Citations

ABSTRACTBackground/AimsMany patients with digestive symptoms describe underlying urinary or gynecologic symptoms, which may increase visceral sensitivity in the abdominopelvic region and amplify distress around digestive symptoms. The aim of this study was to describe the prevalence of urinary and gynecologic symptoms in patients with disorders of gut–brain interaction (DGBI).MethodsConsecutive adult patients with a female reproductive tract who were referred for GI behavioral medicine evaluation for DGBI at a tertiary care center between 2022 and 2023 were prospectively evaluated for symptoms associated with urinary and gynecologic dysfunction. Descriptive statistics were conducted to assess the prevalence of these symptoms within this population by anatomic region affected (esophagus, stomach, and bowel).ResultsA total of 432 patients were included in our cohort with a mean (SD) age of 40.0 years [Q1;Q3 29.0–52.0], with a predominantly White population (86.1%). Dysmenorrhea (61.0%) and menorrhagia (58.6%) were commonly reported among women with digestive symptoms. Urinary symptoms were less common, with 18.7% reporting pain with urination, 33.0% reporting difficulty voiding urine, and 26.1% reporting a history of frequent UTIs. 23% of women experienced ≥ 4 urinary/gynecologic symptoms. There were no significant differences in the type of urogynecologic symptoms reported based on the affected area of the GI tract.ConclusionUrogynecologic symptoms are common among patients with DGBIs affecting the entirety of the GI tract. We presume the presence of these comorbid symptoms is likely to impact symptom severity, quality of life, and could affect treatment response. Future studies are necessary to understand the mechanisms behind these shared conditions as well as develop effective treatments that address their overlap.

Objective Present the rationale for the development of a new, patient-facing vital sign for adult hearing. Study Design Structured A3 process. Setting Fourteen virtual meetings and two in-person meetings held between May 2021 and June 2022. Main Outcome Measure(s) Identification and refinement of a countermeasure to develop and imbed a hearing health vital sign for adult hearing. Results Through a rigorous, structured A3 process, the Hearing Health Collaborative identified and refined the rationale for and the qualities associated with a public-facing vital sign for adult hearing loss. Specifically, such a vital sign must embody five qualities: simple, accessible, stable, inclusive, and meaningful. These qualities together would ensure that a hearing health vital sign would be useful not only as a screening tool but also as an instrument to guide next steps in workup and potentially treatment. Conclusions Successful identification and implementation of a hearing metric or “vital sign” for the presence of adult hearing loss, using precedent convention of other medical diseases, may help reframe public perceptions surrounding hearing loss, improve awareness and literacy regarding the presence of the disease, and prompt action to seek diagnostic assessment.

Purpose: The current quality improvement project aimed to improve functionality within a psychiatric consult liaison nurse (PCLN) service through implementation of an educational pathway. Method: Pre- and postintervention qualitative interviews were conducted with eight PCLNs, and themes were generated via content analysis. Quantitative surveys were also conducted, and data were analyzed using means and standard deviations. Paired t tests were used to test for significance. Results: Qualitative results identified five themes: Flexibility vs. Uncertainty , Ambiguity vs. Direction , Structured vs. Unstructured Education , Efficiency/Time Management , and Communication . Quantitative surveys indicated the intervention improved the consistency of the psychoeducation provided ( p = 0.03) and enhanced the structure of the PCLN role ( p = 0.04). The intervention did not significantly improve communication between PCLNs and medical–surgical nurses. Conclusion: Qualitative findings showed that the educational pathway improved efficiency, time management, and communication, and quantitative findings showed it can help with consistency and structure to the role. Implementing an educational pathway for PCLNs is feasible and effective for health care systems.

Background and aims Percutaneous endoscopic gastrostomy (PEG) is an essential procedure for patients who require long-term enteral nutrition but are unable to eat orally. However, it carries a risk of bleeding, particularly in patients on anticoagulation or dual antiplatelet therapy (DAPT). This study aimed to assess the bleeding risk associated with continuing anticoagulation or DAPT during PEG placement. Methods Using the TriNetX US Collaborative Network Database, we analyzed four cohorts: patients on anticoagulants, patients not on anticoagulants, patients on DAPT, and patients on aspirin (ASP), focusing on gastrostomy-related bleeding within 7 and 30 days, along with secondary outcomes such as mortality and the need for blood transfusion or endoscopic reintervention. Results Our analysis showed no statistically significant difference in the 7-day bleeding risk between the anticoagulant and no anticoagulant groups. However, a higher 30-day bleeding risk was observed in the anticoagulant group (0.9 vs. 0.4%, P = 0.007). There was no significant difference in the incidence of severe bleeding events requiring endoscopic intervention or blood transfusion. In addition, the difference in the bleeding risk between the DAPT and ASP groups was not statistically significant within 7 and 30 days. Conclusion These findings suggest that while anticoagulant use increases the risk of minor post-PEG bleeding, it does not lead to a higher incidence of severe bleeding. Additionally, the continuation of DAPT was not associated with statistically significant increase in bleeding risk. This study provides valuable insights into the management of antithrombotic therapy in patients undergoing PEG.

Background: Skin cancer patients who undergo Mohs surgery may require subsequent reconstructive rhinoplasty for large nasal defects. Autologous cartilage is the primary source of supporting cartilage grafts, but carries the risk of potential donor-site complications. In this study, we demonstrate the safety and efficacy of nonterminally irradiated fresh frozen human costal cartilage allografts (CCAs) in reconstructive rhinoplasty after skin cancer removal. Methods: A retrospective chart review of 25 patients who underwent reconstructive rhinoplasties using human CCA after basal cell carcinoma resection was conducted. Human CCA undergoes a process of sterilization without terminal irradiation and is stored frozen (−40°C to −80°C). Anthropometric measurements were taken on pre- and postoperative photographs to evaluate nasal tip projection. Adverse events were evaluated. Results: There were 25 participants, with an average age of 71 years at the time of surgery (range: 42–90). The average follow-up duration was 12 months (range: 3–66 mo). Types of grafts used included alar batten graft (n = 17, 68%), nasal tip graft (n = 7, 28%), and alar batten graft with nasal tip graft (n = 1, 4%). Measurements on the 2-dimensional photographs of the patients showed no significant resorption or deviation at the 6- or 12-month follow-up. No significant complications related to the use of the cartilage were noted. Conclusions: Our data highlight the low complication rate and aesthetically positive outcomes from using nonterminally irradiated human CCA for reconstructive rhinoplasties in post-Mohs surgery for older patients. This approach offers a reliable source of high-quality cartilage for reconstruction.

Radiomic parenchymal phenotypes on mammograms were used to predict breast cancer risk among both Black and White women, notably for false-negative findings and symptomatic interval cancer.

Objectives Generative artificial intelligence (GAI) tools can enhance the quality and efficiency of medical research, but their improper use may result in plagiarism, academic fraud and unreliable findings. Transparent reporting of GAI use is essential, yet existing guidelines from journals and institutions are inconsistent, with no standardised principles. Design and setting International online Delphi study. Participants International experts in medicine and artificial intelligence. Main outcome measures The primary outcome measure is the consensus level of the Delphi expert panel on the items of inclusion criteria for GAMER (Rreporting guideline for the use of Generative Artificial intelligence tools in MEdical Research). Results The development process included a scoping review, two Delphi rounds and virtual meetings. 51 experts from 26 countries participated in the process (44 in the Delphi survey). The final checklist comprises nine reporting items: general declaration, GAI tool specifications, prompting techniques, tool’s role in the study, declaration of new GAI model(s) developed, artificial intelligence-assisted sections in the manuscript, content verification, data privacy and impact on conclusions. Conclusion GAMER provides universal and standardised guideline for GAI use in medical research, ensuring transparency, integrity and quality.

Acute right ventricular failure (ARVF) is commonly seen in the intensive care unit and constitutes a significant clinical challenge, with associated high in-hospital mortality. Recently, the treatment of ARVF has significantly changed, with the progressive implementation of mechanical circulatory support devices that now represent important tools for clinicians in treating this condition. However, despite recent advancements, the optimal approach for ARVF remains elusive, and precise treatment algorithms and comprehensive management protocols are still lacking. In the present review, we explore the pathophysiology of ARVF, highlighting the different mechanisms that may lead to this clinical entity and emphasizing the left and right heart’s complex interplay. We analyze the different therapeutic options that are now available for short- and long-term management of ARVF, with a particular focus on the advantages and disadvantages of the mechanical circulatory support devices actually used. Furthermore, we propose future directions in the field and a possible flowchart for the treatment of this condition.