Citations

Abstract The substantial carbon footprint imparted by medical services warrants increased attention to their environmental impact. National guideline organizations such as the US Preventive Services Task Force (USPSTF) recommend multiple modalities for average-risk colorectal cancer (CRC) screening with varying resource intensity. The aim of this study was to quantify the environmental burden for 2 of the most used CRC screening modalities, colonoscopy and the multi-target stool DNA (mt-sDNA) test. A validated CRC microsimulation model was used to estimate the number of screening and follow-up tests for a cohort of 1 million average-risk individuals who underwent screening between ages 45 and 75. Component resources used for mt-sDNA, including waste products, energy, and transportation for colonoscopy and mt-sDNA, were collected from January 1, 2023, to January 1, 2024, and converted to carbon-equivalent emissions. Resources used for colonoscopy were captured from the literature. Resources devoted to screening colonoscopy were substantially (59%) higher than those to mt-sDNA, even when including follow-up colonoscopy. Of note, follow-up colonoscopy accounted for the majority (64%) of total emissions for the mt-sDNA screening strategy. Compared with colonoscopy screening, mt-sDNA substantially reduces the carbon emissions attributable to population-level CRC screening. Environmental impact should be included as a factor when choosing among guideline-recommended CRC screening strategies.

Abstract A collection of patients are seen in the neurointensive care unit and other medical and surgical intensive care units. Diagnosis, neuroimaging, and management in acute conditions are discussed in detail. In this new edition, we place more emphasis on how diagnostic and management decisions can go awry. When pertinent, we discuss new care paradigms, the latest support modalities, and new therapies, interventions, and technologies, but the main purpose is to convey a sense of what our specialty is all about. The book is useful for all health care professionals, essential material for learners and fellows in intensive care specialties and informational for staff attending physicians and hospitalists.

Abstract Based on expert consensus, the American Society of Transplantation recommends 7–14 days of preventive antibiotic therapy for solid organ transplant recipients from donors with positive blood cultures. We evaluated management and outcomes of kidney transplant recipients from these donors.

Background: Both perineural and intravenous dexamethasone have been proposed as effective adjuncts that prolong the duration of peripheral nerve blocks. The authors sought to explore whether combining systemic with perineural dexamethasone yields any additive or synergistic effect on the characteristics and analgesic effects of peripheral nerve blocks. Methods: Adult patients having distal radius open reduction and internal fixation and/or carpometacarpal arthroplasty under supraclavicular block were randomized to intravenous dexamethasone, a combination of perineural plus intravenous dexamethasone, or no dexamethasone (control). Sensory block duration was set as the primary outcome. Secondary outcomes included motor block duration; postoperative rebound pain scores as well as worst pain at 8, 16, 24, 32, 40, and 48 h; opioid consumption at 0 to 24 and 25 to 48 h; incidence of nausea/vomiting; and presence of burning sensation in the blocked limb at 24 and 48 h. The null hypothesis was lack of difference in sensory block duration between the three groups. Results: A total of 104 patients were included in the analysis (intravenous dexamethasone, 37; intravenous plus perineural dexamethasone, 34; control, 33). Compared to intravenous dexamethasone alone, adding perineural dexamethasone did not yield any incremental benefits in any of the outcomes examined. The mean ± SD of sensory block duration was 21.3 ± 7.3 h in the intravenous dexamethasone group, 20.6 ± 6.1 h in the perineural plus intravenous group, and 16.8 ± 6.8 h in the control group. The mean difference (95% CI) of sensory block duration was significantly prolonged by 4.5 h (95% CI, 1.3 to 7.7; P = 0.006) in the intravenous dexamethasone group and 3.8 h (95% CI, 0.8 to 6.8; P = 0.015) in the perineural plus intravenous dexamethasone group compared to control; however, no difference was observed when the two dexamethasone groups were compared to each other (0.7 h [95% CI, –2.5 to 3.9]; P = 0.670). Compared to control, both intravenous and intravenous plus perineural dexamethasone similarly reduced 24-h pain scores and opioid consumption and decreased incidence of rebound pain. Conclusions: The authors’ findings suggest that intravenous dexamethasone alone is sufficient to improve analgesic outcomes for patients receiving supraclavicular block for upper extremity surgery. Combining the intravenous and perineural dexamethasone routes does not yield an additive or synergistic effect on the characteristics and analgesic effects of supraclavicular block.

Objective The aim of the study was to assess the characteristics and outcomes of adults with attention-deficit/hyperactivity disorder (ADHD) and a previous history of restrictive eating disorder symptoms. Method We retrospectively reviewed the health records of patients with ADHD and a history of disordered eating who were treated at our institution with medications that have potential anorexiant properties from October 1, 2022, through March 31, 2024. Results We initially identified 159 patients who were referred to an ADHD program at our institution during the study period. Of 72 patients who met criteria for an ADHD diagnosis, 18 had SCOFF questionnaire scores of 2 or higher, which suggests symptoms of a restrictive eating disorder. Of these 18 patients, 3 had a previous diagnosis of an eating disorder documented in their health records. Each patient was treated with medications chosen to manage their reported ADHD symptoms, regardless of eating disorder concerns. All patients had improvements in ADHD symptoms without reporting adverse effects on disordered eating behaviors. Body weight and body mass index values did not significantly change after treatment with atomoxetine, dextroamphetamine/amphetamine, or methylphenidate (all P ≥ 0.14). Conclusions Our findings are consistent with those of previous reports and suggest that ADHD treatment, including treatment with stimulant medications, is safe and tolerable for patients with a history of restrictive eating disorder symptoms.

Although generative artificial intelligence can create podcast summaries of radiology articles, summaries are limited by hallucinations and lack of audience appropriateness, requiring further investigation to justify use as an educational tool.

Background: The number of medial ulnar collateral ligament (MUCL) reconstructions is increasing. The epidemiology surrounding revision MUCL reconstructions in professional baseball players has not been well defined. Purpose/Hypothesis: The purpose was to report the epidemiology of revision MUCL reconstruction in professional baseball players. The authors hypothesized that the number of revision MUCL reconstructions has increased over time and that the rate of return to sport at the same level of play is <70%. Study Design: Case series; Level of evidence, 4. Methods: All professional baseball pitchers who underwent revision MUCL reconstruction between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Rates of return to play, time to return to play, and return to same level of play were recorded and analyzed for pitchers with a minimum follow-up of 2 years. Surgical variables, including technique and graft choice, were also recorded. Results: Overall 191 pitchers (mean age, 26.0 years) underwent revision MUCL reconstruction. The mean time between primary and revision surgery was 1381 days (45 months). Of these players, 130 (68%) were Minor League Baseball pitchers. Hamstring tendon autograft was the most commonly used graft source (n = 90; 47%) when compared with palmaris longus autograft (n = 67; 35%). In terms of tunnel configuration, the modified Jobe and docking techniques were used in equal occurrence (n = 70; 37%). After revision MUCL reconstruction, only 72% of professional baseball pitchers were able to return to play at any level at a mean 556 days (18 months), and only 58% were able to return to the same level of play at a mean 604 days (20 months). The mean time between primary and revision MUCL reconstruction was 45 months (3.75 years). Conclusion: Revision MUCL surgery continues to be a challenging problem, where the procedure is complex, rehabilitation timelines are prolonged, and outcomes are not always optimal. Accordingly, the authors recommend that these procedures be performed by surgeons with high levels of experience.

Background: Concussions have previously been shown to have persistent neurological changes represented by altered reaction time and postural stability in high-level athletes. The effects of concussions on professional basketball players’ performance and subsequent injuries during the 90 days after return to play (RTP) have not been investigated. Purpose/Hypothesis: the purpose of this study was to evaluate player statistical performance and risk of musculoskeletal (MSK) injury within 90 days of RTP from a diagnosed concussion. It was hypothesized that within the 90 days after RTP from a concussion, players would be at a greater risk for MSK injury with an associated decrease in player statistical performance. Study Design: Descriptive epidemiology study. Methods: Concussions sustained by National Basketball Association (NBA) players between the 2015-2016 and 2021-2022 seasons, excluding the 2019-2020 season, were evaluated using a publicly available database. The database was queried to identify any MSK injury in the 90-day post-RTP period after a concussion, along with time loss after subsequent injury. Performance statistics were obtained from each player’s preindex season and postindex season, as well as defined time points within the 90-day post-RTP period. Each concussed player was matched 1 to 1 with a nonconcussed control using position, win shares, player efficiency rating, and points per game. MSK injury incidence and player statistics in the concussion group were compared with controls using unpaired Student t tests. Results: A total of 70 concussions were identified in 70 professional basketball players and included in this analysis. A total of 49 players sustained an MSK injury in the 90-day post-RTP period (70%). Compared with controls, the odds of sustaining an MSK injury in the concussed cohort were 11.3 times greater (95% CI, 5.04-25.2; P < .001). Games missed after subsequent MSK injury were similar between the concussed and control groups ( P = .687). Comparisons over the 90-day post-RTP period did not reveal any significant changes in points per game, minutes per game, or true shooting percentage ( P > .05). When compared with controls, no changes in performance statistics were significantly different ( P > .05). Conclusion: Our analysis demonstrates that basketball players who sustain concussions are at a significantly increased risk for subsequent MSK injury within the 90-day post-RTP period but not player performance. Knowledge of this increased risk of MSK injury in concussed athletes can help guide concussion management for proper RTP and targeted rehabilitation in professional basketball players.