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Pharmacist-Led Initiative To Increase Naloxone Prescribing For Patients On High-Dose Opioids In A General Internal Medicine Clinic, Christine E. Leduc, Hyun J. Lee, Polly D. Fraga

The Lahey Journal

Abstract

Introduction:

Opioid overdose is a pressing public health concern in the United States. In 2022, prescription opioids were involved in 15% of all opioid deaths.1 Despite CDC recommendations for prescribing naloxone to high-risk patients, primary care physicians prescribe only 1.5 naloxone prescriptions per 100 prescriptions of high-dose opioids.2,3 Strategies are needed for healthcare institutions to expand naloxone access and mitigate opioid-related harm. This pilot study assesses the impact of a pharmacist-led quality improvement patient outreach initiative on increasing naloxone prescribing for adult patients taking ≥ 50 MME per day of prescription opioids as recommended by current CDC guidelines.

Methods: …

Cryptococcal Meningitis: A Retrospective Analysis Of Immunocompetent And Immunocompromised Cases, Daniel Kotas, Ho-Man Yeung

Journal of Community Hospital Internal Medicine Perspectives

Introduction. Cryptococcal meningitis (CM) primarily affects immunocompromised individuals, but up to 20% of cases occur in immunocompetent patients. However, there are limited clinical comparisons between immunocompromised and immunocompetent patients.

Methods. This is an IRB approved, single-centered retrospective chart review study. Patients aged >18 admitted between 2012 and 2022 with Cryptococcus neoformans meningitis were included. Demographic, associated conditions, clinical data, and clinical outcomes were obtained. Patients were categorized into immunocompromised and immunocompetent groups.

Results. 37 patients with CM were identified, with 32 (86.5%) immunocompromised patients and 5 (13.5%) immunocompetent patients. The median time to first lumbar puncture was …

Incidence And Risk Factors Of Pleural Effusion In Patients With Autoimmune Diseases: A Retrospective Cohort Study, Jacob Sutton, Marwah Muhammad, Muhammad Hashim Khan, Anastasia Slobodnick

Journal of Community Hospital Internal Medicine Perspectives

Background: Pleural effusion is a common manifestation of autoimmune and connective tissue disorders, but large-scale data on its incidence, risk factors, and outcomes are limited. This study aimed to assess the clinical characteristics, hospital course, and outcomes of patients with pleural effusion associated with autoimmune diseases compared to those without autoimmune conditions.

Methods: We conducted a single-center retrospective cohort study of adult patients admitted with pleural effusion. Patients were divided into two groups: those with autoimmune diseases (study group, n = 1,346) and those without autoimmune conditions (control group, n = 1,278). Data were extracted from electronic health records, and …

Analyzing Mortality Trends In A Uk Pediatric Critical Care Long-Stay Patient Cohort, Trishul Kothari, Nicola Kelly, Hari Krishnan Kanthimathinathan

Journal of Pediatric Intensive Care

Objectives: Long-stay patients in PICU are at-risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counselling and support. We aim to analyse the factors associated with higher mortality in the long-stay PICU patient cohort. Methods: Retrospective single centre study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a three-year study period (1st April 2017 to 31st March 2020). Outcomes analysed included in-PICU mortality, and mortality within 12 months of PICU discharge. Variables analysed for association …

Examining The Influence Of Cognitive Load And Self-Efficacy On The Development Of Clinical Reasoning In The First Clinical Education Experience Of First Year Physical Therapy Students, Andrew S. Bartlett, Brittney Gunterstockman

Internet Journal of Allied Health Sciences and Practice

Purpose: Clinical reasoning is critical for effective decision-making and patient outcomes in physical therapy. Although self-efficacy, cognitive load, and clinical reasoning have been studied individually, limited research has examined these constructs holistically. This study explored the influence of cognitive load and self-efficacy on the development of clinical reasoning during the first clinical education experience of first-year Doctor of Physical Therapy students using a think-aloud protocol. Methods: All participants completed measures of self-efficacy (New General Self-Efficacy [NGSE], Physical Therapist Self-Efficacy [PTSE]) and cognitive load (intrinsic, extraneous, germane) before and after their first clinical education experience. Think-aloud protocols were conducted at …

Practical Aspects Of Religious Social Work In Modern Ukraine, Inna Vladislavivna Kovalchuk

Occasional Papers on Religion in Eastern Europe

This work analyzes the current state and specifics of the activity of religious organizations in the social sphere of Ukraine. Special attention is paid to the transformation of religious social work in the conditions of a full-scale war, where religious communities have become key agents of humanitarian, psychological and spiritual assistance. The article examines the mechanisms of interaction between the church, the state and non-governmental organizations in solving social problems. The findings are based on the practical experiences of those working with internally displaced persons (IDPs), veterans, large families, and individuals facing difficult life circumstances. Unique methods of denominational assistance …

The End-Of-Life Option Most People Don’T Know About: Is It Legal?, Pamela Bucy Pierson

Idaho Law Review

This article is about an end-of-life option that many people have not heard of: Voluntary Stopping Eating and Drinking (VSED). With VSED, a person deliberately ceases intake of food and fluid to hasten their death. VSED is a peaceful, pain-free end-of-life option chosen by an increasing number of individuals in their last chapter of life who are suffering from chronic, incurable, progressively debilitating diseases. While there is considerable scholarship on the lawfulness of VSED, there is confusion in the existing literature on whether VSED is suicide, and on the related question whether individuals who provide comfort and care to VSED …

What Do We Do At The End Of A World?: Cultivating Emergent Leadership In A Time Of Collapse, Brent Godfrey

Journal of Legal Education

No abstract provided.

Knowledge Dilution And Tinted Pedagogical Dissemination: A Call For De-Colonizing Commercial Textbooks In Teacher Education For International Students, S. A. N. Zaidi, Cherian, F.V.

Journal of Comparative & International Higher Education

Abstract

This qualitative study examines how commercially produced textbooks mediate professor agency and shape the racialized and epistemic positioning of international students within a Canadian Teacher Education program. Situated within the internationalization of higher education, the study interrogates how textbook-driven curricular practices reproduce racial hierarchies, Eurocentric knowledge systems, and epistemic exclusion. The study responds to ongoing debates on race, racism, and racialization by examining how knowledge production and dissemination in classrooms may marginalize the lived experiences and intellectual contributions of international and racialized students. Data were collected through semi-structured interviews and document analysis in programs serving racialized and international students. …

In Memoriam: Claudette Colvin, Luke Hunter

History in the Making

No abstract provided.

Assessing And Addressing Financial Risk In Capitated Primary Care Contracts, Michael R. Wieck Dba, Laurence Smith, Steven R. Stout Dba

Engaged Management ReView

We employ multivariate statistical modeling and Monte Carlo simulation to study systematic and unsystematic financial risk faced by physician groups under capitated contracts with Medicare Advantage Organizations (MAOs). We use mixed methods and a standard reimbursement formula for risk-sharing contracts with primary care physicians (PCPs). We find that diversifying risk simply by increasing the size of a practice is insufficient to mitigate risks of large negative cash flows from capitation contracts and can result in financial failure. However, if use of costly medical services by patients is reduced from levels typically experienced under traditional Medicare to the levels of patients …

Strategies For Integrating Death Education Into Asynchronous Online Counselor Training, Kara E. Wolff

Journal of Technology in Counselor Education and Supervision

Online counselor education has grown exponentially, with a greater number of courses being offered in an asynchronous format. This presents challenges and opportunities for counseling training in death education, a subset of grief counseling. Death anxiety and death avoidance can result in counselors-in-training's disengagement with strictly didactic materials in this area. Instead, death education must offer opportunities for experiential processing and personal reflection to be effective. Specific teaching strategies that foster the development of death acceptance and death competence within asynchronous online counselor education courses are offered.

Integrating Oncology Into Entry-Level Physical Therapist Curricula, Shana Harrington, Christopher M. Wilson, Morgan Zaranec, Lori Boright

Oncology Rehabilitation in Practice

Print issue available for $25.

Background: Cancer and its treatments commonly result in adverse effects that impair function, well-being, and quality of life, necessitating access to skilled physical therapists (PTs). Although oncology is an essential component of physical therapist practice, entry-level education in cancer rehabilitation has historically been limited. In 2025, the Essential Competencies for Physical Therapy Entry-Level Education in Oncology were developed through a mixed-methods, modified Delphi process, establishing 19 competencies across six domains and defining minimum expectations for new graduates. To support translation of these competencies into academic curricula, a practical implementation resource was needed.

Purpose: To …

Supportive And Palliative Care: Addressing The Unspoken Burden Of Cancer On Significant Others, Esmeraldo C. De Las Armas Iv

Jurnal Keperawatan Indonesia

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges …

Jerusalem, City Of David Visitor Center: The Early Islamic, Medieval And Late Ottoman Pottery, Benjamin J. Dolinka

Qadum: Journal of Excavation Reports from Israel

The excavation at the entrance to the Visitor Center in the City of David uncovered a small but significant assemblage of ceramics, all from stratified contexts, including bowls, basins, storage jars, jugs, a cooking pot and a clay tobacco pipe. The pottery dates from the Abbasid period (ninth–tenth centuries CE), the medieval period (mid-twelfth–late fourteenth centuries CE) and the late Ottoman period (mid- to late nineteenth century CE). The ceramic evidence from the excavation provides important insights into the occupational history of the site during these periods.

Rare Presentation Of Sequential Mucosa-Associated Lymphoid Tissue Lymphoma, Follicular Lymphoma, And Chronic Lymphocytic Leukemia: A Case-Based Review, Khushi J. Desai, Ansy H. Patel, Patrick T. O’Dowd, Joseph A. Tworek, Preeti G. Misra, Li Ding

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Occurrence of 2 (or more) Hodgkin's and non-Hodgkin's lymphoma concordantly or sequentially in a single patient is very rare.

Case: An 88-year-old Italian male with a history of mucosa-associated lymphoid tissue (MALT) lymphoma in remission and indolent follicular lymphoma under surveillance, presented with acute autoimmune hemolytic anemia (AIHA). While initially speculated to be secondary to follicular lymphoma relapse, stable mesenteric lymphadenopathy compared to prior CT abdomen/pelvis and smudge cells on peripheral smear prompted further evaluation. Peripheral blood flow cytometry indicated a mature B-cell neoplasm, which was confirmed to be chronic lymphocytic leukemia (CLL) with a bone marrow biopsy. Minimal …

Corynebacterium Bacteremia In A High-Risk Host: A Diagnostic Dilemma Of Contamination Versus True Infective Endocarditis, Arman Manjikian, Christopher Aboujaoude, Nicole Rock, Don Pepito

Journal of Community Hospital Internal Medicine Perspectives

Corynebacterium species are often regarded as skin contaminants when isolated from clinical cultures. However, in select high-risk patients, these organisms can lead to significant infections, including infective endocarditis. We present the case of a 76-year-old woman with multiple comorbidities, including end stage renal disease (ESRD) on hemodialysis and an exposed tunneled central catheter, who developed Corynebacterium-associated native mitral valve endocarditis requiring surgical intervention. Despite prompt antimicrobial therapy and bioprosthetic valve replacement, her hospital course was complicated by heart block, empyema, and eventual cardiac arrest. This case highlights the importance of recognizing Corynebacterium as a potential pathogen in vulnerable patients …

Severe Multisystem Toxicity From Combination Ipilimumab And Nivolumab In Metastatic Melanoma: A Case Report, Bushra Amer, Sheetal Manerkar

Journal of Community Hospital Internal Medicine Perspectives

Immune checkpoint inhibitors (ICIs) have transformed cancer therapy by enhancing antitumor immunity. Despite their remarkable efficacy in malignancies, particularly metastatic melanomas, the use of ICIs have been linked to life-threatening immune-related adverse events (irAEs) affecting several organ systems. Combination therapy with ipilimumab and nivolumab increases both efficacy and the risk of severe irAEs. We report a rare case of metastatic melanoma treated with combination ipilimumab and nivolumab, complicated by multisystem irAEs. The patient developed hepatitis, cholangitis, ocular toxicity, and neurologic progression, highlighting the severity and complexity of immune-mediated toxicities following dual checkpoint blockade. This case underscores the potential for severe, …

The Data Broker Loophole: Medicare’S Version, Ana Wacker

Washington Journal of Law, Technology & Arts

U.S. consumers participate in the exchange of less data privacy for the benefit of cheaper pricing, innovative services, and the illusion of choice. However, consumer choice at the expense of minimal data privacy has encouraged data broker markets to thrive on pure profit incentives. Seniors participating in Medicare enrollment feel the impact of these profit motives acutely. The Medicare enrollment process is littered with Third Party Marketing Organizations (TPMOs) who use lead generators to target seniors. With no consent, lead generators target Medicare eligible individuals and forward their personal information to insurance agents for a fee. The lead generators operate …

Occupational Therapists’ Emerging Role In Running Bereavement Support Groups, Diana Daus, Rondalyn V. Whitney, Susan Taddonio

The Open Journal of Occupational Therapy

Grief is well recognized as a stress response and, as such, significantly impacts engagement in meaningful occupational performance and engagement in meaningful occupations. Prolonged grief disorder (PGD), a newly recognized diagnosis, reflects the public health risk for the bereaved. Multiple client factors and performance patterns of those experiencing grief disrupt multiple areas of occupation. This opinion paper evaluates occupational therapy’s role in bereavement groups in the occupational therapy scope of practice.

The Emotional Labor Of Clinicians And The Need For Reflective Support, Benedicta Olonilua, Bs, Evan Nardone, Md

The Medicine Forum

Physicians who work in Palliative Care or adjacent fields like Oncology often bear a unique emotional weight in addition to the typical responsibilities that come with the job. The nature of their work puts them in frequent contact with serious illness, dying, and grief. Additionally, they are often required to engage in conversations that are not only medically complex but also deeply personal and, at times, emotionally charged. While this emotional labor is an inherent part of the job, it can become especially heavy when there is no space to process it. Over time, this can build up and eventually …

The Intersection Of Ventilator Support And Hospice In Late Als Diagnosis, J. Marco Cipriaso, Md, Kenna Hawes, Md, Margot Noyelle, Md, Megan Cecchine, Md

The Medicine Forum

Amyotrophic lateral sclerosis (ALS) often leads to respiratory failure that can be treated with respiratory support in the form of tracheostomy plus invasive mechanical ventilation. It typically occurs late in the disease course, often allowing patients to adequately prepare by discussing their goals of care. We describe a case of a patient whose ALS was diagnosed after he had TMV initiated. As a result, the patient and family faced a daily decision on when to withdraw ventilator support, and he was unable to achieve his ultimate wish to die at home. We highlight this to recognize that serious illnesses with …

Lvad Patient With Delayed Family Involvement Due To Incarceration, J. Marco Cipriaso, Md, Kathleen Mechler, Md

The Medicine Forum

Left ventricular assist device (LVAD) placement requires an extensive support system for success. Patients who are incarcerated face unique challenges in achieving this due to prison rules. We describe a case in which an LVAD patient suffered a massive intracranial hemorrhage, leaving him unable to make his own decisions. Medical teams did not involve his family in admissions for his slow chronic decline, but family were asked to make decisions for him at this acute change causing them significant distress. We advocate that families of incarcerated patients be more routinely involved in provider communications and education related to their chronic …

Table Of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum: Volume 27

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 27, 2025-2026

TABLE OF CONTENTS

• Case Reports
• Letter to the Editor
• Research Studies
• Humanities & Reflections

A Qualitative Study Of Key “Regulatory” Factors Influencing Patient Access To Medical Assistance In Dying In Canada, Ruthie Jeanneret, Eliana Close, Jocelyn Downie, Ben P. White

Dalhousie Law Journal

Medical assistance in dying (“MAiD”) was legalized federally in Canada after the landmark case, Carter v Canada (AG), 2015 SCC 5. Bill C-14 introduced a federal legislative framework for MAiD in 2016, which was amended by Bill C-7 in 2021. Some Bill C-7 amendments directly responded to the decision in Truchon c Canada (PG), 2019 QCCS 3792. Other amendments responded to several factors identified as barriers to patient access, including the requirement for two independent witnesses, the 10-day reflection period, and the requirement to provide final consent at the time of administration of MAiD medication. However, emerging literature identifies that …

Incidence Of Post-Ercp Pancreatitis Among Solid-Organ Transplant Recipients: A Retrospective Cohort Study, Josh Warner

Graduate Medical Education Research Journal

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Rising Enzymes: The Hepatic Fallout Of Refeeding Syndrome, Emma Sheridan

Graduate Medical Education Research Journal

NA

Saag Calculation Inconsistent With Cause Of Ascites: A Case Report, Sammy Woller

Graduate Medical Education Research Journal

NA

Colorectal Cancer Risk In Microscopic Colitis And Eosinophilic Colitis: A Retrospective Analysis, Emma Sheridan

Graduate Medical Education Research Journal

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