Medical Specialties Commons^™

Reducing Foley Catheter Reinsertion Through Implementation Of An Evidence Based Postpartum Urinary Retention Algorithm, Nicole Evaro

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

A Rare Case Of Hydroxychloroquine-Induced Cardiogenic Shock, Nikhil Erabelli, Pranayvir Lotey, Alice J. Chu, Marwan F. Jumean

Journal of Shock and Hemodynamics

Cardiac complications are common in systemic lupus erythematosus (SLE), but drug-induced cardiomyopathy remains underdiagnosed. Hydroxychloroquine (HCQ) cardiotoxicity is rare, and the few reports of HCQ-associated cardiogenic shock have followed acute overdose rather than chronic therapeutic use. A 36-year-old woman with SLE on long-term HCQ and heart failure with mildly reduced ejection fraction (EF) presented with exertional dyspnea, lower extremity edema, and retrosternal chest pain. Echocardiography showed a new EF of 20% to 25%, and computed tomography demonstrated pulmonary edema. The patient’s lactate levels rose despite intravenous furosemide, consistent with Society for Cardiovascular Angiography and Interventions stage C cardiogenic shock. Right …

Saudi Heart Association Position Statement On The Management Of Uncontrolled And Resistant Hypertension, Waleed Alhabeeb, Ismail Raslan, Adel Tash, Bader Ali Almustafa, Badr Ali Alzahrani, Fadel A. Alrowaie, Faisal Alghamdi, Fawaz Almutari, Ibrahim Jelaidan, Maryam Alqaseer, Mohamed Alkharasani, Raed Aldahash, Salem Assiri, Suleiman M. Kharabsheh, Sultan Al Dalbhi, Wejdan Ibrahim Aburas

Journal of the Saudi Heart Association

Background: Despite advances in antihypertensive therapy, blood pressure control remains suboptimal globally and in Saudi Arabia, where uncontrolled hypertension continues to contribute significantly to disease burden. Resistant hypertension represents a high-risk phenotype associated with increased cardiovascular and renal morbidity.

Methods: This Saudi Heart Association position statement was developed by a multidisciplinary expert panel using a structured consensus approach and a comprehensive, non-systematic review of the literature. Evidence on epidemiology, pathophysiology, diagnosis, and management of uncontrolled and resistant hypertension was critically appraised to formulate clinically applicable recommendations.

Results and conclusions: Uncontrolled and resistant hypertension are driven by complex mechanisms including activation …

A Single Institution Study Of Tert Promoter Mutations Detected Upon Preoperative And Postoperative Testing Of Thyroid Nodules: Characterization And Clinicopathologic Significance Of Tert Mutations Occurring In Isolation And In Conjunction With Other Mutations Or Gene Fusions, Reem Khraishi, Pradip Manna, Ujwala Gosavi, Phillip Palmer, Andrew Neeson, Violet Quann, Elizabeth Cottrill, Stacey Gargano

Jefferson Hospital Staff Papers and Presentations

Introduction

• Telomerase reverse transcriptase (TERT) promoter mutations occur in follicular cell-derived thyroid neoplasms, often coexisting with other mutations and associated with aggressive clinicopathologic features.
• The significance of TERT mutations occurring in isolation (iTERT) is unclear.
• We examined TERT-positive thyroid specimens (preoperative FNA and postoperative FFPE) to evaluate the clinicopathologic significance of this mutation occurring in isolation vs. in conjunction with other genetic alterations.

Comments On Prevalence Of Cerebrovascular Disease In Patients With Coronary Artery Disease After Pharmacological Stress Test, Xiaowei Wang, Jingwen Wei

Journal of the Saudi Heart Association

No abstract provided.

Reply To The Letter Comments On Prevalence Of Cerebrovascular Disease In Patients With Coronary Artery Disease After Pharmacological Stress Test., Muhammad S. Muhammad Hagrass, Haytham S. Ghareeb

Journal of the Saudi Heart Association

No abstract provided.

A Massively Parallel Reporter Assay Of Mecp2 Cis-Regulatory Elements Reveals Genetic Candidates For Male-Biased Autism, Rebecca Meyer-Schuman, Fisher Cherry, Yang Sui, Athanasios Papastathopoulos-Katsaros, Yi Zhong, Yidan Li, Tianyun Wang, Kelsey Hennick, Druha Karunakaran, Hanna Berk-Rauch, Zhandong Liu, Aravinda Chakravarti, Tomasz Nowakowski, Evan E Eichler, Huda Zoghbi

Faculty, Staff and Students Publications

Autism affects male individuals four times more often than female individuals, yet the basis of this sex bias remains unclear. One hypothesis is that this sex bias is due to genetic variants in X chromosome genes where haploinsufficiency causes neurodevelopmental disorders (NDDs). In heterozygous XX female probands, a complete loss-of-function variant in one of these genes often causes syndromic NDD, but the same variant is too deleterious for survival in hemizygous XY males. A mild hypomorphic variant, however, may be tolerated in a female carrier but may produce milder neurological phenotypes in a male proband. We tested this by investigating …

Reply To The Letter: Comments On “Intravenous Atropine In Reducing Reperfusion Arrhythmias, Conduction Abnormalities, And Hypotension In Inferior St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention”, Mohamed Ismail Rashed, Islam Mahmoud Bastawy, Ahmed Lotfy Mohamed, Mohamed Gamaleldin Elewa

Journal of the Saudi Heart Association

No abstract provided.

Comment On Intravenous Atropine In Reducing Reperfusion Arrhythmias, Conduction Abnormalities, And Hypotension In Inferior St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Azeen Qaisar

Journal of the Saudi Heart Association

No abstract provided.

Parent Anxiety And Response To A Telehealth Intervention For Hypoglycemia Fear: Secondary Analysis Of A Randomized Trial., Susana R. Patton, Alexandra Monzon, Nicole Kahhan, Jacob M. Redel, Kimberly Driscoll

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Parents of young children with type 1 diabetes (T1D) frequently report fear of hypoglycemia (FH), which can impact their diabetes management. REDCHiP (Reducing Emotional Distress for Childhood Hypoglycemia in Parents) is a telehealth-delivered cognitive behavioral intervention shown to reduce FH, but less is known about which parents benefit most.

OBJECTIVE: This secondary analysis examined whether pretreatment parent anxiety moderated REDCHiP's effects and explored responder patterns by intervention arm and pretreatment anxiety.

METHODS: This was a secondary analysis of a large, randomized clinical trial comparing REDCHiP to an attention control condition (ATTN). We assessed outcomes before treatment (time 1) and …

Forniceal Deep Brain Stimulation Improves Memory In Rett Syndrome Mice By Promoting The Maturation Of Newborn Hippocampal Neurons, Qi Wang, Bin Tang, Zhenyu Wu, Huda Y Zoghbi, Jianrong Tang

Faculty, Staff and Students Publications

Deep brain stimulation (DBS) is associated with an increase in hippocampal neurogenesis and memory benefits, but the causal mechanism is unclear. Here, we use a mouse model of Rett syndrome, a severe learning disability syndrome caused by MECP2 loss of function, to find that DBS promotes the maturation and integration of newborn dentate granule cells (DGCs) into the neural circuit. Suppressing hippocampal neurogenesis prevented DBS from improving learning and memory. Newborn methyl-CpG-binding protein 2 (MeCP2)-deficient DGCs in Rett syndrome mice showed attenuated development and synaptic dysfunction, but DBS rescued DGC dendritic arborization, synaptogenesis, and long-term synaptic plasticity. DBS achieves this, …

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.

Evaluating A Peer Support Program: Impact On Peer Supporters In A Tertiary Care Children’S Hospital, Lauren R. Anderson, Heather Dekeyser, Sonja I. Ziniel, Michele Loi, Emily Muther, Kami Wolfe Schneider, Christine Waasdorp Hurtado, Jo Vogeli, Jennifer Reese

Journal of Wellness

Introduction: Healthcare workers experience emotional distress following poor patient outcomes, which can negatively impact wellbeing and retention. Peer support programs are an evidence-based approach to mitigating distress through provision of confidential counseling by a trained peer. However, data on impact of participation on peer supporters is limited. We aimed to evaluate and describe the peer supporters’ experience at our tertiary children’s hospital.

Methods: A web-based survey was developed with input from key partners. Content was reviewed via cognitive interviews. The survey was administered to 167 trained peer supporters during the spring of 2022. Demographic comparison data were gathered from an …

Multiple Quality Control Checkpoints Safeguard Small Nuclear Rna Biogenesis And Prevent Assembly Of Aberrant Spliceosomes, Tiantai Ma, Claire Huntington, Zhuoyi Song, Rea M Lardelli, Eric L Van Nostrand, Jens Lykke-Andersen

Faculty, Staff and Students Publications

Defective small nuclear (sn)RNAs are produced from hundreds of human snRNA pseudogenes and mutant snRNA genes associated with human developmental disorders. Machineries that prevent defective snRNAs from disrupting pre-mRNA splicing remain poorly defined. Here, we identify multiple checkpoints in snRNA biogenesis monitored by quality control machineries that subject defective snRNAs to degradation and prevent their assembly into spliceosomes. We show that variant U1 snRNAs produced from human pseudogenes, some at rates approaching canonical snRNAs, are impaired in 3' cleavage and targeted for degradation by the NEXT-exosome while failures in subsequent protein assembly steps promote NEXT-exosome- or terminal uridylyl transferase 4/7-mediated …

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 …

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 …

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 …

Navigation-Assisted Minimally Invasive Direct Pars Repair For Lumbar Spondylolysis., Jack Mangan, Richard M. Schwend, John Anderson, Michael Benvenuti, K Aaron Shaw

Manuscripts, Articles, Book Chapters and Other Papers

Spondylolysis is a common cause of mechanical low back pain in adolescent athletes. While nonoperative management is frequently successful, a subset of patients fail conservative treatment and require surgical intervention. Direct repair of the pars defect offers a motion-preserving alternative to fusion in appropriately selected patients, but traditional open and fluoroscopy-guided minimally invasive techniques are limited by soft-tissue morbidity and variability in screw placement accuracy, and detailed technical descriptions of navigation-assisted approaches remain limited in the literature. We present a detailed, illustrated technique for navigation-assisted minimally invasive direct pars repair, in which a single midline incision accommodates bilateral fixation with …

Hyaluronic Acid Rectal Wall Infiltration And Reversal In Patients With Prostate Cancer Undergoing Radiation Therapy-A Case Series, 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.

Improving Access To Specialized Rare Cancer Care Through A Navigation-Driven Centralized Metastatic Uveal Melanoma Multidisciplinary Tumor Board, Jameson Lynch, Rn

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Background

Metastatic uveal melanoma (mUM) is a rare malignancy; up to 50% of patients with uveal melanoma develop systemic metastases, with liver involvement occurring in up to 90% of metastatic cases.1 Thomas Jefferson University Hospital has extensive experience managing liver-dominant mUM, supported by prior single-institution longitudinal data involving 730 patients with uveal melanoma liver metastasis.3 This mUM program represents a specialized referral model for complex liver-dominant disease, offering multidisciplinary review, advanced liver-directed treatment planning, and coordinated access to specialty oncology care. Oncology navigation facilitates this model by coordinating intake, acquisition of outside imaging and records, pre-travel case preparation, tumor board …

High-Fidelity Simulation Model For The Posterior Sagittal Anorectoplasty In Anorectal Malformations With Rectovestibular And Rectourethral Fistula., Tobias Jhala, Lukas Bischoff, Ismael Elhalaby, Jonathan Aichner, Jörg Fuchs, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical training for posterior sagittal anorectoplasty (PSARP) in anorectal malformations is limited by the rarity of the condition and restricted operative exposure. Existing low-cost simulators facilitate learning of procedural steps but lack realistic tissue characteristics and anatomical fidelity.

METHODS: A high-fidelity animal-tissue simulation model was developed using poultry slaughter by-products. The model combines the perineal anatomy of a chicken with a segment of turkey esophagus to recreate multilayer tissue structures and simulate rectovestibular and rectourethral fistulae. Model construction and surgical simulation were designed to reflect the standardized operative steps for PSARP defined by international consensus.

RESULTS: The model reproduces …

Establishment Of A Diabetes-Tailored Data Intelligence Platform Enhances Clinical Care, Enables Risk-Based Monitoring, And Facilitates Population-Health-Based Approaches At A Pediatric Diabetes Network., Brent Lockee, Craig Vandervelden, Daniel R. Tilden, Kelsey Panfil, Erin M. Tallon, Emily Dewit, Katie Noland, David D. Williams, Harpreet Gill, Susana R. Patton, Priya Prahalad, Juan Espinoza, Amey Waghmode, Mitchell Barnes, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Patient-generated health data (PGHD) represents an opportunity to customize care, particularly in type 1 diabetes (T1D) care where continuous glucose monitor (CGM) and insulin pump usage continues to rise. Previous solutions to integrating CGM data into the electronic health record (EHR) have been limited in their ability to integrate data from multiple sources, ensure data fidelity, integrate data from multiple data streams, and rapidly adapt to changes in data output from numerous vendors. We developed a novel data infrastructure contained outside of the EHR to provide an alternative approach to PGHD integration, enable diabetes centers to identify and predict …

Impact Of Neighborhood And Individual Social Drivers Of Health On Outcomes Following Congenital Heart Surgery., Andrew Well, Heather Van Diest, Brett R. Anderson, Wei Zhang, Kathleen Carberry, Alexandra Lamari-Fisher, Jeremy Affolter, Erin A Gottlieb, Jeffery P. Jacobs, Charles D. Fraser, Carlos M. Mery

Manuscripts, Articles, Book Chapters and Other Papers

Background Despite advances in congenital heart surgery (CHS) and improvements in outcomes, disparities continue to exist. Social Drivers of Health (SDoH) have been associated with many aspects of health and wellness including congenital heart disease. The goal was to evaluate the impact of individual and neighborhood-level SDoH on outcomes following CHS.

Methods Retrospective review of the Society of Thoracic Surgeons Congenital Heart Surgery Database from 2014 to 2022 linked via ZIP code with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). ZIP codes were ranked by their SVI score with the first quintile the least vulnerable and …

Relationship Extraction For Adverse Drug Events In Clinical Notes Using Large Language Models: A Retrospective Cross-Sectional Study, Joseph M Plasek, Yiming Li, Mary G Amato, Dinah Foer, Diane L Seger, Shayma Alzaidi, Huiyuan Zhou, Gretchen Purcell Jackson, David W Bates, Li Zhou

Faculty, Staff and Students Publications

Background: Adverse drug events (ADEs) are a critical indicator of patient safety but are often documented only in free-text clinical notes. The potential of recent advances in natural language processing (NLP), particularly generative large language models (LLMs), to identify ADEs remains understudied. This study aimed to compare the performance of multiple LLMs in identifying ADE-Drug relationships in inpatient and ambulatory clinical notes.

Methods: We used clinical notes from the 2018 National NLP Clinical Challenge (n2c2) ADE dataset (inpatient; n = 505) and from outpatient encounters (n = 2555) between October 1, 2018, and December 31, 2019, at a large academic …

Glial Dysfunction And Memory Impairments In A Model Of Pediatric Obstructive Sleep Apnea, 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 …

Natural History Of Pi-Rads 3 Lesions On Serial Prostate Mpmri, Ron Marom, Yuval Rand, Meitar Atias, Sophie Barnes, Ibrahim Fahoum, Gal Keren-Paz, Mario Sofer, Ofer Yossepowitch, Snir Dekalo, Avi Beri, Roy Mano

Faculty, Staff and Students Publications

Objective: PI-RADS 3 lesions on prostate multiparametric MRI (mpMRI) are indeterminate findings with debated management. We evaluated their radiologic evolution on follow-up mpMRI and correlated imaging changes with biopsy outcomes.

Methods: We retrospectively identified 166 men with at least one PI-RADS 3 lesion on initial mpMRI and at least one follow-up mpMRI without intervening treatment. Lesions were classified at follow-up as regressed (downgraded to PI-RADS ≤ 2), stable (remained PI-RADS 3), or progressed (upgraded to PI-RADS 4-5). Lesions were stratified by zonal location. MRI-targeted biopsy results were reviewed when available (n = 64).

Results: On follow-up, 52% of lesions regressed, …

Comparative Performance Of Predictive Nomograms For Pathological Upstaging In Clinical T1 Renal Masses: An Independent External Validation, Michael Vainrib, Amos Neheman, Omri Schwarztuch Gildor

Faculty, Staff and Students Publications

Background: Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera, and Mei, to assess their discrimination, calibration, and clinical utility in a contemporary cohort.

Patients and methods: We retrospectively reviewed patients undergoing surgery for cT1 renal masses at our institution. The primary endpoint was pathological upstaging to pT3a. Model performance was evaluated using the Area Under the Curve (AUC) for discrimination and the Brier Score for overall accuracy. Calibration was assessed using parametric and nonparametric Loess-smoothed curves. Clinical utility was quantified using …

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 …