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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 …

Beyond Bed Numbers: A Proposed Quality Improvement Framework For Reviewing Icu Acuity, Workload, And Medical Staffing, Raha West, Ahmed Elhaddad, Behrad Baharlo, Parind Patel

HCA Healthcare Journal of Medicine

Background

Intensive care unit (ICU) medical staffing is often planned using bed numbers or fixed ratios. These counts do not describe the work required when patients deteriorate, urgent tasks overlap, or clinicians have duties outside the unit. A structured review could help teams discuss whether available cover can meet these demands.

Methods

We undertook a targeted narrative synthesis of adult ICU staffing guidance, acuity and workload measures, physician workload studies, and capacity-strain research available through 8 September 2026. We examined study settings, findings, and limitations to inform the framework domains. The authors proposed the review prompts and response options. No …

Brief, Handoff, Backbrief, Forecast, Review: A Communication Cycle For Safer Trauma And Surgical Intensive Care Unit Transitions, Constantine Stephens, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Safety in trauma and surgical critical care is inseparable from the reliability of communication at transitions of care. Handoffs are recurrent, high-risk moments in which teams transfer not only information but responsibility, prioritization, uncertainty, and contingency planning; failures at these points propagate into omissions, delayed escalation, and preventable harm to patients and strain on the workforce. Structured handoff tools improve completeness and clarity but inconsistently change hard clinical endpoints, and tools alone do not create the culture of safety on which high-reliability organizations (HROs) depend. This narrative review synthesizes civilian handoff research, human-factors and HRO theory, situation-awareness, psychological safety, trauma …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

Development And Implementation Of A Scholarly Curriculum For Internal Medicine Residents And Subspecialty Fellows, Yuri Matusov, Hawas Kaderi, Liza Raffi, Louie Cao, Jacqueline Lee, Mariko Ishimori, Odelia Cooper

Graduate Medical Education Research Journal

Background. To create and assess the efficacy of a standardized curriculum for trainees in the core competency of critical appraisal of medical literature.

Methods. We implemented a 10-hour scholarly lecture curriculum, in 1-hour blocks, over 1 academic year for postgraduate trainees in internal medicine (IM) and IM subspecialties at a single major academic medical center. The aims of the curriculum were to increase trainee comfort with clinical research methodology, to place this methodology in the context of historical and current ethical challenges, to provide trainees with guidance on how to conduct clinical research at the institutional level, and to provide …

Asteroid Hyalosis Mimicking Vitreous Hemorrhage On Point-Of-Care Ultrasound Following Blunt Ocular Trauma: A Case Report, Obiaara Ukah, Jared Marx

Graduate Medical Education Research Journal

Background. Ocular complaints account for approximately 1.5% of emergency department (ED) visits, and point-of-care ultrasound (POCUS) is a valuable tool for evaluating posterior chamber pathology, including vitreous hemorrhage (VH), retinal detachment, and vitreous detachment. However, benign conditions may mimic these pathologies and create diagnostic uncertainty. We describe a case of asteroid hyalosis (AH), a benign vitreous condition that was initially mistaken for vitreous hemorrhage on ocular POCUS following blunt ocular trauma. This case highlights an uncommon sonographic mimic of VH and contributes to the emergency medicine literature by emphasizing ultrasound features that may help distinguish AH from true posterior chamber …

Emergent Endovascular Therapy For Malignant Superior Vena Cava Syndrome Complicated By Extensive Central Venous Thrombosis: A Case Report, Austin Johnson, Andrew Mezher, Ehab Saad Aldin, Lei Yu

Graduate Medical Education Research Journal

Background. Superior vena cava (SVC) syndrome is a potentially life-threatening condition caused by obstruction of venous return through the SVC, most commonly due to malignancy. Although endovascular therapy (ET) has emerged as an effective treatment for rapid symptom relief, malignant SVC syndrome complicated by extensive central venous thrombosis and respiratory failure remains a high-acuity presentation requiring urgent intervention. This case highlights the role of emergent ET as a life-saving bridge to definitive oncologic treatment in critically ill patients.

Case. A 58-year-old male with squamous cell carcinoma of the lung presented with acute respiratory failure, facial and upper extremity swelling, and …

Iatrogenic Popliteus Tendon Injury During Total Knee Arthroplasty, Saswat Samant, Bibhudutta Sahoo, Saurav Narayan Nanda, Suman Mishra, Satya Ranjan Patra, Himanshu Mishra

Graduate Medical Education Research Journal

Background. The popliteus tendon (PT) plays a role in knee unlocking and posterolateral stability, yet the clinical impact of its iatrogenic injury during total knee replacement (TKR) remains poorly defined. This study aimed to evaluate the outcomes of patients with documented intraoperative PT injury during posterior-stabilised TKR.

Methods. A retrospective review was conducted on 111 varus knees undergoing posterior-stabilised TKR. Among these, seven cases (6.3%) of intraoperative PT injury were identified. The cohort had a mean age of 71 years and an average preoperative varus deformity of 14°. PT repair was performed in two of the seven injured cases.

Results. …

Systemic Treatment Considerations For Psoriasis In Alpha-Gal Syndrome: A Case Report And Ingredient Review, Emily Saurborn, Ian Depew, Madelyn Ross, Mckenzie Lambiotte, Shane Cook

Marshall Journal of Medicine

Background: Psoriasis is a chronic skin condition characterized by an overactive immune system, leading to increased keratinocyte proliferation and angiogenesis. Treatment ranges from topical solutions to systemic therapy and lastly, biologics. However, the latter options are typically manufactured with mammalian-derived ingredients. Alpha-gal syndrome (AGS) is an acquired IgE-mediated hypersensitivity reaction to galactose-alpha-1,3-galactose, an enzyme required for digesting carbohydrates in mammalian products. In addition to dietary avoidance of mammalian products, patients with AGS may need to avoid certain medications due to their formulations.

Case Presentation: We present a case of a 53-year-old female with a severe alpha-gal allergy evaluated in the …

Association Between Echocardiographic Epicardial Adipose Tissue Thickness And Atrial Fibrillation In A Single-Centre Pakistani Cohort, Ateeb Mahmood Khan, Fateh Ali Tipoo Sultan, Aiman Sultan, Adeel Khoja

Journal of the Saudi Heart Association

Objectives: To assess the association between echocardiographic epicardial adipose tissue (EAT) thickness and atrial fibrillation (AF) in a single-centre Pakistani cohort of patients referred for transthoracic echocardiography (TTE).

Methods: Patients referred for TTE at Aga Khan University Hospital (AKUH), Karachi, were prospectively enrolled over a six-month period (1 September 2024 – 28 February 2025) using a convenience sampling approach; nearly all patients referred for TTE with AF during this period were captured, while patients in sinus rhythm were enrolled by convenience sampling alongside them, in order to ensure an adequate number of AF cases for comparison. EAT was measured in …

Cardiac Marker Levels In Patients With Sickle Cell Disease During Emergency Room Visits: A Retrospective Study, Adel F. Al-Marzouki, Osman Radhwi, Nadine Alharbi, Sondos Jar, Weam Bajunaid, Abdulaziz Alzahrani, Majed Alhuzali, Sultan Aljuaid, Naif Abdulaziz Meighrbl

Journal of the Saudi Heart Association

Background: Millions of people worldwide suffer from a genetic hemoglobinopathy known as sickle cell disease (SCD). It is a long-term condition marked by progressive multiorgan failure. Among SCD patients, cardiovascular complications are the main leading cause of death. Cardiovascular complications raise cardiac markers levels as well as sickle cell vaso-occlusive crisis (VOC). This makes it challenging to determine the source. This research aims to identify the association between cardiac markers and myocardial infarction in SCD patients at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.

Material and Method: This retrospective study was conducted from June 2022 to March 2023. …

Recognizing Coronary Artery Disease In Women, Krista Ohmie Pa-C, Cck, Aacc

Lynchburg Journal of Medical Science

The purpose of this review is to identify sex-specific factors in the prevention, diagnosis, and treatment of cardiovascular disease in women as it continues to be the number one cause of their mortality. A search of the literature was conducted using PubMed as well as resources from the American College of Cardiology and the American Heart Association with multiple articles identified for use. The risk of cardiovascular disease in women is affected by traditional risk factors such as hypertension and diabetes, but is compounded by length of estrogen exposure, pregnancy, and higher rates of systemic inflammation. Systemic barriers such as …

Life After Ecmo: A Comprehensive Review Of Longterm Complications, Mia Olson Pa-C

Lynchburg Journal of Medical Science

Extracorporeal life support is the ability to temporarily supplement pulmonary and/or cardiac function in the setting of severe organ failure, with the most widely used version of this technology being extracorporeal membrane oxygenation (ECMO). While ECMO acutely improves outcomes in many patients with acute cardiopulmonary failure, evidence shows that survivors are at risk for long-term complications. These may include physical limitations, neurocognitive impairment, and psychological distress, all of which cumulate to impact a patient’s quality of life. The purpose of this research paper is to examine the literature on long-term complications associated with ECMO therapy and their impact on patient …

Continuity Beyond Delivery: A Family Medicine Approach To Racial And Ethnic Equity In Postpartum Care, Dominique J. Tarrant

Lynchburg Journal of Medical Science

This narrative review examines interventions to improve postpartum care continuity, reduce disparities, and advance maternal health equity, emphasizing structured follow-up, care coordination, and family medicine integration. The postpartum period, often called the “fourth trimester,” should connect recovery with lifelong health. However, many women, particularly those from racially and ethnically minoritized populations, encounter missed screenings, inadequate support, and structural barriers that increase their risk of adverse maternal outcomes. Electronic searches of PubMed and Google Scholar were conducted from October 27 through November 7, 2025, using combinations of “postpartum care,” “family medicine integration,” “racial and ethnic disparities,” “health equity,” and “fourth trimester.” …

Multimodal Analgesia For Postoperative Pain Management In Total Shoulder Arthroplasty, Caroline Heramb

Lynchburg Journal of Medical Science

Total shoulder arthroplasty (TSA) is an increasingly common orthopedic procedure, yet postoperative pain management continues to rely heavily on opioid analgesics. Although multimodal analgesia (MMA) has become the standard of care in total hip and knee arthroplasty, consensus regarding the optimal multimodal approach for TSA remains limited. A comprehensive literature search was conducted using PubMed, CINAHL, the Cochrane Library, and Google Scholar. Following screening with inclusion and exclusion criteria, 42 articles were selected for review and synthesized. Current evidence supports MMA pathways incorporating regional anesthesia, non-opioid pharmacologic agents, perioperative corticosteroids, cryotherapy, and patient education to reduce postoperative opioid requirements without …

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Microbiome-Modulating Dietary Interventions For The Treatment Of Insulin Resistance In Polyendocrine Metabolic Ovarian Syndrome (Pmos), Ashley Davis

Lynchburg Journal of Medical Science

No abstract provided.

Primary Treatment Of Congenital Aortic Stenosis In Infants: A Comparative Analysis Of Balloon Aortic Valvuloplasty And Surgical Aortic Commissurotomy, Kayumov Arabbek Ravshanovich, Sinelnikov Yuriy Semenovich, Amansakhatova Ekaterina Nazarovna, Nalimov Konstantin Aleksandrovich, Roseykin Evgeniy Vladimirovich, Manukian Serezha Nersesovich, Soynov Ilya Aleksandrovich

Journal of the Saudi Heart Association

Objective

To compare the efficacy and safety of balloon aortic valvuloplasty (BAV) and surgical aortic commissurotomy (SAC) as primary treatment strategies for congenital aortic stenosis in infants during the first year of life.

Methods

This retrospective two-center cohort study included 89 infants with congenital aortic stenosis treated between April 2015 and June 2025 at two tertiary centers. Patients were divided according to the initial intervention: BAV (n = 39) and SAC (n = 50). The primary endpoint was any repeat intervention on the aortic valve. Secondary endpoints included hospital and late mortality, recurrent hemodynamically significant aortic stenosis, and clinically significant …

Continuous Pacing During Lbbap With A Lumenless Lead: A Simplified, Zero-Cost Sliding-Contact Technique, Leonardo Marinaccio

Journal of the Saudi Heart Association

Left bundle branch pacing with lumenless leads usually requires disconnecting pacing cables during rotation, creating an electrical blind spot during septal advancement. We describe the "sliding-contact" technique, a zero-cost modification enabling continuous real-time monitoring. Retracting the rubber shroud of a standard sterile alligator pacing clip reduces jaw tension, allowing unrestricted lead pin rotation while preserving electrical continuity. In 42 consecutive cases, LBBAP was successfully performed without complications. Beat-to-beat feedback on QRS morphology, impedance, and injury current was maintained throughout rotation, improving procedural precision and safety without specialized equipment.

Inferior Vena Cava–Left Atrial Connection Hidden Beneath Large Secundum Defect. A Case Report, Alisia Yuana Putri, Muhammad Surya Tiyantara

Journal of the Saudi Heart Association

Inferior vena cava (IVC) drainage into left atrium is an exceptionally rare congenital anomaly and may remain unrecognized when associated with a large atrial septal defect (ASD). A 35-year-old-man presented with progressive exertional dyspnea and fatigue. Transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization demonstrated a large secundum ASD with severe septal malalignment, while systemic venous drainage was interpreted as normal. During surgical ASD repair, an unexpected IVC-to-left atrium connection was identified and redirected to right atrium. Careful assessment of IVC inflow is essential in patients with large malaligned ASD despite normal oxygen saturation.

The Potential Relationship Between Red Complex Tannerella Forsythia And Obstructive Sleep Apnea, Abby Dibble Ms, Kristi M. Soileau

New Orleans Dental Association News

The pathogenesis of periodontitis is no longer attributed to a single infectious organism but rather to a dysbiosis-affiliated microbial community that disrupts host immune response. Within this polymicrobial ecosystem, Tannerella forsythia has emerged as one of the principal periodontal pathogens because of its ability to evade host defenses, promote tissue destruction, and establish cooperative interactions with neighboring microorganisms. As a Gram-negative, obligate anaerobic bacterium belonging to the red complex group, T. forsythia is consistently associated with advanced periodontal disease and is increasingly recognized as an important contributor to both local periodontal destruction and systemic inflammation. A 2024 meta-analysis of ten …

Practical Implementation Of An Osteoarthritis Treatment Program In A Radiation Oncology Center Within Md Anderson’S Cancer Network, Aaron Shaykevich, Adam Grippin, Warren Floyd, Brady Cripe, Alexander Augustyn, Shalin Shah, Samantha Buszek

Advances in Cancer Education and Quality Improvement

Background: Low-dose radiation therapy (LDRT) for symptomatic osteoarthritis (OA) can add to the workload of radiation oncology services, particularly in small centers with limited capacity and staff. After we launched an OA LDRT program in December 2024, referrals grew rapidly at our rural, single-linac radiation oncology practice at UT MD Anderson’s Cancer Network Partner site (Community Health Network in Indianapolis, IN), leading to long wait times and workflow strain.

Methods: We used load leveling to reserve capacity for cancer care and make OA scheduling predictable. Five 15-minute benign consult slots were set aside each week. Patients then went on a …

Progressive Remodeling Of Global Protein Interaction Networks In A Mouse Model Of Tauopathy, Weiwei Lin, Sadhna Phanse, Sophie J F Van Der Spek, Noah Lampl, Morgan C Stephens, Zihan Wang, Joseph T Nigro, Alejandro Rondon Ortiz, Ryan Hekman, Anna Lourdes F Cruz, Rebecca Roberts, Lulu Jiang, Juan Botas, Andrew Emili, Benjamin Wolozin

Faculty, Staff and Students Publications

Neurodegenerative disease is marked not just by loss of proteins or cells, but by dynamic rewiring of macromolecular interaction networks that precede and drive pathology. Here, we present a temporally resolved, systems-scale map of multi-protein complex remodeling in a tauopathy model, integrating co-fractionation mass spectrometry, quantitative phosphoproteomics, and machine learning to decode phosphorylation-dependent shifts in protein interactomes across disease progression. This interactomic atlas serves as a resource to investigate functional assemblies, including MAPT-Dpysl2 and Cyfip1-actin, as well as ptk2b-Kars/Dars and ptk2b-Msn-Farsb-complexes, that modulate early disease phenotypes in vivo. Notably, it captures the composition, dynamics, and regulatory state of protein complexes …

Progressive Remodeling Of Global Protein Interaction Networks In A Mouse Model Of Tauopathy, Weiwei Lin, Sadhna Phanse, Sophie J F Van Der Spek, Noah Lampl, Morgan C Stephens, Zihan Wang, Joseph T Nigro, Alejandro Rondon Ortiz, Ryan Hekman, Anna Lourdes F Cruz, Rebecca Roberts, Lulu Jiang, Juan Botas, Andrew Emili, Benjamin Wolozin

Faculty, Staff and Students Publications

Neurodegenerative disease is marked not just by loss of proteins or cells, but by dynamic rewiring of macromolecular interaction networks that precede and drive pathology. Here, we present a temporally resolved, systems-scale map of multi-protein complex remodeling in a tauopathy model, integrating co-fractionation mass spectrometry, quantitative phosphoproteomics, and machine learning to decode phosphorylation-dependent shifts in protein interactomes across disease progression. This interactomic atlas serves as a resource to investigate functional assemblies, including MAPT-Dpysl2 and Cyfip1-actin, as well as ptk2b-Kars/Dars and ptk2b-Msn-Farsb-complexes, that modulate early disease phenotypes in vivo. Notably, it captures the composition, dynamics, and regulatory state of protein complexes …

Flow In Sport Performance: A Systematic Review Of Psychological Mechanisms And Conceptual Gaps, Nanda Farah Muftia, Heny Setyawati, Donny Wira Yudha Kusuma, Churia Dina Rahmatin, Dewi Ayu Kusumaningtyas, Siti Baitul Mukarromah, Adi S

Indonesian Journal of Research in Physical Education, Sport, and Health

Background: Athletic performance is a psychologically complex process, with “flow” recognized as central to optimal performance. However, its emergence is often treated as automatic and lacks sufficient explanation through broader psychological mechanisms. Objective: This study synthesizes recent literature on flow in sport performance, emphasizing psychological mechanisms, situational determinants, and conceptual gaps. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Eight peer-reviewed, English-language articles (published 2022-2026) retrieved exclusively from the Scopus database met the inclusion criteria and were analyzed using thematic synthesis. Result: Flow is a dynamic psychological process, not a static state. Supporting optimal athletic performance through enhanced …

The Commercialization Of Wellness: Gray Market Peptides & Cancer, Bryan M. Burt

Advances in Cancer Education and Quality Improvement

No abstract provided.

From Burnout To Belonging: A Faculty Well-Being Director's Perspective On Leadership, Workplace Culture, Organizational Efficiency, And The Broader Role Of Physician Well-Being, Ajit K. Bisen

Advances in Cancer Education and Quality Improvement

Burnout remains a major challenge in health care, despite increasing investments in physician well-being initiatives. As the faculty well-being director for my department, my perspective on physician well-being has shifted from focusing primarily on individual resilience, mindfulness, and wellness initiatives to recognizing the important roles of leadership, workplace culture, and organizational efficiency. Physician well-being is an essential foundation for high-quality patient care, stronger teams, patient safety, quality improvement, and healthier organizations. Here, I discuss the 3 key shifts in thinking that have influenced my approach as faculty well-being director.

Life After Death, Mridula Nadamuni

Advances in Cancer Education and Quality Improvement

This poem explores the reflections of a physician following a poignant interaction with a patient, as each confronts the reality that time on Earth is limited.

Towards Upstate Well Center: Lessons Learned In Organizational Well-Being Over The Last Decade, Nayla M. Khoury, Asalim Thabet, Kerryanna M. Elhage, Jarrod L. Bagatell, Kaushal Nanavati, Leslie J. Kohman

Advances in Cancer Education and Quality Improvement

Background: Upstate Well has evolved over more than 10 years through the integration of multiple partners, programs, and initiatives. The scope and complexity have increased alongside stronger relationships, shared ownership, and supportive infrastructure.

Methods: This report analyzes implementation lessons learned through program development and impact assessment over 5 years.

Results: Upstate has a growing number of wellness champions across the institution, collaboration among multiple wellness programs, and lessons learned from select programs. Themes include (1) supportive infrastructure, including new full-time equivalent positions to support Upstate Well; (2) active collaboration between stakeholders, and appointed wellness champions in each department; (3) improved …

From Career Alignment To Action: Strengthening Academic Mentoring Through Structured Reflection, Fanni Farago, Julie Izzo, Courtney L. Holladay, Diane C. Bodurka, Michelle Hildebrandt, Suezen Salinas

Advances in Cancer Education and Quality Improvement

Background: As faculty roles and responsibilities become increasingly complex and demanding in contemporary academic medicine, fostering and sustaining faculty well-being has emerged as a critical organizational priority. In response to this need, this brief report describes early insights from the first year of implementation of the Academic Mentoring Program (AMP), a formal and expanding faculty mentoring initiative at UT MD Anderson. Our findings highlight the potential value of incorporating a structured career development assessment (CDA) tool into the mentee intake and engagement effort, evaluating development alignment, professional activities, and organizational expectations.

Methods: We conducted descriptive statistical analysis and qualitative thematic …