Medical Specialties Commons^™

Introducing The University Of New Mexico 12-Level Functional Scale: A Novel Approach For Assessing Functional Recovery In Orthopaedic Trauma Patients, Devin A. Maez, Rick J. Gehlert, Thomas A. Decoster

Western Journal of Orthopaedics

The University of California at Los Angeles (UCLA) Activity Scale and other common activity scales are primarily used for patients undergoing joint reconstructive surgery. However, no such scale exists for musculoskeletal trauma patients. The authors propose The University of New Mexico (UNM) 12-Level Functional Activity Scale to address this gap in assessing functional activity and managing postoperative care for orthopaedic trauma patients. A comprehensive review of existing scales led to the development of the UNM Scale, emphasizing simplicity, objectivity, and potential benefits in patient education and interdisciplinary collaboration. The UNM Scale provides a structured approach to assess and monitor functional …

Fluoroscopy-Guided Versus 3d Navigated Percutaneous Sacroiliac Screw Fixation: A Comparison Of Radiation Exposure And Surgical Duration, Tyler J. Chavez, Jeremiah M. Langsfeld, Solomon Oloyede, Gordon H. Lee, Urvij Modhia

Western Journal of Orthopaedics

Background: Pelvic ring injuries are complex surgical challenges requiring significant radiation exposure for safe placement of sacroiliac (SI) screw fixation. Traditionally, SI fixation has been performed with conventional C-arm fluoroscopy to guide screw placement. 3D navigated imaging is a technique that uses fluoroscopic scans and a navigation tracker to guide screws in space. The purpose of this study is to characterize a single institution’s experience with navigated SI fixation and the resulting radiation exposure to patient and staff. Methods: Records of 60 patients who underwent SI fixation using either conventional fluoroscopy (43) or 3D navigation (17) were reviewed. Exposure data …

Fishtail Deformity Complication Of Distal Humeral Fractures In Children, Jorge E. Licano, Ryan Price, Devin A. Maez, Selina A. Silva

Western Journal of Orthopaedics

Background: Pelvic ring injuries are complex surgical challenges requiring significant radiation exposure for safe placement of sacroiliac (SI) screw fixation. Traditionally, SI fixation has been performed with conventional C-arm fluoroscopy to guide screw placement. 3D navigated imaging is a technique that uses fluoroscopic scans and a navigation tracker to guide screws in space. The purpose of this study is to characterize a single institution’s experience with navigated SI fixation and the resulting radiation exposure to patient and staff. Methods: Records of 60 patients who underwent SI fixation using either conventional fluoroscopy (43) or 3D navigation (17) were reviewed. Exposure data …

Rare Case Of Fungal Osteomyelitis Affecting An Intramedullary Lag Screw, Matthew C. Watterson, Robert T. Rella, Timothy K. Summers, David Michaeli, Jess Mullens

Western Journal of Orthopaedics

Osteomyelitis is an infection of the bone that is most commonly of bacterial origin. Cases of fungal osteomyelitis are rare, and treatment often requires a prolonged course of antimicrobials. The authors report a case of a 72-year old man with fungal osteomyelitis affecting an intracortical lag screw, which was discovered during fixation of the left femoral shaft following an injury that occurred 68 years after placement of the affected lag screw. Chronic osteomyelitis can be indolent and subclinical, with the patient experiencing no signs or symptoms of the disease despite having bone infection for decades. This condition may become clinically …

Closed Treatment Of Displaced Radial Neck Fracture In An Adult, Nicholas Newcomb, Tomas Holy, Naomi Kelley, Nathan T. Morrell

Western Journal of Orthopaedics

Making up 1.5% to 4.0% of all fractures, radial head and neck fractures are typically treated based on the severity of angulation at the radial neck or if range of motion (ROM) is blocked. In this study, we present a case of a 43-year old woman with a Mason Type 2 radial neck fracture, successfully treated with closed reduction and one week of immobilization, resulting in near anatomic radial neck angulation without the need for operative intervention. The patient returned to work within two weeks and regained full ROM by six months, maintaining near anatomic reduction throughout. Keywords: Elbow Injury; …

Two-Stage Total Knee Arthroplasty (Tka) For A Rigid And Infected Knee: A Rare Case Report Of Aspergillosis, Túlio Vinícius De Oliveira Campos, David G. Kasuya Barbosa, Victor A. Kasuya Barbosa, Santiago Enrique Sarmiento Molina, Guilherme Moreira De Abreu Silva, Marco Antônio Percope De Andrade

Western Journal of Orthopaedics

Knee infection caused by Aspergillus is a rare condition that presents a diagnostic challenge for orthopaedic surgeons and musculoskeletal specialists. This case report aims to describe the treatment of a patient with active articular Aspergillus infection and knee arthrofibrosis through a two-stage total knee arthroplasty (TKA). A 37-year old woman presented with knee arthrofibrosis, which was complicated by an Aspergillus infection. The treatment involved a two-stage procedure: 1) bone cuts for TKA and systemic antibiotic therapy; and 2) TKA with the use of specific antibiotic-loaded cement. The patient has been followed for 30 months, showing no signs of failure.

Proximal Tibia Biplanar Anterior And Lateral Closing Wedge Osteotomy With Concomitant Revision Anterior Cruciate Ligament Reconstruction: A Case Report, Shane H. Johns, Lisandro Nardin, Jessica A. Nelson, Robert Schenck

Western Journal of Orthopaedics

This report documents a unique, successful strategy to manage a failed anterior cruciate ligament reconstruction (ACLR) in the setting of coronal and sagittal plane malalignment. The patient is a 38-year-old man with a history of a failed ACLR who presented with recurrent knee instability. Imaging revealed a posterior tibial slope (PTS) of 17° complicated by a varus malalignment of 10°. A single-stage anterior and lateral closing wedge tibial osteotomy (biplanar) with simultaneous revision anterior cruciate ligament reconstruction was performed. Final radiographic evaluation revealed that the tibial osteotomy healed with correction of coronal alignment to a physiologic 3° varus and a …

Recurrent Baker’S Cyst In A Pediatric Athlete: A Case Report, Gaurav Singh, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

Also known as popliteal cysts, Baker’s cysts are fluid-filled lesions found in the popliteal fossa, typically originating from the gastrocnemius-semimembranosus bursa. While these cysts are relatively common in adults, with a prevalence ranging from 5.0% to 41.0%, they are extremely rare in children, showing an incidence of just 2.4%. In most cases, Baker’s cysts result from intra-articular knee pathologies that lead to an increased production and sequestration of synovial fluid. The authors present the case of an athletic 16-year-old adolescent boy with a recurrent left-knee Baker’s cyst with magnetic resonance imaging showing no intra-articular pathology. Despite conservative treatment, including non-steroidal …

Treatment Of Congenital Cruciate Ligament Absence In A Teenager Knee-Ding Stability, Gaurav Singh, Anna Bergquist, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

The congenital absence of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) is an extremely rare condition, with an estimated prevalence of 0.017 per 1,000 live births for ACL agenesis. The authors present the case of a 15-year-old adolescent girl with autosomal dominant multiple synostosis, who developed progressive bilateral knee pain and functional limitations. Bilateral knee x-rays revealed trochlear dysplasia and an absent tibial eminence, suggesting a congenital ligamentous abnormality. Magnetic resonance imaging confirmed the bilateral absence of both the ACL and PCL. Surgical reconstruction of both ligaments was performed, with the first procedure taking place in October …

Effect Of Integrated Neuromuscular Inhibition Technique On Iliotibial Band Friction Syndrome, Esraa Tarek Farouk Ahmed, Amir Mohamed Saleh, Hassan Hussien Ahmed, Doaa Rafat El Azab

Journal of Medicine in Scientific Research

Background: It was reported that, 25% of adults experience limited mobility and a diminished quality of life due to knee pain. The iliotibial band friction syndrome (ITBFS) is a frequent overuse injury that causes lateral knee pain. It is marked by recurrent lateral knee pain as well as motor impairment in the lower extremities. Pain worsens with exercise and weight-bearing activities, especially at 30° of knee flexion, and patients usually have a history of overuse caused by knee flexion and extension.Objective: To determine the impact of the integrated neuromuscular inhibition technique on pain intensity, knee range of motion and knee …

Endoscopic Management Of Third Ventricular Colloid Cysts: Efficacy, Safety, Technique, Result, And Limitations, Mohammad Abdulsalam Soliman

Journal of Medicine in Scientific Research

Background: Colloid cysts of the third ventricle are rare, benign lesions that may cause life-threatening obstructive hydrocephalus. Full-endoscopic resection has emerged as a minimally invasive alternative to microsurgical approaches. This study evaluates the surgical outcomes and safety profile of the trans-frontal endoscopic technique, with emphasis on the swiveling technique for capsule excision. Methods: This retrospective and prospective cohort study included 24 patients who underwent full-endoscopic trans-frontal resection of third ventricular colloid cysts at Al- Ahrar Teaching Hospital, a tertiary neurosurgical center in Egypt, between January 2016 and December 2024. All procedures were performed using a 6° angled rigid neuroendoscopy with …

Demographic And Clinical Characteristics Of Patients With Charcot Neuro-Osteoarthropathy In People With Diabetes Mellitus In Six Countries: A Multicenter Observational Study From 1996 To 2022, E. B. Jude, C. Siafarikas, A. Rastogi, R. Bem, T. Tankova, M. -F. Kong, Javier La Fontaine, J. Pappachan, N. Tentolouris

School of Podiatric Medicine Publications

Aim: To describe the demographic and clinical characteristics of patients with Charcot neuro-osteoarthropathy (CNO) and to examine for differences between participants with Type 1 diabetes mellitus (DM) (T1DM) and Type 2 diabetes mellitus (T2DM).

Materials and Methods: Multicenter observational study in eight diabetic foot clinics in six countries between January 1, 1996, and December 31, 2022. Demographic, clinical, and laboratory parameters were obtained from the medical records. Analyses were performed using parametric or nonparametric statistical tests for variables with normally or nonnormally distributed values, respectively. Comparisons of the qualitative data were performed using the chi-square test.

Results: Seven hundred seventy-four …

Rare Case Of Osteomyelitis Caused By Achromobacter Xylosoxidans, Christopher P. Girgis, Tyler L. Coye, Elizabeth Ansert, Amanda L. Killeen, Peter A. Crisologo

School of Podiatric Medicine Publications

Achromobacter xylosoxidans is a rare opportunistic aerobe that has rarely been documented in the literature as a causative agent for osteomyelitis. It can present with antibiotic resistance, making treatment without operative management challenging. We present the case of a 51-year-old male with a past medical history of uncontrolled type 2 diabetes. The patient presented to a clinic with a grade 2 infection to the right fifth digit, as defined by the International Working Group on the Diabetic Foot, and was subsequently admitted for intravenous antibiotics and operative management. Magnetic resonance imaging revealed abnormal signal of the phalanges of the fifth …

Comparative Effectiveness Of Conservative Versus Early Surgical Treatments On Wound Healing Outcomes Of Diabetic Foot Ulcers: A Literature Review, Paul Tran, Yasim Zafar, Andrea Piña, Stephanie N. Campbell

School of Podiatric Medicine Publications

Diabetic foot ulcers (DFUs) are a severe complication of diabetes mellitus and the leading cause of lower extremity amputations worldwide. Peripheral neuropathy and peripheral arterial disease secondary to complications of diabetes mellitus may result in ulcers going unnoticed, increasing the risk of severe osteomyelitis, necrotizing infection, hospitalization, amputation, and sepsis. While conservative management of DFUs remains the first-line approach—emphasizing wound care, infection control, glycemic management, and offloading—there is growing debate about whether delaying simple surgical interventions worsens long-term outcomes. Surgeries such as tenotomy, digital amputation, and tendo-Achilles lengthening are minimally invasive options that can correct deformities, prevent recurrence, and promote …

A Qualitative Study Of End-Stage Liver Disease And Liver Transplant Referral Practices Among Primary Care Providers In Nonurban America, Vashisht Madabhushi, Matthew Wright, Gabriel Orozco, Allison Murphy, Antonio R. Garcia, Natalie D. Pope, Xiaonan Mei, Alexandra Cocca, Roberto Gedaly, Meera Gupta

Surgery Faculty Publications

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: …

A Community Effort To Develop Common Data Elements For Pre-Clinical Spinal Cord Injury Research., Britt A. Fedor, Abel Torres-Espin, Romana Vavrek, Maryann E. Martone, John L. Bixby, John C. Gensel, Vance Lemmon, Jeffrey S. Grethe, J. Russel Huie, Adam R. Ferguson, Karim Fouad, The Preclinical Sci Common Data Elements (Cde) Workshop Participants

Spinal Cord and Brain Injury Research Center Faculty Publications

For nearly 350 years, the process of disseminating scientific knowledge has remained largely unchanged. Scientists conduct experiments, analyze the data, and publish their findings in the form of scientific articles. Since the turn of the century, this process has been challenged by numerous open science and data sharing efforts to enhance transparency, reproducibility, and replicability of scientific research. Big data approaches, together with machine learning and artificial intelligence, are frequently used to gain insight into the ever-growing complexity of biological systems and biomedical research. To utilize these approaches and harness the continuously increasing computational power requires data to be both …

Cross-Species Comparisons Between Pigs And Mice Reveal Conserved Sex-Specific Intraspinal Inflammatory Responses After Spinal Cord Injury, Reena Kumari, Gabrielle V. Hammers, Robert H. Hammons, Andrew N. Stewart, Steven M. Maclean, Tracy Niedzielko, Lonnie E. Schneider, Candace L. Floyd, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Objective Therapeutic translation is challenging in spinal cord injury (SCI) and large animal models with high clinical relevance may accelerate therapeutic development. Pigs have important anatomical and physiological similarities to humans. Intraspinal inflammation mediates SCI pathophysiology. The purpose of this study was to evaluate the effect of sex on inflammation and outcomes in a pig thoracic contusion/compression SCI model.

Methods Adult (gonad-intact) male and female Yucatan miniature swine were subjected to either SCI or sham (laminectomy-only) injury.

Results SCI caused locomotor dysfunction (measured with the Porcine Thoracic Injury Behavior Score) with some recovery over 6 weeks and limited tissue sparing …

Cytosolic Phospholipase A2 In Infiltrating Monocyte Derived Macrophages Does Not Impair Recovery After Spinal Cord Injury In Female Mice, Ethan Glaser, Timothy J. Kopper, William M. Bailey, Hassan K. Kashif, Reena Kumari, Andrew N. Stewart, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Spinal cord injury (SCI) leads to permanent motor and sensory loss that is exacerbated by intraspinal inflammation and persists months to years after injury. After SCI, monocyte-derived macrophages (MDMs) infiltrate the lesion to aid in myelin-rich debris clearance. During debris clearance, MDMs adopt a proinflammatory phenotype that exacerbates neurodegeneration and hinders recovery. The underlying cause of the lipid-mediated MDM phenotype shift is unclear. Our previous work suggests that cytosolic phospholipase A2 (cPLA2) plays a role in the proinflammatory potentiating effect of myelin on macrophages in vitro. Cytosolic phospholipase A2 (cPLA2) frees arachidonic acid from phospholipids, generating eicosanoids that play an …

Exploring The Links Among Brain Iron Accumulation, Cognitive Performance, And Dietary Intake In Older Adults: A Longitudinal Mri Study, Valentinos Zachariou, Colleen A. Pappas, Christopher E. Bauer, Elayna R. Seago, Brian T. Gold

Neurology Faculty Publications

This study evaluated longitudinal brain iron accumulation in older adults, its association with cognition, and the role of specific nutrients in mitigating iron accumulation. MRI-based, quantitative susceptibility mapping estimates of brain iron concentration were acquired from seventy-two healthy older adults (47 women, ages 60–86) at a baseline timepoint (TP1) and a follow-up timepoint (TP2) 2.5–3.0 years later. Dietary intake was evaluated at baseline using a validated questionnaire. Cognitive performance was assessed at TP2 using the uniform data set (Version 3) neuropsychological tests of episodic memory (MEM) and executive function (EF). Voxel-wise, linear mixed-effects models, adjusted for longitudinal gray matter volume …

Barriers To Adherence To Standard Of Care In Appalachia: A Qualitative Assessment In Gastrointestinal Cancers, Brittany Levy, Jennifer T. Castle, Roshmita Bardhan, Mark Dignan, Avinash S. Bhakta

Internal Medicine Faculty Publications

Purpose: Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy.

Methods: Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a …

Circulating Molecular Drivers Of Bone Remodeling In Pancreatitis, Rachel L. Hill, Dhiraj Yadav, Phil A. Hart, David C. Whitcomb, Kristen J. Mcquerry, Kelsey N. Karnik, Kimberly M. Stello, Darwin L. Conwell, Madhumathi Rao

Internal Medicine Faculty Publications

INTRODUCTION: 

Pancreatitis-associated osteopathy is a clinically significant but mechanistically underexplored complication of pancreatic disease. We aimed to characterize stage-specific alterations in bone remodeling biomarkers across the spectrum of disease: recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP).

METHODS: 

In a cross-sectional analysis of North American Pancreatitis Study 2 participants, we measured serum mechanistic (sclerostin, dickkopf-1, receptor activator of nuclear factor κβ ligand, and osteoprotegerin), hormonal (fibroblast growth factor 23, insulin, and leptin), and modulatory (osteopontin, oncostatin, and osteoactivin) markers in controls (n = 30), RAP (n = 40), and CP (n = 40) using a multiplex assay. Group differences were …

Digital Health Interventions For Colorectal Cancer Screening Uptake: A Scoping Review, Sujin Kim, Andrew J. Whipkey, Jihye Bae, Avinash S. Bhakta

Internal Medicine Faculty Publications

Digital health interventions (DHIs) are increasingly employed to improve colorectal cancer (CRC) screening uptake, yet comprehensive syntheses of their effectiveness across diverse contexts remain scarce. This scoping review examines how individual, contextual, technological, and timing-related factors shape CRC screening outcomes in DHI-based trials. Following PRISMA-ScR guidelines, we conducted a systematic search of PubMed, Google Scholar, and ClinicalTrials.gov from March 1 to April 20, 2024, identifying 4,523 records through databases and an additional 2,039 through backward citation tracking. After deduplication and screening, 51 studies were included and charted using the PICOT (Population, Intervention, Comparison, Outcome, and Timing) framework. Included studies spanned …

Early-Onset Bevacizumab-Associated Knee Osteonecrosis In A Young Adult With Astrocytoma, Chandra L. Kakarala, Nicole A. Lisek, Clyde Coleman, John L. Villano, Katherine L. Copely, Patricia A. Santos

Internal Medicine Faculty Publications

We describe a rare case of knee osteonecrosis in a 22-year-old man with astrocytoma and neurofibromatosis type 1 after short-term treatment with bevacizumab and corticosteroids. Magnetic resonance imaging (MRI) identified infarctions and osteonecrosis of the distal femur and proximal tibia. Osteonecrosis associated with bevacizumab is typically limited to the jaw; this case highlights the potential for earlier, extra-jaw involvement. Clinicians should maintain a high index of suspicion for osteonecrosis in patients on vascular endothelial growth factor inhibitors, especially with concurrent steroid use, and consider prompt MRI in the evaluation of unexplained joint pain.

Impact Of Fast Advancement And Early Fortification Of Enteral Feedings In Preterm Infants, A Retrospective, Observational Study., Enrique Gomez-Pomar, Holly Clarke, Jamie Adams

Pediatrics Faculty Publications

UNLABELLED: We aimed to evaluate the outcomes and growth of preterm infants at a Neonatal Intensive Care Unit that focuses on early initiation, fast advancement, and early fortification of enteral feeds.

METHODS: Retrospective study conducted at a community hospital level III NICU. Extensive feeding data and outcomes were collected by utilizing a NutritionIQ software application, NICUtrition®. Infants born between 26- and 34-weeks gestational age were included, whereas infants with congenital defects, deceased or with incomplete data were excluded. Frequency and descriptive statistical analysis were conducted using chi-square and Fisher's exact test. Unadjusted odds ratios were computed for categorical variables and …

Rcpneoperu Trial: A Cluster Randomized Pilot Trial To Assess Traditional Neonatal Resuscitation Compared To Partially Virtual Training In Remote Areas., Carlos A Delgado, Enrique Gómez Pomar, Pablo Velásquez, Víctor Sánchez, Roberto Shimabuku, Luis Huicho

Pediatrics Faculty Publications

OBJECTIVE: To assess the effects of a neonatal resuscitation training program using traditional training and partial distance learning.

METHOD: Through an open cluster-randomized trial, the authors compared a traditional approach involving face-to-face theory and practice sessions using information and communication technology to offer theory and distance examination, followed by face-to-face practice. Twelve health facilities were allocated by blocked randomization. Comparisons were made adjusting for clustering in qualitative and quantitative data. The primary outcome was the percentage of infants with heart rates ≥100 per minute at the second minute after birth. The authors performed a cluster-level analysis for cluster randomized trials, …

Congenital Malignant Ectomesenchymoma Presenting As A Neck Mass In A Newborn, Ianna S. C. Blanchard, Ravi C. Bhavsar, Ashley M. Olszewski, Nathan R. Shelman, John A. D'Orazio, Prasad Bhandary, Thitinart Sithisarn

Pediatrics Faculty Publications

Background: Malignant Ectomesenchymoma (MEM) is a rare, aggressive soft tissue neoplasm with both neuroectodermal and mesenchymal differentiation. Congenital cases are extremely uncommon, posing significant diagnostic and therapeutic challenges.

Case Presentation: We report a case of a full-term male neonate presenting with a large congenital neck mass and respiratory distress at birth. Imaging revealed a lobulated, heterogeneously enhancing mass in the left submandibular region with a mass effect on the airway. Open biopsy and gross resection on day six of life confirmed MEM with rhabdomyoblastic and neuroectodermal differentiation. Post-surgical staging classified the tumor as Stage I, Clinical Group II. Despite initial …

Man With An Itchy Back, Katherine Schaffer, Nevin Adamski, Brittany Ambrose, Kathleen Anderson

Department of Emergency Medicine Faculty Publications

[First paragraph] A 61-year old man with no significant past medical history presented with painful bug bites on his lower back 1 day after a 1.5-week-long visit to Africa. He noticed bug bites on his lower back 3 days ago; since then, they have increased in size and become more painful. He was prescribed doxycycline at urgent care earlier that morning and had taken 1 dose. He is taking prophylactic medications for malaria and has had no fever at home. Vital signs, exquisitely tender papular lesions with a central punctum and surrounding erythema in the bilateral paralumbar regions.

Blurry With A Chance Of Ultrasound: A Case Of Sudden Vision Loss, Anjeza Cipi, Emily Sealy

Department of Emergency Medicine Faculty Publications

[Case presentation] A 30-year-old man with Crohn’s disease presented to the emergency department (ED) with sudden, painless vision loss in his left eye. He described a central dark spot that rapidly progressed over 5 minutes to near-complete central vision loss, sparing peripheral vision. He denied trauma, exertion, Valsalva, or anticoagulant use. Point-of-care ultrasound (POCUS) was performed on supine patient using a high-frequency linear probe (10-15 MHz) with copious gel over the closed eyelid, avoiding direct pressure. While instructing the patient to look in different directions, the eye was scanned in its entirety in transverse and sagittal planes. Gain and depth …

Hooked On Sight: Teen With Eye Trauma, Anjeza Cipi, Emily Sealy

Department of Emergency Medicine Faculty Publications

[Case presentation] A 14-year-old male with no prior ocular history presented to the emergency department after accidentally striking his left eye on a metal garden hook while on vacation. He experienced a brief flash of light but denied floaters, vision changes, pain, or diplopia. Visual acuity was 20/20 bilaterally with correction. Pupils were equal and reactive, intraocular pressures were normal, and extraocular movements were intact. The injury noted is seen in Figures 1 and 2. There was no evidence of scleral penetration or foreign body on slit lamp examination. Intraocular pressure measurements were deferred until globe rupture was ruled out …

Letter Of Concern From The Association Of Academic Chairs Of Emergency Medicine Regarding Acgme Proposed Changes, Richard J. Hamilton, Lance B. Becker, Richard E. Wolfe, D. Adam Algren, Arnold Thomas, Michael Baumann, Ross P. Berkeley, Terrell S. Caffery, Chad Cannon, Theodore J. Corbin, Michael E. Chansky, Harinder S. Dhindsa, Charles L. Emerman, David A. Farcy, Chris Fox, Michael A. Gibbs, Christopher S. Goode, Steven "Andy" Godwin, Dietrich Jehle, David Johnson, Samuel M. Keim, Babak Khazaeni, Barry J. Knapp, Clint Hawthorne, John D. Hoyle Jr., Michael Christopher Kurz, Evan Leibner, Robert Mcnamara, Robert F. Mccormack, Edward A. Michelson, Chadwick Miller, Ashley Norse, Andrew Nugent, Brian J. O'Neil, David T. Overton, Edward A. Panacek, William F. Paolo, Denis R. Pauzé, Amanda L. Perez, Ralph J. Riviello, Scott W. Rodi, Peter S. Pang, Juan A. Gonzalez Sanchez, David P. Sklar, Ben C. Smith, Jeffrey R. Stowell, Marc D. Squillante, J. Jeremy Thomas, Terry Vanden Hoek, Gregory A. Volturo, E. Lea Walters, Thomas E. Wyatt, Donald M. Yealy

Department of Emergency Medicine Faculty Publications

This letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate …