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Background: In the United States, Southeast Asian immigrant and refugee women face many barriers to cervical cancer screening. This work describes and evaluates the use of community health workers and community-based participatory research in providing community-level interventions through a community-academic partnership to address these barriers.

Methods: Community advisory board members and mother-daughter dyads were recruited to help develop and refine cervical cancer educational materials.

Results: Feedback from 9 community advisory board members and 5 mother-daughter dyads identified areas for improvement to increase cultural sensitivity of materials and ensure the equity of voices during discussions.

Conclusions: Through this community-academic partnership, we developed cervical cancer prevention educational materials and workshops for Southeast Asian immigrant and refugee communities to serve as a resource to future cervical cancer screening programs.

Introduction: Elsberg syndrome is an uncommon cause of lumbosacral radiculitis that presents as a constellation of symptoms, including urinary retention, bowel incontinence, severe constipation, impotence, and saddle anesthesia.

Case presentation: A 32-year-old female presented to the emergency department with complaints of bilateral leg pain and urinary retention. Two weeks prior, she noticed new genital lesions and had a positive nucleic acid amplification test for herpes simplex virus (HSV) type 2. Magnetic resonance imaging of the lumbar spine showed extraforaminal enhancement and edema-like signal within all the lumbosacral nerve roots. Cerebrospinal fluid (CSF) studies, CSF culture, and meningitis panel were unremarkable.

Discussion: Elsberg syndrome likely accounts for 5% to 15% of patients with cauda equina syndrome. However, physicians often leave out Elsberg syndrome in the differential diagnosis of acute cauda equina syndrome and do not perform HSV testing to facilitate definitive diagnosis. As a result, Elsberg syndrome is underreported.

Conclusions: A high degree of clinical suspicion should be deployed when diagnosing patients with bilateral lumbosacral radiculitis, as early detection and treatment of Elsberg syndrome prevents long-term morbidity.

Introduction: Efficient emergency medical care is becoming more important with continually increasing emergency department volumes. Decreasing door to discharge (D2D) times has been shown to improve patient satisfaction and decrease wait times and health care costs. We hypothesize that standardized onboarding for new faculty physicians in microhospital emergency departments will reduce D2D times.

Methods: In this retrospective observational study, D2D times were tracked for newly hired physicians at 2 microhospital emergency departments within an academic health system during 2021-2022. Physicians hired after July 2022 received an onboarding process that emphasized reducing D2D times. D2D times for these physicians were compared with those of physicians hired earlier who did not receive any onboarding. D2D means and standard deviations (SD) of each group were compared with 2-sample t tests.

Results: There were 25 newly hired emergency department physicians across both study locations over 2 years; 15 received no onboarding, while 10 received onboarding. At one of the emergency departments, physicians who received onboarding had a significantly reduced mean D2D time compared with those who received no onboarding (119 minutes [SD = 29] vs 146 minutes [SD = 34], P = 0.049). At the other emergency department, there was no significant difference in D2D times between physicians who did or did not receive onboarding (97 minutes [SD = 35] vs 102 minutes [SD = 30], P = 0.760). Across both locations, physicians who received onboarding had a nonsignificant reduction in D2D times compared with those who received no onboarding (110 minutes [SD = 32] vs 126 minutes [SD = 39], P = 0.160).

Conclusions: After implementing an onboarding process for new physician hires, there was a statistically significant decrease in D2D times at one of the microhospital emergency departments. Thus, an onboarding process may represent a simple, cost-effective technique that emergency departments can use to reduce D2D times and prevent overcrowding. Future work may evaluate the efficacy of such processes in non-microhospital emergency department settings.

Introduction: Tube thoracostomy (TT) is used to drain the pleural cavity in the setting of both traumatic and nontraumatic pathologies. Literature has shown that inappropriate tube positioning occurs in 30% of patients, including TTs placed within the fissure, which may result in further interventions in these patients. Our goal was to compare the rates of TT placed into a lung fissure in a controlled model using a simple approach to direct the tube more toward the bed than the patient's head at the time of placement to validate further investigations of the clinical applicability of this technique.

Methods: We performed 650 tube thoracostomies in 3 separate cadaver torsos with tracheal intubation and bag valve mask approximating a 50% pneumothorax. TTs were performed by experienced clinicians using a "more toward the head" direction and a "more toward the bed" direction while varying other factors, including side of the chest, tube size, and location on the chest wall, followed by lung re-expansion to better evaluate each approach in different common clinical scenarios. A power analysis was performed for our primary outcome of tube placement in a lung fissure by direction, not for any additional variables. Multivariate analysis was used to determine whether the "head" or "bed" direction was more likely to result in tube placement in a fissure when controlling for other changes.

Results: A total of 650 TTs were placed in 3 cadavers by 2 experienced performers. The overall rate of tube placement in a fissure was 41% using the "head" direction and 13% using the "bed" direction. On multivariate analysis, the "bed" direction also was shown to have significantly decreased tube placement in a lung fissure when controlling for side, tube size, and location (P  <  0.01; odds ratio 0.22; 95% CI, 0.14 - 0.33).

Conclusions: Aiming more toward the bed than toward the head during TT placement is associated with a significantly decreased chance of placing the TT within a lung fissure in this highly controlled cadaveric proof-of-concept model. This technique requires no changes to standard TT placement set-up, time, cost, or equipment. We propose that it warrants further investigation as a potential intervention to decrease malpositioned tubes.

Introduction: This case study aimed to investigate a disparity in the medical education pipeline by investigating the impact of fundamental microsurgical training on interest and desire to pursue a career in medicine. This research introduces a method to attract undergraduate students from various backgrounds to the field of microsurgery through a hands-on microsurgical training course.

Methods: Microsurgical training took place 6 hours a week for 6 weeks. Techniques included knot-tying and anastomoses on 1-, 2- and 3-mm synthetic vessels using both end-to-end and back-wall techniques. Participant's knowledge and confidence in microsurgical skills were evaluated using a presurvey, postsurvey, and vessel patency. One undergraduate student with no prior surgical knowledge completed one-on-one microsurgical training designed for integrated plastic surgery residents and was supervised by a microsurgical educator.

Results: The undergraduate student achieved the microsurgery level equivalent to a third-year surgical resident in the same training program and could complete patent anastomoses using end-to-end and back-wall methods on a 1-mm, 2-mm, and 3-mm synthetic vessel. The student's timing for different skills decreased over time while their confidence level increased. Their time for tying 3 knots decreased from 2.53 minutes to 19 seconds, while their time for a 3-mm end-to-end anastomosis decreased by 5.13 minutes.

Conclusions: Medical knowledge may not be necessary before starting microsurgery training. Early, hands-on exposure may make a medical career less intimidating.

Introduction: Irritable bowel syndrome (IBS) often is treated as a partially diet-responsive functional bowel disorder. Few interventions have been found to be effective in diet-refractory IBS, leading to lifestyle disruptions due to persistent symptoms. The efficacy of low-dose home ketamine therapy suggests others may benefit.

Case presentation: A female patient in her 60s with progressive presumed IBS with diarrhea found diet-based treatments ineffective, resulting in severe lifestyle disruptions. After a hysterectomy, intolerance to opioids for postoperative pain prompted the use of intravenous ketamine. An unexpected and prolonged improvement in IBS symptoms resulted. The patient sought continued treatment with ketamine for IBS symptoms and experienced continued symptomatic relief with 20 mg oral ketamine every 2 weeks at home.

Discussion: No other published cases of ketamine for IBS were found.

Conclusions: While dietary changes remain the gold standard for IBS, this patient experience highlights ketamine as a potential adjunct therapy.

Chromosomal trisomy presents with a range of clinical manifestations, from subtle to life-threatening conditions that include trisomy 16, the most common aneuploidy in first trimester abortions. Most cases are linked to maternal complications and spontaneous abortions, typically detected prenatally. Infants who survive with trisomy 16 often have mosaic variants and may exhibit various anatomical and metabolic abnormalities, though a trisomy 16 diagnosis does not guarantee the presence of such abnormalities. We share the case of a 15-year-old boy who has mosaic trisomy 16. He was diagnosed after birth and showed mild symptoms without any major anatomical issues. However, he did experience several metabolic problems, such as insulin resistance, obesity, hormonal imbalances, and vitamin D deficiency. This report highlights the diverse clinical characteristics of trisomy 16, comparing them to previously reported cases.

Introduction: Inferior vena cava agenesis (IVCA) is a very uncommon vascular condition, occurring in about 0.0005% to 1% of the population. It is often overlooked as a potential cause of deep venous thrombosis and pulmonary embolism, particularly in younger patients.

Case presentation: A 25-year-old Hispanic woman presented to the emergency department with leg swelling and pain. She later developed shortness of breath and chest pain, prompting her transfer to the intensive care unit. Chest and abdominal computed tomographic angiography confirmed a left pulmonary embolism, absence of the infrarenal vena cava, and a thrombus in the left superficial iliac and femoral veins. She was treated with thrombolytic therapy followed by a successful thrombectomy.

Discussion: IVCA is a rare vascular condition caused by either a developmental failure of the inferior vena cava or thrombosis with secondary resorption. This leads to a complex collateral venous system with slower blood flow, increasing the risk of stasis and thrombus formation. IVCA should be considered in young patients with recurrent thromboembolism who lack typical risk factors. Diagnosis is best achieved through computed tomography or magnetic resonance angiography. Management usually involves long-term anticoagulation, with surgery reserved for select cases.

Conclusions: IVCA is an uncommon cause of thromboembolism events. It is important to consider this diagnosis in young patients after immune, genetic, or traumatic issues have been ruled out, as prompt treatment can help prevent serious health risks.