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Background Guide catheter (GC) placement, whether distal or proximal, may influence the efficacy and safety of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, definitions of placement and procedural strategies vary across studies, limiting clarity. Methods We systematically searched PubMed, Embase, Scopus, and Web of Science from inception to September 1, 2024. Comparative studies of adult patients with anterior circulation AIS-LVO undergoing MT that reported GC placement were included. Both balloon GCs (BGCs) and non-BGCs were eligible. Data were pooled using random-effects models in R. Outcomes included functional independence (modified Rankin Scale 0–2 at 90 days), successful reperfusion (modified thrombolysis in cerebral infarction ≥2b or expanded thrombolysis in cerebral infarction ≥2c), first-pass recanalization (FPR), mortality, puncture-to-recanalization (PTR) time, and complications. Subgroup analyses were performed by thrombectomy technique and catheter type. Results Seven retrospective studies comprising 2148 patients (1042 proximal, 1106 distal) were analyzed. Distal placement was associated with higher rates of functional independence (risk ratio (RR): 1.25, 95% confidence interval (CI): 1.10–1.42), successful reperfusion (RR: 1.13, 95% CI: 1.04–1.22), and FPR (RR: 1.35, 95% CI: 1.15–1.58), as well as lower 90-day mortality (RR: 0.52, 95% CI: 0.28–0.82). PTR time was shorter with distal placement (mean difference: −7.7 min, 95% CI: −10.8 to −4.6). No significant differences were observed for symptomatic intracranial hemorrhage (RR: 0.96, 95% CI: 0.55–1.65) or emboli to new territory (RR: 0.84, 95% CI: 0.28–2.52). Benefits were consistent across both BGCs and non-BGCs. Heterogeneity existed in outcome definitions and techniques, and publication bias could not be excluded. Conclusions Distal GC placement is associated with improved reperfusion, efficiency, and functional outcomes in MT for anterior circulation AIS-LVO, without increased complications. Given the retrospective nature of included studies, anatomic confounding, and inconsistent outcome definitions, findings should be considered preliminary. Multicenter trials are needed to confirm whether catheter position independently predicts MT outcomes.

Objective Despite promising outcomes from pilot initiatives, the transition to widespread adoption and upscaling of eHealth solutions in the hospital context remains challenging. This study aims to explore the barriers and facilitators influencing the implementation of eCoaches from the perspective of professionals. Methods A qualitative research design was employed, involving individual semi-structured interviews with management and healthcare professionals ( n = 10) who were involved with an eCoach either for heart failure (HF) or inflammatory bowel disease (IBD). Both eCoaches supported remote monitoring, advisory, educational, and interactive care activities. Interview topics were guided by the Consolidated Framework for Implementation Research (CFIR), including the original five domains and the added domain Patients′ needs and Resources. Data were analyzed thematically. Results Barriers and facilitators were identified across all CFIR domains: eCoach design and licensing costs (Intervention Characteristics); financial compensation (Outer Setting); integration into care pathways, Information and Communication Technology (ICT) infrastructure, team dynamics, and task reallocation (Inner Setting); intrinsic motivation, beliefs, and competencies of professionals (Characteristics of Individuals); patient resources and digital literacy (Patients’ Needs and Resources); and availability of evidence and management information (Process of Implementation). Conclusion This study underscores the complex nature of implementing eCoaches within the hospital setting, where barriers and facilitators span multiple interrelated domains. To overcome “pilotitis” and achieve the sustainable integration of blended care for patients with chronic conditions, comprehensive implementation strategies that concurrently address all relevant domains are essential. By illuminating the experiences of healthcare professionals, this study offers actionable insights to guide the design, implementation, and upscaling of eCoaches and related eHealth technologies.

Abstract Introduction The lower urinary tract injury, although often not life-threatening, can result in devastating long-term morbidity and, in some cases, permanent disability. Male genital trauma adversely affects male sexual function. Aim This 5th International Consultation on Sexual Medicine guideline on male genitalia trauma evaluates urologic trauma literature to guide clinicians in the best-evidenced management with specific emphasis on preservation and optimization of male sexual function. Methods A systematic literature search was conducted to identify relevant English-language publications and contemporary guidelines using the PubMed database (search dates January 1, 1990 to June 1, 2024) on the following terms: “trauma,” “penis,” “urethra,” “testis,” and “scrotum.” The available literature was discussed, and selected articles with the highest evidence available were used to create consensus guideline statements, categorized based on the Grading of Recommendations Assessment, Development and Evaluation system. In the absence of sufficient evidence, additional information was provided as a Clinical Principle or Expert Opinion. Results Fourteen recommendations are provided with corresponding levels of evidence and grades of recommendation. Conclusions Treating clinicians should be mindful that both the male genitalia trauma itself and treatment outcomes invariably affect various male sexual functions. Optimal treatment of male genitalia trauma is essential and should incorporate patient tolerances, needs, and preferences to minimize long-term sexual dysfunction.

A 59-year-old woman presented with a persistent, nonpruritic erythematous rash on both lower extremities. Dermoscopy showed petechiae and hemosiderin deposition, and biopsy revealed perivascular lymphocytic infiltration with red blood cell extravasation, confirming Schamberg disease. Laboratory studies were unremarkable. Minimal improvement with topical corticosteroids prompted addition of oral rutoside, ascorbic acid, and pentoxifylline, resulting in gradual fading of lesions. Schamberg disease is a benign, chronic pigmented purpuric dermatosis that can mimic vasculitis. Diagnosis requires clinical and histologic correlation, and management focuses on cosmetic improvement and patient reassurance regarding its nonprogressive nature.

Background: Lyme disease is the most common vector-borne disease in United States children. It was traditionally thought to be limited to the Northeast and upper Midwest due to the prevalence of tick and deer vectors in these regions. We hypothesize that as Lyme disease cases in children continue to increase throughout the country, nontraditional regions such as the Midwest and South may have an increased rate of Lyme disease compared with the Northeast region. Methods: The Pediatric Health Information System (PHIS) database was queried for patients 19.0 years or younger who were treated for Lyme disease between 2004 and 2019 through Emergency Department and in-patient records using ICD coding. Data from 49 pediatric hospitals was included and the centers were split into 4 regions based on geographic location. The data was separated into 2 time periods: 2004 to 2014 and 2015 to 2019. Slopes were compared using a general linear model with interaction to determine if annual rates of Lyme disease were statistically different between the 2 time periods. The data was then split by geographic region and again the annual rate of Lyme disease was compared between the 4 regions. A P -value <0.008 was considered significant to adjust for multiple comparisons. Results: Between 2004 and 2019, 7,572 cases of Lyme disease were reported with a mean age of 9.5 years (range: 0.08 to 19.00 y) and 58% male. From 2004 to 2019, there was an annual increase of 46.5 cases. When separated by region from 2004 to 2019, the Midwest had a higher increased annual rate of Lyme disease (30.7 additional cases/year) compared with the Northeast (10.0 additional cases/y), the South (3.6 additional cases/y), and the West (2.2 additional cases/y). Conclusions: Lyme disease continues to show an increased rate across the United States. The annual increase in cases in the Midwest was significantly higher than the other regions from 2004 to 2019. There does appear to be a significant regional spread, particularly in the Midwest. Awareness of the increased rate and spread of Lyme disease across the US is crucial in helping to identify national and regional strategies to diagnose and treat this disease in children. Level of Evidence: Level IV.

What is a coaching mindset? At its core is a conviction to agency: Learners are responsible for their own choices

Abstract INTRODUCTION Research is limited regarding meaningful change thresholds for individual patients on clinical outcome assessments (COAs) frequently used in clinical trials for Alzheimer's disease and related dementias (ADRD), particularly in population‐based studies early in the disease course. METHODS There were 646 study participants in the population‐based Mayo Clinic Study of Aging (MCSA), 54–99 years old (47% females), who developed the clinical syndromes of mild cognitive impairment (MCI) with complete data to establish clinically meaningful within‐patient change thresholds in cognitive and functional COAs. RESULTS Using the diagnosis of incident MCI as the anchor, mean (95% confidence interval [CI]) annualized estimates of change were: Clinical Dementia Rating (CDR) scale Sum of Boxes (SB) 0.49 (0.43, 0.55), Mini‐Mental State Examination (MMSE) −1.01 (−1.12, −0.91), and Functional Activities Questionnaire (FAQ) score 1.04 (0.82, 1.26). DISCUSSION This study provides within‐patient estimates of clinically meaningful change early in disease progression in a community‐based sample. Highlights We studied incident mild cognitive impairment (MCI) participants from a population‐based study. Within‐patient change thresholds were estimated for clinical outcome assessments (COAs) used in clinical trials for Alzheimer's disease and related dementia (ADRD). These estimates may be used to plan and evaluate clinical trials involving disease‐modifying therapies (DMTs).