Baylor University Medical Center Proceedings最新文献

This study investigated erythema ab igne (EAI) and comorbid skin cancers. Each EAI case, searched by ICD-10-CM code L59.0 in the All of Us database, was compared to four controls, matched by sex at birth, age, and self-identified race/ethnicity. Demographics and skin cancer comorbidities were assessed with odds ratios (ORs) and 95% confidence intervals (CIs) using Wald's method. EAI was most prevalent between 60 and 70 years of age. A female-to-male ratio of 1:1 was observed between ages 40 and 50. EAI patients had a statistically significant increased risk of basal cell carcinoma (OR, 10.67; 95% CI, 2.76-41.30; P < 0.001), squamous cell carcinoma (OR, 27.84; 95% CI, 1.42-545.59; P = 0.03), and melanoma (OR, 8.00; 95% CI, 1.43-44.60; P = 0.02). Additional tumors were analyzed, but insufficient case/control data was obtained from the database. In conclusion, EAI is positively correlated with skin cancers. Awareness and prevention of EAI is warranted.

Background: Previous studies have reported worse outcomes in women following percutaneous coronary intervention (PCI), but contemporary studies examining sex differences in in-hospital outcomes and 90-day readmission risk are lacking. Therefore, we sought to compare 90-day readmission rates and in-hospital adverse outcomes after PCI.

Methods: We used the United States National Readmissions Database to stratify all inpatient PCIs from 2017 to 2018 by sex. We then performed propensity score matching of the two groups based on demographics, medical history, hospital characteristics, clinical presentation, socioeconomic status, and procedures. The primary outcome of interest was 90-day readmission to the hospital. Secondary outcomes included 30-day readmission, in-hospital mortality, and additional in-hospital outcomes. We performed Cox proportional-hazards modeling to compare the hazard of readmission between women and men and logistic regression to calculate odds ratios for the secondary outcomes of interest.

Results: After propensity score matching, 206,556 women and 205,134 men were included. At index hospitalization, women experienced higher odds of in-hospital mortality, hypovolemic shock, and need of blood transfusion, while men experienced higher odds of cardiac arrest, intracranial hemorrhage, and acute kidney injury. Women had a higher hazard of 30-day readmission (hazard ratio 1.16, 95% confidence interval 1.14-1.18, P < 0.01) and 90-day readmission (hazard ratio 1.14, 95% confidence interval 1.12-1.15), with the greatest difference seen among younger women <45 years of age. Findings were similar after stratification into different age groups and clinical presentations.

Conclusion: Substantial sex differences in outcomes after PCI persist, with variable sex differences in in-hospital complications, and women at higher risk of 30- and 90-day readmission to the hospital. Given the clinical and reimbursement implications of readmissions to patients and health systems, urgent efforts are needed to close these gaps.

In the operating room of a teaching hospital, there is a need to balance surgical efficiencies, patient safety issues, and time management with preparing residents for mature practice. Gaps exist between attendings' perspectives and residents' perspectives on the quality of surgical teaching, wherein residents may perceive an unfocused stream of talk rather than a direct, structured approach. Based on a guided discovery learning model and a review of existing approaches for surgical teaching, the BID model-Briefing, Intraoperative, Debriefing-was applied for teaching in the operating room. The briefing adopts the precepts of deliberate practice while focusing on a small number of specific learning objectives. The intraoperative teaching segment consists of immediate feedback and guidance directed by the learning objectives. The debriefing element solidifies the learning that occurred and allows residents an opportunity to reflect on their performance. This approach guides future practice while fitting within the busy constraints of teaching surgeons.

The relationship between Alexis Carrel, who received the Nobel Prize in Physiology or Medicine in 1912, and Simon Flexner, director of the Rockefeller Institute for Medical Research, is well documented. However, Carrel's collaboration with Abraham Flexner, a key figure in US medical reform, is less widely recognized, and it seems there are no previous mentions of a connection with William Osler. This historical vignette offers insights into the interactions among these three figures during World War I. Five letters, preserved in the library of the National Academy of Medicine in Paris, are presented in full.

Objective: We hypothesized that patients who underwent cesarean delivery and received oxytocin boluses followed by an infusion would have a lower incidence of secondary uterotonic administration compared to patients who had an oxytocin infusion without boluses.

Methods: Patients who had cesarean deliveries at our hospital from September 1, 2021 through December 31, 2021 and from September 1, 2022 through December 31, 2022, corresponding to the oxytocin bolus and oxytocin infusion cohorts, respectively, were included. Patient demographic, physical, and clinical characteristic data were collected by a study investigator. Intramyometrial oxytocin, intramuscular methylergonovine, intramuscular carboprost tromethamine, and sublingual misoprostol were defined as secondary uterotonics.

Results: There were 266 and 283 patients in the oxytocin bolus and oxytocin infusion cohorts, respectively. The odds ratio for patients in the oxytocin bolus cohort receiving a secondary uterotonic was 0.25 (95% confidence interval 0.16, 0.41; P < 0.01).

Conclusion: Patients in the oxytocin bolus cohort were approximately 75% less likely to receive a secondary uterotonic agent compared to patients in the oxytocin infusion cohort. A limitation of this study was that we defined intramyometrial administration of oxytocin as a secondary uterotonic, and our results may not be generalizable to hospitals that do not use intramyometrial oxytocin.