Citations

BACKGROUND AND OBJECTIVES: This study assessed the efficacy and safety of stereotactic radiosurgery (SRS) in comparison with watchful waiting for managing Koos grade II vestibular schwannomas (VS). METHODS: A retrospective, multicentric analysis was conducted, focusing on patients with Koos grade II VS who either received SRS (SRS group) or were observed (observation group). To ensure comparability between groups, propensity score matching was used, including factors such as demographic characteristics, tumor dimensions, and hearing assessments. The primary end points examined were tumor control, maintenance of serviceable hearing, and neurological outcomes. RESULTS: A total of 92 patients were equally matched across both cohorts, with a median follow-up of 37 months for the SRS group and 27.5 months for those observed. The SRS cohort exhibited superior tumor control over observation across 3, 5, and 8 years, achieving a 100% control rate vs 47.9%, 40.1%, and 34.3% for the observation group at these time intervals, respectively ( P < .001). Serviceable hearing preservation rates were comparable between the 2 groups throughout 3, 5, and 7 years (72.9% for SRS vs 65.4% for observation at 3 years; P = .86). Moreover, SRS management correlated with a lower incidence of vestibular symptoms (odds ratio = 0.11, P = .002), with no significant disparity in the deterioration of cranial nerve (CN) V or CN VII functions. Notably, the likelihood of experiencing any CN impairment was significantly diminished in the SRS cohort (odds ratio = 0.47, P = .04). CONCLUSION: For patients with Koos grade II VS, SRS offers superior tumor control rate and a lower risk of CN dysfunction without sacrificing hearing preservation.

ABSTRACT The use of the glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide has markedly increased for the treatment of weight loss and management of diabetes mellitus. Gastrointestinal adverse effects of GLP-1/GIP agonist therapy, including nausea, vomiting, and constipation, are common. We report a case of colonic ischemia in a 62-year-old woman which developed in association with the use of tirzepatide for weight loss. This report highlights a potential risk relationship between GLP-1/GIP agonist therapy and colonic ischemia and identifies risk factors that should be considered before prescribing tirzepatide.

AbstractObjectivesTo examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization.Study Setting and DesignIn this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates.Data Sources and Analytic SampleThe Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters.Principal FindingsFindings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72‐h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short‐term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order.ConclusionsThis study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.

Background: Rapidly reversible weakness with neck flexion (McArdle sign) is common in patients with multiple sclerosis (MS). The pathophysiology is unknown. Objective: To evaluate changes in central motor conduction time (CMCT) in patients with and without McArdle sign. Methods: We measured McArdle sign with a torque cell and CMCT with neck flexed and extended in patients with MS, other causes of myelopathy, and healthy controls. Results: CMCT was prolonged with neck flexion disproportionately in those with MS-associated myelopathy (MSAM) with prominent McArdle sign compared to MS patients with lesser degrees of McArdle sign, and to controls. Conclusion: McArdle sign may result from stretch-induced slowing of conduction due to demyelination.

Gastric subepithelial lesions (SELs) represent a heterogenous group of mass lesions that arise from the gastric mucosa. Several endoscopic techniques can be used to manage gastric SELs once the decision is made to pursue resection, including endoscopic submucosal resection, endoscopic submucosal dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection. In addition to other clinical and anatomic factors, lesion size has important implications on the ability to obtain a complete resection while minimizing risk of adverse events. This article reviews technical considerations and available data regarding how size may impact the endoscopic approach to gastric SEL resection.

Objective: To examine perceived operating room (OR) ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Background: Poor ergonomics causes musculoskeletal injuries affecting all OR staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. Methods: We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single center (n = 238). We developed a questionnaire through item generation and reduction, followed by reliability and validity testing. Results: Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% of anesthesiologists experienced musculoskeletal (MSK) injuries, with no difference in professional groups’ perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived as beneficial by 80% to 90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavorable perceptions from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff. Conclusions: While structural/organizational issues are reported as barriers to ergonomics, solutions appear as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams.

Background and Purpose Thrombectomy in distal, medium vessels is a topic of increasing interest. To date, there are few in vitro studies focused on performance of ≤5F catheters in medium vessels. The purpose of this study is to compare the performance of the 3F, 4F, and 5F MIVI Neuroscience Q Catheters versus Penumbra 3F, 4F, and MicroVention Sofia 5F Catheters. Methods Using in vitro methods, we assessed and compared the following parameters: aspiration flow rates, clot uncorking forces, impulse, and clot ingestion. For flow rate, each aspiration catheter was immersed in a cylindrical container. Flow rate at one second was used to calculate impulse. For clot uncorking force, the force required to disengage a catheter from a simulated clot was recorded. For ingestion, we measured time to ingest soft and medium stiffness synthetic clots. Results The measured flow rates without a stent retriever for the Q3, Q4, and Q5 catheters were 3.54 ml/s, 5.32 ml/s, and 6.87 ml/s. The measured flow rates without a stent retriever for the 3MAX, 4MAX, and 5F Sofia were 1.46 ml/s, 2.56 ml/s, and 1.73 ml/s. The impulse calculated for one second was 26 mNs for Q5 vs 9 mNs for Sofia 5, 35 mNs for Q4 vs 15 mNs for 4Max< and 35 mNs for Q3 vs 9 mNs for 3Max. The average system ingestion for Q was significantly faster than the competitive catheters. Conclusions The Q catheters demonstrated higher flow rates, higher uncorking force, and faster complete clot ingestion than competitive catheters.