was to adapt an anxiety sensitivity intervention for mobile health delivery to perinatal populations experiencing economic marginalization.

Methods: A community-engaged and user-centered design approach informed the prototype of Reaching Calm. We conducted "think-aloud" interviews with perinatal individuals (n=15) experiencing elevated anxiety and economic stressors.

Understaffed and overworked: The stark reality of acute care surgeon staffing in the United States, an Eastern Association for the Surgery of Trauma multicenter study.

Objectives: Rightsizing the workforce to clinical demand requires a balance of work intensity, productivity, and a definition of clinical full-time equivalent (cFTE). We hypothesized a shortage of acute care surgeons based on a 204-shift per year (average, 17 per month) definition of a 1.0 cFTE established in our prior mixed-methods study (two service weeks plus five calls per month).

Outcomes of same-day discharge after left atrial appendage closure with and without pre-discharge transthoracic echocardiography.

Background: Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo Left Atrial Appendage Closure. SCAI/HRS consensus recommends routine post-procedure TTE before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.

Benefits of Cardiac Rehabilitation: Mechanisms to Restore Function and Clinical Impact.

Cardiac rehabilitation (CR) has evolved from foundations as a postmyocardial infarction mobilization strategy for patients who were typically unstable, into a comprehensive, multidisciplinary program for most patients with cardiovascular disease aimed at optimizing cardiovascular health, reducing morbidity, and enhancing functional recovery. Although contemporary CR patients are now usually more stable from a cardiovascular perspective, needs have expanded for comprehensive approaches to exercise, lifestyle, care coordination, risk factor modification, and stress management. Furthermore, contemporary CR patients now typically include older adults who are contending with cardiovascular disease in the context of multimorbidity, frailty, sarcopenia, sensory limits, and cognitive impairment.

Artificial Intelligence-Assisted Narratives: Analysis of Surgical Residency Personal Statements.

Objective: Personal statements (PSs) express applicants' personal characteristics and motivations informing pursuit of a surgical career. Generative artificial intelligence (AI) is a revolutionary technology. There are currently no data to suggest how and to what extent AI is used in surgical residency applications.

No evidence of a detrimental effect of pitavastatin on neurocognitive function among people with HIV.

Objective: Effects of statins on neurocognitive function remain poorly understood, with some studies suggesting harm and others suggesting benefit. Limited observational data among people with HIV (PWH) is biased by indication for statin prescription. We sought to assess statin effects on neurocognitive function among PWH.

Mediational analysis of severe retinal injury causation in children with acute closed head injury.

Background: While generally regarded as discriminating findings, elevating the probability of abusive head trauma, the association of severe retinal injuries with inertial biomechanics, shaking, and abuse has been challenged.

Objective: Evaluate five causational models of severe retinal injury utilizing multivariable mediational analysis.

Participants: Children, under age three-years, admitted to 18 pediatric intensive care units with acute, symptomatic, closed head injury who had not been injured in a car-crash and who had received an ophthalmologist's retinal examination.

Prevalence and correlates of multiple injections per injection episode among people who inject drugs in rural U.S. communities.

Background: Multiple injections per injection episode (MIPIE) is increasingly common among people who inject drugs (PWID). While MIPIE may lower overdose risk, it could elevate infectious disease risk. This study examined the prevalence of MIPIE among rural PWID in the United States and its associations with injection behaviors associated with disease transmission (e.

Advancing the APRN and PA professions through medical staff membership: An organizational case study.

Granting medical staff membership to advanced practice registered nurses (APRNs) and physician associates (PAs) is a national trend endorsed by The Joint Commission in 1983 and by the Centers for Medicare & Medicaid Services in 2012. APRNs and PAs must participate in the system in which medical care policies are made and communicated. Medical staff privileges enable these clinicians to help develop and implement hospital and medical staff policies that improve the quality and appropriateness of patient care.

"It's Harder to Chase Pain Than It Is to Prevent It": Perinatal Individual and Care Professional Attitudes Towards Preventing Perinatal Mood and Anxiety Disorders in Obstetric Settings.

Purpose: Depression and anxiety disorders are prevalent in the perinatal period and disproportionately impact individuals who experience economic marginalization. <15% of at-risk individuals are referred for recommended preventative counseling interventions. Little is known about the attitudes of care professionals and perinatal individuals towards prevention.

Retrograde Femoral Access Flipped Antegrade Technique and its Effect on Patient Outcomes Following Lower Extremity Angiography.

Background: Common femoral artery access is a critical step in the endovascular treatment of peripheral artery disease. Traditionally, access is obtained either by a retrograde approach from the contralateral leg with an "up-and-over" aortic bifurcation technique, or in an antegrade fashion in the ipsilateral leg. Retrograde arterial access flipped antegrade in the ipsilateral femoral artery incorporates the technical ease of retrograde access (RA) with mechanical advantages of antegrade access (AA).

Rare case of schwannomatosis presenting with cauda equina syndrome: a case report.

Background: Schwannomatosis is a rare disorder characterized by multiple schwannomas without vestibular schwannomas or other features of neurofibromatosis type 2 (NF2). It commonly presents with neuropathic pain, neurological deficits, and soft tissue tumors but rarely leads to cauda equina syndrome, a serious condition requiring urgent intervention.

Materials And Methods: We report a 28-year-old Pakistani female with progressive back pain, lower limb weakness, sensory deficits, bladder and bowel incontinence, and multiple tender swellings, consistent with cauda equina syndrome.

Benzodiazepines and Opioid co-use Among Rural People Who Use Drugs: Findings From the Rural Opioid Initiative.

Background: Benzodiazepines and opioids are among the most frequently misused psychoactive substances, but their patterns of co-use (polysubstance use) in rural areas are unclear. As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.

Methods: The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties.

Stress and Strain: Ergonomic Practices and Associated Injuries Among Pediatric Surgeons.

Introduction: Ergonomic injuries pose significant risks to surgeons, affecting health, productivity, care access, and retirement age. Despite unique challenges in pediatric surgery, including varied patient sizes and operations, little is known about pediatric surgeons' ergonomics. This study aimed to assess ergonomic practices and associated injuries among pediatric surgeons.

Barriers to accessing medications for opioid use disorder among rural individuals.

Background: Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived.

Methods: We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD.

Prehospital Blood Administration in Traumatic Hemorrhagic Shock.

Following the military's advancement of prehospital blood into the field, civilian prehospital blood programs are becoming more prevalent. However, there are significant differences between civilian and military prehospital operations that should be considered. Civilian prehospital systems also vary widely in terms of resources, transport times, and patient types.

Comparison of Different PCI Strategies for Coronary DES In-stent Restenosis: A Bayesian Network Meta-analysis.

Background: Though superior to bare-metal stents (BMS), drug-eluting stents (DES) based PCI still have significant in-stent restenosis (ISR). Balloon angioplasty (BA), drug-coated balloons (DCBs), and DES are common modalities to treat ISR. The existing guidelines recommend treating ISR with either DCB or DES for BMS-ISR and DES-ISR, despite differences in the underlying mechanisms.

Association Between Erythromycin or Clindamycin Resistance and 30-Day Mortality in Patients With MSSA Bacteremia.

The objective of the present study is to assess the association of erythromycin and clindamycin susceptibilities with 30-day mortality in patients with MSSA bacteremia treated with cefazolin. Retrospective cohort study of patients with least one positive blood culture growing MSSA and treated with cefazolin for at least 3 consecutive days. Groups included patients who had an MSSA strain that was both erythromycin and clindamycin susceptible (E/C-S), the comparator group included patients with erythromycin resistant and clindamycin resistant or susceptible (E/C-R) MSSA strains.