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Solitary lung nodule consistent with colorectal cancer (CRC) metastasis in a young male: A7026
No full textExploring the impact of inpatient practice and gender on physician well-being
No full textThis article aims to describe the evolution of physician well-being. Ensuring professional fulfillment and mitigating the risk for burnout are priorities for all physicians. However, the threats and obstacles to preserving well-being are not universal. In both the inpatient and ambulatory settings, there are growing administrative burdens, increased clinical workload, and insufficient time per patient encounter. Among inpatient pediatric subspecialties, particularly high rates of burnout are reported within the field of pediatric critical care. The obstacles to career satisfaction and well-being in both areas are complex and myriad. The demands unique to women in medicine are different than those for men in medicine. Caregiving and gender-based inequities force women out of health care at rates higher than men. A career in medicine risks a woman\u27s fertility and health. Despite increased prevalence of women-dominated subspecialties (eg, pediatrics), their presence in leadership roles continues to be relatively low. We have chosen to focus this article on issues facing inpatient physicians and the unique difficulties of being a woman provider in health care
Methodology for a COVID-19 recovery surveillance study conducted through an academic-state partnership
No full textObjective: We describe the methodologic approach to rapidly launching a population-based surveillance study in spring 2020 to examine the lasting physical, mental, and economic effect of COVID-19 among adults in Michigan.
Materials and methods: We established a partnership between the University of Michigan School of Public Health and the Michigan Department of Health and Human Services to conduct this study. Using a sequential stratified sampling strategy, we randomly selected adults with polymerase chain reaction-confirmed SARS-CoV-2 infection in the Michigan Disease Surveillance System. From 2020 through 2022, respondents completed detailed surveys on the lasting effect of their COVID-19 illness online in English or by telephone in English, Spanish, or Arabic, reflecting the diverse population in Michigan. We created and used sampling weights to reduce survey nonresponse bias and tested the performance of the weights with a nonresponse bias analysis.
Results: Of all sampled people (n = 17 584), 5521 completed our baseline survey a median of 4.5 months after their COVID-19 onset, for a response rate of 32.1%. Most respondents completed the survey online in every region except Detroit, where 67.1% completed the survey by telephone, highlighting the importance of multimode surveys to increase accessibility and generalizability. Our findings suggest minimal nonresponse bias in the weighted baseline sample.
Practice implications: This unique academic-state partnership resulted in timely and actionable findings related to the lasting effect of COVID-19 that were unavailable elsewhere. While this effort was successful, it was built out of necessity given the limited resources available to local and state health departments to conduct surveillance during the COVID-19 pandemic
Pembrolizumab-induced duodenitis mimicking celiac disease
No full textPembrolizumab is a programmed cell death-1 (PD-1) inhibitor frequently used as primary immunotherapy in many cancers, including melanoma, lung, renal cell, cervical, urothelial, and gastric cancers. Given its immune-checkpoint inhibition and upregulation of the immune response, pembrolizumab has been associated with many immune system-related adverse effects including stomatitis, conjunctivitis, pneumonitis, myositis, and even type 1 diabetes mellitus. Colitis is the most frequent gastrointestinal adverse reaction, with upper gastrointestinal reactions like esophagitis, gastritis, and duodenitis being rare. In this report, we present a case of pembrolizumab-induced enteropathy that endoscopically and histologically mimicked celiac disease
Multimodality imaging in evaluating and guiding percutaneous left atrial appendage occlusion
No full textLeft atrial appendage occlusion (LAAO) has emerged as an important intervention for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are unable to tolerate long-term anticoagulation. The development of advanced imaging technologies and techniques, such as 3D echocardiography with multiplanar reconstruction (MPR), multidetector computed tomography (MDCT), 3D intracardiac echocardiography (ICE), 3D printing, and simulation, has revolutionized pre-procedural planning, intra-procedural guidance, and post-procedural surveillance, ensuring improved precision and outcomes. Transesophageal echocardiography (TEE) remains a foundational imaging modality for assessing LAA morphology, excluding thrombi, and obtaining accurate measurements for device sizing. Recent advances in 3D TEE and MPR techniques enable enhanced visualization of complex LAA anatomies, improving device selection and procedural planning. Multidetector computed tomography has a growing role, offering high-resolution 3D reconstructions for detailed anatomical assessment. Additionally, its applications in 3D printing and virtual device simulation provide patient-specific insights, facilitating optimal device sizing and improving procedural efficiency. Intra-procedurally, 3D ICE has gained traction as a valuable alternative to TEE. With its real-time imaging capabilities and high spatial resolution, 3D ICE allows precise guidance during transseptal puncture and device deployment while reducing the need for general anesthesia. Post-procedurally, both TEE and MDCT play critical roles in assessing device stability and identifying complications such as device-related thrombus and peri-device leak. This review highlights the evolving role of multimodality imaging in LAAO, including innovations such as 3D ICE, 3D printing, and simulation. It also reviews recent literature to establish state-of-the-art imaging practices, providing a comprehensive discussion of imaging applications across pre-, intra-, and post-procedural phases to optimize outcomes and minimize complications in LAAO
Feasibility of implementing self-measured blood pressure monitoring in primary care settings serving patients with social needs: A qualitative study
No full textThe magnitude and distribution of pressure of obstetric forceps on a fetal head mannequin model
No full textIntroduction: Considerations for forceps specific shape and dimensions are usually not available for review. This study evaluates surfaces of contact, magnitude of force, and pressure distribution of different forceps on a fetal head model.
Materials and methods: Pressure-sensitive films were cut following planar impressions of commonly used forceps. After biparieto-bimalar applications on a term fetal head model, the films were scanned and areas of contact, pressure, and force calculated. Comparisons were made between different types of film and forceps. Significance was considered if p \u3c 0.05.
Results: Fifty-four forceps impressions were analyzed. With decreasing film sensitivities, smaller contact areas (p \u3c 0.01) and higher mean pressures (p \u3c 0.01) were detected. No significant differences were noted between different forceps regarding contact areas, pressure, or force. Most impressions reveal pressure points in the range of 980-1400 psi.
Conclusion: Ergonomic improvements can be made to the design of forceps blades in order to improve maternal-fetal morbidity