Digital Commons Network^™

Sporadic Creutzfeldt-Jakob Disease: A Case Report Of Rapidly Progressive Dementia, Diane Olski, Karissa Charles, Cristin Grant, Courtnee Harpine, Shannon Leonard, Sarah Puim

South Atlantic Division GME Research Day 2025

No abstract provided.

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Limosilactobacillus Reuteri Promotes Melatonin Release From Human Intestinal Organoids Via 5′Ectonucleotidase Activity, Micah D Forshee, Erika J Nachman, Esha R Shenoy, Heather A Danhof, Ludwig Ermann Lundberg, Stefan Roos, Robert A Britton

Faculty, Staff and Students Publications

Strains of Limosilactobacillus reuteri have been used to prevent or treat various conditions; however, the mechanisms by which they exert beneficial effects are not completely understood. Infant colic is one example in which L. reuteri DSM 17938 reduces clinical symptoms. While the etiology of colic is unknown, abnormal melatonin levels in infants have been suggested as a possible contributor. L. reuteri DSM 17938 has been shown to produce adenosine from AMP via production of the extracellular enzyme 5′ectonucleotidase (5′NT). Adenosine is a potent signaling molecule that impacts several important aspects of host physiology, including the release of melatonin from the …

When Probiotics Guidelines Differ: A Practical Guide For Clinicians And Researchers, Geoffrey A Preidis, Hania Szajewska, Marla Cunningham, Howard Bauchner, Daniel J Merenstein

Faculty, Staff and Students Publications

Many professional organizations publish clinical practice guidelines for the use of probiotics in gastrointestinal disorders. Generally, no two guidelines align perfectly, and some differ markedly. These discrepancies occur because clinical practice guidelines are not purely mechanical outputs of data synthesis. They are shaped by structured interpretation, value judgments, and predefined thresholds for uncertainty. These elements become particularly visible when effect sizes are small, heterogeneity is high, and outcomes vary in clinical relevance-as is the case with probiotic research. This article examines why discordance among probiotic guidelines is predictable and provides practical guidance for clinicians who must decide among conflicting recommendations …

Steroid Receptor Coactivator 3-Deficient Regulatory T Cells Eradicate Multiple Solid Tumors In Syngeneic Mouse Models, Nuri Sung, Eunsu Kim, Yosef Gilad, Yuri Park, Adam M Dean, Yan Xia, Jianming Xu, Clifford C Dacso, David M Lonard, Sang Jun Han

Faculty, Staff and Students Publications

Steroid receptor coactivator 3 (SRC-3) is highly expressed in regulatory T cells (Tregs) and is important for their immunosuppressive activity. Recently, we demonstrated that disrupting SRC-3 expression in Tregs eliminates triple-negative breast cancer (TNBC) and prostate cancer in syngeneic animal models by generating an anti-tumor immune microenvironment without inducing immune-related adverse events (irAEs). Further analysis of these mice revealed that SRC-3 knockout (KO) Tregs infiltrated breast tumors and facilitated the infiltration of CD8

Is Your Cyst Really A Ganglion Cyst? A Case Report Of Angioleiomyoma Mimicking A Plantar Fascia Cystic Lesion, Christopher Anjorin Ms Dpmc, Joseph Bender Dpm

School of Podiatric Medicine - Student Research

Ganglion cysts are among the most common benign soft tissue masses encountered in podiatric clinical practice, and their diagnosis is often presumed based on location, clinical observation, and transillumination. However, this case highlights a diagnostic idiosyncrasy: a lesion clinically presumed to be a ganglion cyst within the plantar fascia was ultimately identified as an angioleiomyoma following surgical excision and histopathological evaluation. This finding underscores the importance of maintaining a broad differential diagnosis when assessing cystic lesions, particularly those that transilluminate, as benign vascular tumors may closely mimic more common entities in both clinical presentation and imaging. More importantly, what if …

Deep Brain Stimulation In Early-Stage Alzheimer's Disease: A Systematic Review Of Neuropsychological Outcomes, Nora Huey

Doctoral Dissertations

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory impairment, and disruption of neural networks involved in cognitive functioning. Although existing treatments may provide symptomatic benefit, there remains a need for interventions capable of slowing or stabilizing disease progression. Deep brain stimulation (DBS) has emerged as a potential neuromodulatory intervention for early-stage AD through stimulation of memory- and cognition-related neural circuitry. This dissertation employed a systematic review research methodology to examine teh neuropsychological and neurobiological outcomes associated with DBS targeting the fornix (DBS-f) and nucleus basalis of Meynert (DBS-NBM) in individuals with early-stage AD over 12–24 …

Adolescent And Young Adult Cancer Survivorship: Supportive Care Needs, Resources, And Barriers, Allison Bryn Koplos

Master's Projects and Capstones

Background: Adolescent and young adult (AYA) cancer survivors experience unique physical, psychosocial, developmental, and healthcare-related challenges that often persist beyond treatment completion. Although survivorship resources have expanded, gaps in supportive care needs persist. This scoping review examined the supportive care needs, survivorship resources, and barriers to accessing supportive care among AYA cancer survivors.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Peer-reviewed literature published between 2000 and 2026 was identified through searches in PubMed and Google Scholar. Studies examining supportive care needs, survivorship resources, or supportive care services …

Multiomic And Single-Cell Analysis Of Tumors And Their Immune Microenvironment For Personalized Cancer Therapy, Kartik Singhal

WUSM Theses and Dissertations – All Programs

Precision oncology aims to match cancer treatment to the biology of an individual patient’s tumor. However, tumors that share a diagnosis can differ in their molecular features, cellular composition, clinical course, and response to therapy, making it difficult to determine which treatment will benefit an individual patient. This dissertation integrates genomic, transcriptomic, and single-cell multiomic computational analysis to characterize tumors across their somatic alterations, transcriptional cell states, microenvironment, and the immune response they elicit.

The first study describes a rare case of donor-derived follicular lymphoma following kidney transplantation. Genomic profiling showed that the donor and recipient tumors shared 31 somatic …

Phytochemical And In-Vitro Cytotoxic Analyses Of Flavonoid Species Isolated From Chromolaena Leivensis, Luke A. Bryant

Electronic Theses and Dissertations

As a leading cause of death worldwide, cancer and its treatments remain a primary source of interest among researchers. Modern studies are looking into bioselective cytotoxicity to create new chemotherapies that do not have the same harsh side effects as those we use today. Natural product research has a promising future for the development of such treatments. Specifically, polar flavonoids may be the key to a bioselective treatment. Such flavonoid species are native to plants, often within flower petals or within the body. A natural antioxidant, they are designed not to harm healthy cells. This study focuses on the plant …

Methylated Cfdna May Distinguish Between High- And Intermediate-Risk Uveal Melanoma: A Pilot Study, Mike Wu, Daniël P. De Bruyn, Ruben G. Boers, Aaron B. Beasley, Daan M. Hazelaar, Stavros Makrodimitris, Joachim B. Boers, Jolanda Vaarwater, Ronald O.B. De Keizer, Robert M. Verdijk, Nicole C. Naus, Dion Paridaens, Saskia M. Wilting, Elin S. Gray, Wilfred F.J. Van Ijcken, Joost Gribnau, Annelies De Klein, Erwin Brosens, Emine Kiliç

Research outputs 2022 to 2026

Background: Uveal melanoma (UM) is a highly aggressive malignancy with a metastatic risk that depends on the molecular subclass. This subclass can be determined through molecular characterization of tumor-derived tissue. With eye-sparing treatments, tumor tissue is rarely available for molecular testing. We hypothesized that minimal invasive biomarkers such as methylated cell-free DNA (cfDNA) or circulating tumor DNA (ctDNA) can be used for prognosis and monitoring of patients. Methods: Plasma cfDNA was isolated from healthy blood donors (HBDs, N = 19) and UM patients (N = 22). Plasma was collected at baseline (localized disease, N = 13) and during follow-up (metastatic …

Cardiovascular Disease And Fracture Risk In People With Type 2 Diabetes: A Nationwide Matched Case–Control Study, Aksayan Arunanthy Mahalingasivam, Annika Vestergaard Kvist, Joop P. Van Den Bergh, Cassandra Smith, Joshua R. Lewis, Peter Vestergaard, Nicklas Højgaard Hessellund Rasmussen

Research outputs 2022 to 2026

To examine, among people with type 2 diabetes (T2D), whether cardiovascular disease (CVD) phenotypes and cardiovascular medications are associated with any fracture as the primary outcome and major osteoporotic fracture (MOF) as a secondary outcome. Nationwide registry-based matched case–control study in Denmark (2013–2021) among people with T2D. Cases were individuals with T2D who sustained an incident fracture (n = 12,390), and controls were fracture-free individuals with T2D matched 1:3 by age, sex, T2D onset date, and weighted Charlson Comorbidity Index (n = 37,170). The exposures were overall CVD, prespecified clinical CVD phenotypes (acute myocardial infarction (AMI), stroke, heart failure, atrial …

Medication Management And Caregiving Stress Or Benefit In Children With Medical Complexity., Casey O'Hare, Nicole Werner, Makenzie Morgen, Sophie Kooiman, James Feinstein, Michelle A. Chui, Gemma Warner, Anna Jolliff, Brittany Storhoff, Kristan Sondegren, Danielle Gerber, Jens Eickhoff, Ryan J. Coller

Manuscripts, Articles, Book Chapters and Other Papers

This study quantified medication management experiences for children with medical complexity and associations with caregiver stress or benefit. Using data from the MedS@HOME trial, involvement of professional caregivers was associated with increased caregiver benefit, and greater network collective efficacy was associated with increased caregiver benefit and decreased caregiver stress.

TRIAL REGISTRATION: ClinicalTrials.gov, ID NCT05816590.

In-Hospital Mortality Patterns And Readmissions In Patients With Chronic Obstructive Pulmonary Disease: An Analysis Of The Role Of Pulmonary Hypertension, Saad Afzal Khan, Trishna Parikh, Adishwar Rao, Akriti Agrawal, Aarohi Parikh, Farah Kazzaz, Sarah Shin, Harry Karmouty-Quintana, Maulin Patel, Kha Dinh, Bela Patel, Bindu Akkanti

Faculty, Staff and Student Publications

Chronic obstructive pulmonary disease (COPD) may be complicated by pulmonary hypertension (PH). We aimed to understand the impact of PH on in-hospital mortality and quantify the 30-day readmission rate among patients with COPD. For this cross-sectional study, we used the Nationwide Readmissions Database from 2017-2020 to identify adults ≥18 years with COPD. Patients were stratified according to PH diagnosis. Baseline characteristics between groups were compared using the Pearson chi-square test and two-sample t-test. Predictors of in-hospital mortality were determined using multivariate logistic regression analysis adjusted for demographics and confounders. The 30-day readmission rate and prevalence of PH subgroups by baseline …

Mtorc2-Nav1.2 Signaling Drives Early Hyperexcitability In Alzheimer’S Disease Mouse Model, Nolan M Dvorak, Jeffrey L Noebels

Faculty, Staff and Students Publications

Hyperexcitability is a biomarker of early-stage Alzheimer’s Disease (AD) and hastens cognitive decline later in its course. Mechanistic target of rapamycin (mTOR) signaling contributes to the slope of this trajectory, as evidenced by early increased brain expression and the rescue of hyperexcitability by genetic deletion of mTOR complex 2 (mTORC2); however, a molecular mechanism directly linking mTOR signaling to membrane hyperexcitability in early-stage AD remains elusive. Here, we show that hyperactive mTOR signaling stimulates the voltage-gated Na+ channel 1.2 (Nav1.2), a previously identified downstream phosphorylation target of mTORC2 and a key regulator of membrane electrogenesis. Augmented Nav1.2 channel function induced …

Application Of Artificial Intelligence (Ai) In Cancer Symptom Management For Adult Cancer Survivors: A Scoping Review, Tao Wang, Haiying Wang, Mengyuan Li, Daniel Bressington, Daniel Terry, Guanjin Wang, Wai Hang Kwok, Jing Yu (Benjamin) Tan

Research outputs 2022 to 2026

Background and aim: Artificial Intelligence (AI) has been increasingly used in cancer survivorship to support symptom management. This scoping review aimed to map existing evidence on AI applications in cancer symptom management for adult cancer survivors, including AI model development, AI-enabled intervention delivery and adoption, symptom targets, key features of the AI approaches used, reported outcomes, influencing factors, and research gaps to inform future priorities.

Method: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Eight electronic databases were comprehensively searched in November 2025 and updated in March 2026. Empirical studies published in …

The Use Of Tens To Help Manage Post-Mastectomy Pain, Alyssa B. Carey, Amanda Giarratano, Verena Gorgi, Lauren Vera

Oncology Rehabilitation in Practice

Transcutaneous electrical nerve stimulation (TENS) has been demonstrated to be an effective non-pharmacological adjunct for postoperative pain management in thoracic surgeries. However, few studies have examined its benefits in managing post-mastectomy pain. This study found that TENS provided positive effects on postoperative pain control, which were associated with improved physical and psychological outcomes. Overall, TENS appears to be a safe and effective modality for managing acute postmastectomy pain.

Use Of Extracorporeal Membrane Oxygenation In Neonates With Congenital Anomalies Of The Kidney And Urinary Tract: A Multicenter Survey Of Current Practices Across Chnc And Pedi-Ecmo Centers., Syed Ahmed, Burhan Mahmood, John M. Daniel Iv, Sandy Johng, Amy Strong, John Ibrahim, June Hu, Kara Short, Kelsey Montgomery, Keri Drake, Kushal Bhakta, Leslie Lusk, Mary Revenis, Pratibha Thakkar, Ruth Seabrook, Samir Pandya, Sarah Keene, Sharada Gowda, Suma Hoffman, Tahagod Mohamed, Tara Beck, Tasnim Najaf, Robert Digeronimo, Natalie Rintoul, Abhishek Makkar

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT).

METHODS: General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy.

RESULTS: Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included …

Life Participation In Parents Of Children With Ckd., Anastasia Hughes, Andrea Matus Gonzalez, Anita Van Zwieten, Chandana Guha, Simon Carter, Germaine Wong, Dale Coghlan, Amanda Dominello, Jonathan C. Craig, Martin Howell, Siah Kim, Karine Manera, Colm O'Reilly, Javier Recabarren Silva, Angela Rejuso, Benedicte Sautenet, Nicole Scholes-Robertson, Amanda Sluiter, Rebecca Wu, Mignon Mcculloch, Natalia Armijo, Ximena Atilano-Carsi, Patricia De La Cerda, Gabriel Alexis Gallardo Letelier, Carla Galvez, Nicole Gonzalez-Agüero, Maria Maldonado, Viola Pinto, Lilian Reyes, Lena Rodriguez, Angelica Rojo, Alejandro Sepúlveda, Luca G. Torrisi, Andrea K. Viecelli, Bashir Admani, Bethany J. Foster, Alexander J. Hamilton, Augustina Jankauskiene, Rebecca J. Johnson, Jasmijn Kerklaan, Isaac Liu, Stephen D. Marks, Cozumel S. Pruette, Franz Schaefer, Sebastian Wolfenden, Allison Jaure, Song-Kids Life Participation Workshop Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The caregiver burden among parents of children with chronic kidney disease (CKD) is high and can impair their life participation, which may in turn have negative consequences on their children's care and outcomes. We aim to describe effects on life participation in parents of children with CKD, from the perspectives of their children, health professionals, and the parents themselves.

METHODS: We thematically analyzed data from the Standardized Outcomes in Nephrology-Children and Adolescents Initiative (SONG-Kids) life participation workshops involving children with childhood CKD, parents or caregivers, and health professionals, for content related to perspectives on life participation among parents of …

Eicosanoids As Biomarkers Of Hyperfiltration-Mediated Injury In Ckd., Tarak Srivastava, Ginger L. Milne, Jianping Zhou, Mohammad H. Rezaiekhaligh, Derek K. Ng, Jennifer L. Roem, Bradley A. Warady, Susan L. Furth, Ram Sharma, Mukut Sharma, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Early biomarkers of hyperfiltration-induced injury are not known. We previously reported elevated urinary prostaglandin E2 (PGE₂) preceding albuminuria in children with solitary kidney, and upregulated cyclooxygenase-2 (COX2)-PGE₂-EP2 axis in unilaterally nephrectomized mice. To determine chronic kidney disease (CKD) stage-associated changes in urinary eicosanoids, baseline urine samples from the CKD in children (CKiD) biorepository (n = 318) and a comparator group of children with enuresis (n = 72) were analyzed.

METHODS: Liquid or gas chromatography-mass spectrometry was used to measure metabolites of arachidonic acid and linoleic acid (ng/mg creatinine, P ≤ 0.05).

RESULTS: The …

Hyaluronic Acid Rectal Wall Infiltration And Reversal In Patients With Prostate Cancer Undergoing Radiation Therapy-A Case Series, Zakaria El Kouzi, Ramez Kouzy, Asif Aziz, Michael K Rooney, Stephen R Lee, Stephen E Mcrae, Ketan Y Shah, Mohamed E Abdelsalam, Ethan Y Lin, Comron Hassanzadeh, Seungtaek Choi, Quynh-Nhu Nguyen, Steven J Frank, Mohamed Shelan, Lauren L Mayo, Sean Mcguire, Steven Yevich, Osama Mohamad

Faculty, Staff and Students Publications

No abstract provided.

Glial Dysfunction And Memory Impairments In A Model Of Pediatric Obstructive Sleep Apnea, Michael R Williamson, Jorge Botas, Mahyar J Hedayatpour, Thea Zlatkov, Akdes Serin Harmanci, Christopher J Yates, Kenneth Nobleza, Roshan Ailani, Adam C Adler, Farrah Kheradmand, Hyun Kyoung Lee, Benjamin Deneen, Hyun-Hwan Jeong, Arvind Chandrakantan

Faculty, Staff and Students Publications

Pediatric obstructive sleep apnea (POSA) is a common childhood disease that often causes aberrant brain development and cognitive deficits. The pathophysiological underpinnings of cognitive impairments in POSA remain unclear. Here, we examined cellular and molecular aspects of pathology in a mouse model of POSA that features learning and memory deficits. We performed single-nucleus RNA-sequencing (snRNA-seq) of the hippocampus to examine gene expression changes in an unbiased and cell type-specific manner. This dataset revealed a striking perturbation of transcriptomes across all brain cell types, particularly within glia and neural stem cells. We validated reduced expression of several differentially expressed genes at …

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

Assessment Of Hypoglycemia Management In Acute Care Hospitals, Carley Warren, Christina Wing, Chenette Burks, Brooke Schmidt, Adam Hasse

HCA Healthcare Journal of Medicine

Background

Hypoglycemia is a common and potentially preventable complication among hospitalized patients, particularly those receiving insulin or other glucose-lowering therapies. Delayed recognition and inconsistent management can increase adverse outcomes. Although protocols exist, variability in treatment selection and timing may influence the likelihood of returning to normoglycemia. Understanding these patterns is critical to optimizing patient safety in acute care settings.

Methods

This retrospective review evaluated hypoglycemia management in adult inpatients across acute care hospitals within a large health system. Patients were included if they were aged 18 years or older, were hospitalized within the health system, and experienced a hypoglycemic event, …

Time To Antibiotic Administration In The Treatment Of Sepsis: A Retrospective Cohort Study, Dennis Anthony Cardriche, Grayson Carter, Thomas Matese

HCA Healthcare Journal of Medicine

Background

The 2026 Surviving Sepsis Campaign (SSC) guidelines recommend antimicrobial therapy within 1 hour for probable septic shock, while the Centers for Medicare and Medicaid Services (CMS) mandates a 3-hour window. Current literature presents conflicting evidence on whether these universal time thresholds yield a definitive survival benefit. This study aims to evaluate the real-world impact of delayed antibiotic administration on patient mortality and length of stay (LOS).

Methods

A retrospective cohort study was conducted analyzing 62 153 adult encounters with severe sepsis or septic shock at emergency departments (EDs) between December 31, 2023, and December 31, 2025. Time to first …

The Use Of Infra-Red Spectroscopy To Assess Intact Skin Of Various Skin Tones, Mary Lee A. Potter, Stacie Sosa, Charlott Polm, Sherry Campton, Wisam Salameh, Ronnie Klein, Yaniv Cohen

HCA Healthcare Journal of Medicine

Background

Pressure injuries (PI) continue to be a serious medical complication in the acute care setting. Industry leaders advocate for the use of objective technologies to provide accurate and quantifiable skin assessments for all patients across diverse skin tones. The Infra-Red Spectroscopy Scanner (IRSS) is a novel non-invasive decision support system (DSS) electro-optic technology that uses near infra-red spectroscopy to examine and assess physical and chemical changes prior to visual skin breakdown in real-time.

Methods

A 2-phase prospective open-label pilot device study was launched under protocol IRM-02-1123 (USA version 3.0, November 1, 2023). In both Phase 1 and Phase 2, …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

Time Is Brain: A Nurse-Informed Multicenter Analysis Of Hospital-Based Mechanical Thrombectomy Pathway Efficiency (Haste), Gina M. Remington, Gita Nadimpalli, Michael Rolli, Nicki Roderman, Rebecca Cain, Sarah Pieprzyca, Debra Philpot, Elizabeth Wiggins, Edward C. Jauch, Shanna Arnold-Egloff

HCA Healthcare Journal of Medicine

Background

Swift response and successful reperfusion are major determinants of outcome in acute ischemic stroke due to large vessel occlusion. Quality initiatives in stroke care have shown that organized, protocol-driven practice can shorten treatment times and improve safety-sensitive clinical outcomes, yet thrombectomy workflow variation persists across health systems, and few studies have translated workflow findings into operational recommendations.

Methods

This retrospective, multicenter study evaluated mechanical thrombectomy workflow performance across 16 facilities in a large United States health system from August 2020 through December 2021. Elastic net regularization was applied to patient-level characteristics to generate residual durations for door-to-imaging, door-to-puncture, imaging-to-puncture, …

A Nurse-Driven Escalation In Trauma Team Activation Reduces Mortality Of Injured Patients, Darrell L. Hunt, Yingxian Liu, Jordan S. Rahm, Bailey Segura, Mercedes Huens, Emily Lopez, Esther Krinsky, Joe Spinell, Andrea Palmer

HCA Healthcare Journal of Medicine

Background

There is a dearth of literature examining the clinical outcomes of injured patients who experience physiological deterioration in the emergency department (ED). At our trauma center, injured patients who develop hemodynamic, respiratory, or mental status instability after arrival are retriaged and upgraded to a full trauma team activation (fTA). The purpose of this study was to compare the clinical outcomes of patients with fTA based on prehospital signs and symptoms (initial) versus upgraded fTA patients.

Methods

This was a single-center, retrospective cohort study of injured patients presenting to a tertiary trauma center between June 1, 2022, and June 30, …

Making Diagnostic Uncertainty Visible At Intensive Care Unit Transitions: A Narrative Review Of Diagnostic Pause Strategies, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Diagnostic error is a significant patient safety issue in critical care. However, it is often difficult to detect during ongoing care. Patients in the Intensive Care Unit (ICU) often have incomplete histories, overlapping symptoms, changing physiology, and concurrent issues. During ICU transitions, patient diagnoses are often reported without clear information on diagnostic confidence, potential alternative diagnoses, pending results, or triggers needing review.

Methods

This clinical narrative review explored diagnostic uncertainty at ICU transitions, specifically those during ICU-to-ward transfers or unplanned escalations to the ICU. A targeted literature search identified studies of adult ICU diagnostic errors, ICU transition safety, ICU-PAUSE …