52426 research outputs found
Sort by
Long-term safety of early discontinuation of antiseizure medication after resolution of acute provoked neonatal seizures.
No full textOBJECTIVE: To assess long-term safety of antiseizure medication (ASM) discontinuation after resolution of acute provoked neonatal seizures and prior to hospital discharge.
METHODS: Prospective, observational, comparative effectiveness cohort study of neonates with acute provoked seizures born from July 2015 to March 2018, and followed until September 2024, at nine U.S. Neonatal Seizure Registry centers with Level IV neonatal intensive care units and Level IV pediatric epilepsy programs. Duration of ASM treatment was quantified as (1) discontinuation before discharge from the neonatal seizure admission or (2) maintenance at the time of hospital discharge. Outcomes were adjusted for propensity to receive ASM at discharge. Propensity for ASM maintenance was defined among enrolled participants by a logistic regression model including seizure etiology, gestational age, therapeutic hypothermia, worst electroencephalography (EEG) background, days of EEG seizures, and discharge neurological exam (all p ≤ .1 in a joint model, except etiology, which was included for face validity). The primary outcome was non-inferiority of cognition (Wechsler Preschool and Primary Scale of Intelligence assessed at age 5-6 years). Secondary outcomes were non-inferiority of functional development (Vineland Adaptive Behavior Scale, 3rd Edition, assessed at 3-8 years) and post-neonatal epilepsy (assessed at 1-8 years).
RESULTS: Among 284 children with at least one follow-up, outcomes were similar in the discontinued vs maintained ASM groups for full-scale IQ at age 5 years (adjusted difference +10 points), functional development at ages 3-8 years (adjusted difference 0 points), and post-neonatal epilepsy at ages 1-8 years (adjusted hazard ratio .93, 95% confidence interval [CI] .48-1.80).
SIGNIFICANCE: Prolonged administration of ASM for several months after resolution of acute provoked neonatal seizures may expose infants to unnecessary medications. These results provide additional evidence for safety of discontinuing ASM for most neonates soon after the resolution of acute provoked seizures-a practice that is recommended in the International League Against Epilepsy (ILAE) guideline for neonatal seizure management
Cost Effectiveness of Hand Postaxial Polydactyly Type B Excision in the Office Versus Operating Room.
No full textPURPOSE: Postaxial polydactyly type B of the hand can be excised in the office with local anesthesia or in the operating room under general anesthesia. Existing studies have not described the cost difference between these treatments. We compared charges, reimbursements, and outcomes of office and operating room excision.
METHODS: All cases of postaxial polydactyly type B excision at a children\u27s hospital from fiscal year 2018-2023 were included. Independent
RESULTS: Of 620 total patients, 30 (4.8%) underwent operating room excisions (22 bilateral and 8 unilateral), and 590 (95%) had office excisions (346 bilateral and 244 unilateral). Average total charges were 78% and 84% less for bilateral and unilateral excisions, respectively, in the office than in the operating room. Insurance companies paid 7600 more for unilateral operating room excisions. Surgeons received 1300 more for unilateral operating room excisions. The treatment strategy did not impact outcomes.
CONCLUSIONS: Given the cost efficacy and safety of office excision, operating room excision should be limited to patient-specific factors requiring general anesthesia.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IIb
The Toxicology Investigators Consortium 2024 Annual Report.
No full textEstablished in 2010, the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) Core Registry has systematically captured data from in-hospital and clinic-based medical toxicology physician consultations across the United States (US) and internationally. The ToxIC Core Registry contains deidentified patient data, including patient demographics, reason for medical toxicology evaluation, exposure agents, clinical signs and symptoms, treatments and antidotes administered, and mortality outcomes. This fifteenth annual report provides data from 8,868 patients entered into the Core Registry in 2024, bringing the total number of cases to 111,276 between 2010 and 2024. These cases were submitted by 41 participating sites encompassing 67 distinct hospitals over 23 US states and 3 international countries. In 2024, ethanol was the most commonly reported exposure agent class (17.8%), followed by opioids (15.8%), non-opioid analgesics (10.5%), and sympathomimetic agents (7.6%). A total of 107 fatalities were reported, corresponding to a case fatality rate of 1.2%. Additional descriptive analyses in this annual report were conducted to describe trends for opioid and psychoactive exposures between 2010 and 2024
A Systematic Review of Medicolegal Social Media Related Issues in Plastic Surgery.
No full textSocial media has become a powerful tool in plastic surgery, offering opportunities to attract patients and share content. However, its use raises medicolegal challenges, including privacy, defamation, and professional boundaries. The impact of social media on lawsuits involving plastic surgeons remains underexplored. A systematic review of publicly available legal cases was conducted using WestLaw and Nexis Uni databases, covering January 2007 - January 2024. 135 unique cases were screened by three independent reviewers. Inclusion required involvement of social media and plastic surgeons or practices. Twenty-seven cases met criteria and were analyzed for plaintiff/defendant status, cause of action, use of anti-SLAPP statutes, and case outcomes. Of the 27 included cases, 17 were filed by plastic surgeons, seven by patients, two by practices, and one by a non-patient. Defamation was the most common claim (15/27). Plastic surgeons and patients were equally represented as defendants. Only three defamation cases resulted in court rulings favoring the plaintiff, and one case was settled in arbitration. Additional claims included invasion of privacy, copyright infringement, trademark violation, and misappropriation of likeness. Cases highlighted risks associated with improper handling of patient photographs and employee-managed accounts. Plastic surgeons face growing medicolegal exposure related to social media. Defamation lawsuits against patients rarely succeed. Surgeons should avoid litigation as a primary strategy and instead mitigate risk through clear policies, professional conduct, and strong physician-patient communication. Proactive reputation management and adherence to ethical standards remain the most effective tools to reduce litigation in the social media era
Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair.
No full text
Semaglutide Augments Vascular Proliferation and Cardiac Performance in a Large Animal Model of Ischemic Cardiomyopathy.
No full textThe search for effective adjuncts to procedural revascularization for patients with coronary artery disease (CAD) has revealed, after several successful outcomes trials, the substantial potential of glucagon-like peptide 1 (GLP-1) analogs such as semaglutide. Because this potential has not been mechanistically illuminated in the setting of CAD and metabolic syndrome, we employed a large animal model to evaluate the cardiac consequences of GLP-1 receptor (GLP-1R) agonism. 16 Yorkshire swine, after provision of a high-fat diet for 5 weeks induce metabolic syndrome, underwent ameroid constrictor-mediated induction of focal CAD. Animals were then either randomized to receive semaglutide (SEM, n=8, 4 male, 4 female), or no drug (CON, n=8, 4 male, 4 female) for 5 weeks, followed by a terminal sternotomy for left ventricular pressure-volume catheterization, coronary collateral characterization, and myocardial resection and sectioning. Coronary arterioles from the peri-ischemic myocardium were mounted and suffused to assess vasoactivity, and molecular changes within the most ischemic territory were assayed using immunoblotting, immunofluorescence, and proteomics. Treated animals exhibited enhanced left ventricular filling, end diastolic volume, stroke volume, and cardiac index (all p\u3c 0.05); increased arteriolar density (p\u3c 0.001); improved microvascular endothelium-dependent vasodilation (p\u3c 0.01); and, as indicated by increases in fibroblast growth factor, angiostatin, endostatin, and endothelial nitric oxide synthase (all p\u3c 0.01), augmented vascular remodeling and endothelial function. In a large animal model that recapitulates the clinical comorbidities of CAD, improved left ventricular arteriolar density, vascular reactivity, and performance throughout the cardiac cycle position semaglutide as a highly promising addition to the adjunctive armamentarium against CAD