6289 research outputs found
Sort by
Modified Versions of Natural Frozen Embryo Transfers Do Not Impact Live Births
No full textOBJECTIVE: To evaluate the effect of protocol modifications to natural frozen embryo transfer (FET) cycles on live birth DESIGN: Retrospective cohort study. SUBJECTS: Patients undergoing natural, modified natural, and stimulated single FETs between January 2014 and December 2021 in a single university affiliated fertility clinic in the United States. EXPOSURE: Four commonly used modified natural, stimulated, and natural FET protocols were evaluated, including: 1. A true natural cycle with no modifications 2. vaginal progesterone supplementation only 3. Human chorionic gonadotropin (hCG) trigger and vaginal progesterone supplementation 4. Aromatase inhibitor, hCG trigger, and vaginal progesterone supplementation. Protocol 3, HVP, was the reference group as it was the most commonly used protocol making up 42.5% of included cycles. MAIN OUTCOME MEASURES: Live births per FET. RESULTS: 4806 cycles from 3517 individual patients were included. The live birth per transfer for all FET cycles was 51.6% (2480/4806 cycles). The reference group that received hCG trigger and VP had an incidence of live birth of 53.4% (1090/2042 cycles). All three study protocols had similar live births. Although the group that did not have modifications had the lowest percentage of live births (41.3%), this was not significantly different from the reference group (aRR (95% CI): 0.89 (0.62-1.28)), after adjusting for confounders. CONCLUSION: In a large cohort of patients live births per FET was similar among commonly used variations in modified natural FET cycles. These results allow for the modification of natural cycles without impacting live births and enables shared decision making between patient and provider
Pneumomastia: A Rare but Benign Mammographic Finding
No full textTeaching point: Pneumomastia is a rare but benign mammographic finding most often related to recent instrumentation. Typically, it does not require further workup, although it may necessitate repeat imaging when the finding is extensive enough to obscure small lesions or microcalcifications
Costs of Academic Engagement in Organized Neurosurgery in the United States.
No full textBACKGROUND AND OBJECTIVES: Organized neurosurgery offers innumerable opportunities for scientific exchange, networking, and continuing medical education (CME). National, regional, and state societies and meetings have rapidly proliferated across neurosurgery, as have neurosurgical-associated publications and journals. This study sought to review individual costs incurred by neurosurgeons seeking engagement in organized neurosurgery to illustrate the costs associated with participation.
METHODS: National, regional, and state neurosurgery societies were identified, and associated annual meetings were recorded. Leading neurosurgery journals, as determined by reputation and impact factor, were selected. Data unavailable online were acquired through direct communication with the respective organization. American Board of Neurological Surgeons board-certification costs were acquired and compared with board-certification costs in comparable specialties (orthopedic surgery (Ortho), plastic surgery (PS), general surgery (GS), neurology). Baseline academic engagement was defined as two general society memberships, two annual meeting registrations, and respective board certification. A CME credit-per-dollar value was created to measure the relative financial value of CME.
RESULTS: A total of 31 societies, 23 meetings, and 18 journals were identified. Society membership costs included American Association of Neurological Surgeons (990), Society of NeuroInterventional Surgery (950). Meetings with the greatest registration fees included the Society of Neurological Surgeons (1675) annual meetings. Individual journal subscription costs included Journal of Neurosurgery (643), Spine (909). In our limited comparison, the specialty of neurosurgery had the greatest baseline academic engagement cost (8105; Ortho: 5570; neurology: $4640). Costs of nontraditional CME are significantly less compared with traditional, meeting-driven CME opportunities.
CONCLUSION: Organized neurosurgery incurs major individual costs by way of society membership, meeting registration, and journal subscriptions. Rising costs for engagement are substantial and may not be sustainable when contrasted with unchanged CME reimbursement, prompting dialog to identify sources of subsidization
Reducing Burnout and Improving Staff Retention in Critical Care
No full textFor hospital-based nurses, how do team-level or systemic interventions, compared to approaches focusing on individual resilience or well-being, affect burnout, retention, and perceptions of patient safety?https://knowledgeconnection.mainehealth.org/nurseresidency/1136/thumbnail.jp
Inpatient addiction care is associated with increased vaccinations, medication for opioid use disorder and naloxone prescribing among patients with infective endocarditis in a rural state
No full textBACKGROUND: Rural states have experienced increasing injection drug use (IDU)-associated infective endocarditis (IE). Inpatient addiction consult services can reduce morbidity associated with substance use and other infectious complications, such as IDU-IE. However data on the impact of such services on healthcare utilization are limited, particularly in rural communities. METHODS: This retrospective study assesses clinical and health service utilization data from index hospitalizations for IDU-IE before and after the implementation of the Integrated Medication for Addiction Treatment (IMAT) program at a tertiary care center in a rural state. We summarized data descriptively, stratified by both pre- and post-IMAT program implementation and IDU-IE and non-IDU IE. We also performed exploratory multivariable analyses assessing the association between IMAT program implementation and various outcomes. The primary outcomes were: 1) 90-day emergency department (ED) visits and 2) 30-day hospital readmissions post-discharge. Secondary outcomes included prescriptions at time of discharge for medication for opioid use disorder (MOUD), naloxone and key vaccinations. RESULTS: We identified n = 99 patients with IDU-IE. Comparing pre- and post-IMAT implementation, 30-day readmissions trended lower post-IMAT (18%) versus pre-IMAT (22%), although the difference was not significant (p = 0.7). 90-day ED visits remained stable (37%, p \u3e 0.9). The proportion of MOUD prescribing (24% versus 80%), hepatitis B vaccination (29% versus 51%), and Tdap vaccination (7.3% versus 41%) increased significantly following IMAT implementation (p \u3c 0.001, p = 0.037 and p \u3c 0.001, respectively). In a regression analysis controlling for age, housing status, primary care provider, age, hepatitis C, cardiac device, Duke\u27s criteria, valve affected, alcohol use disorder, payer, and vascular or infectious complications, the IMAT program was not significantly associated with the primary outcomes or with hepatitis B vaccination. However, the IMAT program was associated with increased MOUD prescribing (aOR: 110; CI:16-1500), naloxone prescribing (aOR 18; CI: 1.1-1600) hepatitis A vaccination (aOR: 5.3; CI: 1.2-32), and Tdap vaccination (aOR: 9.2; CI: 2.0-59). CONCLUSIONS: Inpatient addiction services were associated with increased prescribing of MOUD, naloxone and key vaccinations, though the incidence of acute healthcare utilization did not change. These results highlight hospitalization as an opportunity to connect patients with IDU-IE to MOUD and preventative care, particularly in rural areas where access to such services may be limited. TRIAL REGISTRATION: Not applicable
Reevaluating Arm Precautions: Evidence-Based Practice for Post-Mastectomy and Post-Lumpectomy Patients in Critical Care
No full textIn critically ill post-mastectomy and post-lumpectomy patients, how does allowing intravenous (IV) access in the ipsilateral arm compared to maintaining traditional arm precautions (avoiding IVs, blood draws, and blood pressure on the affected side) affect the incidence of lymphedema, infection, or other complications during hospitalization or critical care stay?https://knowledgeconnection.mainehealth.org/nurseresidency/1146/thumbnail.jp
Improving Functional Outcomes Through Increased Mobility Frequency in Rehabilitation
No full textIn older adults in a Rehabilitation and Skilled facility, how does increased frequency of physical therapy and mobility interventions compared to standard or less frequent physical therapy affect functional independence and mobility outcomes during their stay or at discharge?https://knowledgeconnection.mainehealth.org/nurseresidency/1144/thumbnail.jp
Uncoupling Agents as a Contributor to Refractory Metabolic Acidosis in a Burn Victim: A Case Report
No full textIntroduction: Uncoupling agents impair mitochondrial oxidative phosphorylation, which disrupts adenosine triphosphate production and causes high anion gap metabolic acidosis. These agents, linked to environmental toxins or pharmacologic exposures, present diagnostic and therapeutic challenges due to rapid clinical deterioration. Early identification is crucial for intervention.
Clinical Findings: A 64-year-old male with type II diabetes mellitus sustained burns covering 14% total body surface area during a shed fire with suspected pesticides and rodenticide exposure. He had hypotension with severe metabolic acidosis (lactate 20 mmol/L, pH 7.0, bicarbonate [HCO3] 11 mmol/L) and an anion gap of 35 mEq/L. He was admitted to the surgical intensive care unit.
Clinical Course: His initial treatment included burn debridement, intravenous hydroxocobalamin for potential cyanide toxicity, and bolus sodium bicarbonate therapy followed by a continuous infusion of bicarbonate. Despite continuous renal replacement therapy (CRRT), worsening hyperkalemia (6.2 mEq/L) and hemodynamic instability required escalation of a higher dose of norepinephrine and vasopressin. On day 2, his lactate was 20 mmol/L and HCO3 was 10 mmol/L, and intravenous angiotensin II and epinephrine were started. An abdominal computed tomography scan showed ascites without bowel ischemia. On day 3, his lactate increased to 27 mmol/L and HCO3 decreased to 9 mmol/L, and he was given methylene blue for vasoplegia. An exploratory laparotomy identified colonic necrosis, requiring total abdominal colectomy. Despite maximal CRRT ultrafiltration, the patient died on hospital day 4.
Conclusions: Uncoupling agent exposure can cause refractory high anion gap metabolic acidosis. Early CRRT and bicarbonate therapy may offer transient benefit, but toxicologic testing for definitive diagnosis was not obtained per family wishes