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Tele-stroke: a strategy to improve acute stroke care in low- and middle-income countries.
No full textNeonatal morbidity and mortality in birth centers in the United States 2018-2021: An observational study of low-risk birthing individuals.
No full textBACKGROUND: Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed.
METHODS: Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics.
RESULTS: The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value \u3c 0.001), Apgar score \u3c 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score \u3c 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation \u3e6 h (aOR 0.349; [0.281,0.433], p-value \u3c 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value \u3c 0.001). Birth centers had higher odds of assisted neonatal ventilation for
CONCLUSION: Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores \u3c 4, and intensive care admission were less likely to occur in birth centers
The Pros of Probiotics: A Review of Probiotics Place in Therapy
Get PDFAs different probiotic supplements become increasingly seen in the market, questions regarding their use for gut health from patients rises as well. Because these supplements do not require FDA approval, their safety and efficacy is often unknown and limited research available poses an even greater challenge for healthcare providers when prompted with questions regarding their use. This article summarizes evidence-based recommendations provided by the American Gastroenterological Association (AGA) and the World Gastroenterology Organization (WGO). Of the conditions discussed, supportive evidence on the use of probiotics is mostly seen in the prevention of C. diff associated diarrhea, prevention of antibiotic associated diarrhea and treatment of IBS. Of the millions of different strains available, the recurring genus seen across multiple disease states is Lactobacillus. It is most known that probiotics serve as a source of “good” bacteria, but these supplements may pose a threat in certain patient populations and require careful consideration between patients and providers before starting
Use of Long Spinal Board Post-Application of Protocol for Spinal Motion Restriction for Spinal Cord Injury.
No full textINTRODUCTION: Historically, prehospital care of trauma patients has included nearly universal use of a cervical collar (C-collar) and long spine board (LSB). Due to recent evidence demonstrating harm in using LSBs, implementation of new spinal motion restriction (SMR) protocols in the prehospital setting should reduce LSB use, even among patients with spinal cord injury. Our goal in this study was to evaluate the rates of and reasons for LSB use in high-risk patients-those with hospital-diagnosed spinal cord injury (SCI)-after statewide implementation of SMR protocols.
METHODS: Applying data from a state emergency medical services (EMS) registry to a state hospital discharge database, we identified cases in which a participating EMS agency provided care for a patient later diagnosed in the hospital with a SCI. Cases were then retrospectively reviewed to determine the prevalence of both LSB and C-collar use before and after agency adoption of a SMR protocol. We reviewed cases with LSB use after SMR protocol implementation to determine the motivations driving continued LSB use. We used simple descriptive statistics, odds ratios (OR) with 95% confidence intervals (CI) to describe the results.
RESULTS: We identified 52 EMS agencies in the state of Arizona with 417,979 encounters. There were 225 patients with SCI, of whom 74 were excluded. The LSBs were used in 52 pre-SMR (81%) and 49 post-SMR (56%) cases. The odds of LSB use after SMR protocol implementation was 70% lower than it had been before implementation (OR 0.297, 95% CI 0.139-0.643;
CONCLUSION: Implementation of selective spinal motion restriction protocols was associated with a statistically significant decrease in the utilization of long spine boards among prehospital patients with acute traumatic spinal cord injury
Psychosis to Pancreatitis: A Case Study Exploring the Risks of Hypertriglyceridemia in a Patient Treated With Olanzapine.
No full textOlanzapine is an antipsychotic medication that is used in the management of schizophrenia and bipolar disorder, but it is not without any adverse effects. We present the following case of a 24-year-old man with a history of schizoaffective disorder, obesity, and anxiety, who developed hypertriglyceridemia-induced acute pancreatitis after six months on olanzapine. Despite his adherence to the medication, routine metabolic monitoring was not performed leading to a delayed diagnosis of hypertriglyceridemia and subsequent complications. The case underscores the critical need for regular metabolic monitoring in patients prescribed olanzapine to prevent severe adverse effects and guide timely intervention. Enhanced adherence to monitoring guidelines and consideration of alternative treatments may help mitigate such risks
Endoscopic dilation of small-intestine strictures in Crohn\u27s disease by balloon-assisted enteroscopy: a systematic review and meta-analysis.
No full textBACKGROUND: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn\u27s disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.
METHODS: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using
RESULTS: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5;
CONCLUSION: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery
Postoperative Conundrum: Horner Syndrome Secondary to Anterior Cervical Discectomy and Fusion Procedure
Get PDFIntroductionHorner syndrome is a rare complication following anterior cervical discectomy and fusion (ACDF) surgeries, with an incidence rate of
Case DescriptionWe report a case of a 45-year-old female with a history of non-Hodgkin\u27s lymphoma and chronic obstructive pulmonary disease who developed Horner syndrome post-ACDF. Initially admitted for suspected cholecystitis found on imaging following a fall, the patient\u27s clinical course was complicated by worsening cervical and lumbar pain. This prompted MRI evaluation revealing cervical stenosis at C5-C6 and ACDF was performed without intraoperative complications. However, on postoperative day three, the patient developed left eye ptosis and miosis, consistent with Horner syndrome. Subsequent MRI revealed a new fluid collection suggestive of a seroma. Despite conservative management, Horner syndrome persisted.
DiscussionHorner syndrome post-ACDF is a rare but potentially lifelong complication. Possible etiologies include prolonged retraction of the longus colli muscle and postoperative inflammation leading to seroma formation, potentially compressing sympathetic nerve fibers. Current literature suggests under diagnosis of Horner syndrome post-ACDF, emphasizing the need for heightened clinical suspicion. Future research should focus on refining surgical techniques to minimize sympathetic trunk damage and facilitate early diagnosis and management of this rare complication
Ecological Psychology: A Framework for Mentoring and Career Development in Academic Medicine.
No full textEffective mentoring can help individuals navigate the complex, dynamic environment of academic medicine as they work to develop meaningful and fulfilling careers. Despite robust research into the characteristics of effective mentoring relationships and successful mentoring programs, resources that support mentors and mentees in engaging in career development in academic medicine are limited. Ecological psychology, a theory focusing on how the dynamic interplay between individuals and their environment influences cognition and behavior, offers a promising framework for exploring how mentors and mentees can support positive career development outcomes. In this article, the authors introduce selected principles derived from ecological psychology and supplement these principles with practical, hypothetical examples that demonstrate the use of ecological psychology across the continuum of career development (e.g., from early to middle to late career decisions). By focusing on interactions between individuals and their environment, ecological psychology offers a valuable and practical complement to other theories and frameworks that address career development, such as social cognitive career theory and landscapes of practice. By centering on the dynamic interactions between individuals and their professional environments, ecological psychology offers mentors, mentees, and academic medical centers a practical structure for navigating the intricacies and challenges of career development in academic medicine
Haloperidol-Induced Laryngeal Dystonia: A Case Report on an Antipsychotic-Associated Airway Emergency.
No full textAcute dystonia is a neurological condition characterized by involuntary muscle contractions that can affect various parts of the body. It is commonly triggered by the use of antipsychotic medications, especially within the first few days after administration. Respiratory acute laryngeal dystonia, a particularly severe form of this condition and a very subtype of laryngeal dystonia, can lead to respiratory distress and airway obstruction if not promptly treated. This case report describes a 23-year-old male who developed acute laryngeal dystonia within 24 hours of receiving haloperidol for agitation. The patient presented with hoarseness, difficulty swallowing, and progressive respiratory distress, eventually requiring emergent intubation due to airway compromise. This case underscores the need for healthcare providers to recognize and promptly manage rare but potentially life-threatening side effects of antipsychotic medications. Particular attention must be directed toward patients with risk factors for developing extrapyramidal reactions. Early intervention is crucial to prevent progression to airway obstruction and respiratory failure