Baylor University Medical Center Proceedings最新文献

{"title":"A comprehensive evaluation of intramedullary devices in the management of femoral metastasis: 30-day outcomes.","authors":"Halil Bulut, Maria Jose Maestre, Daniel Tomey","doi":"10.1080/08998280.2025.2465058","DOIUrl":"https://doi.org/10.1080/08998280.2025.2465058","url":null,"abstract":"<p><strong>Introduction: </strong>Bone metastases, affecting 40% to 60% of patients with metastatic disease, are a significant concern, with the femur being one of the most common sites. These metastases significantly impact quality of life and present complex treatment challenges. Intramedullary nailing (IMN) is frequently used for femoral metastases owing to its minimally invasive nature and favorable outcomes.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database (2016-2021). Patients aged 18 and older who underwent IMN for metastatic femoral disease were included. The primary endpoints were 30-day reoperation and readmission rates. Secondary endpoints assessed 30-day postoperative complications.</p><p><strong>Results: </strong>The cohort primarily comprised female patients (62.7%, n = 482) with notable comorbidities such as hypertension (48.9%) and high smoking rates (71.3%). Low rates of specific reoperations (0.4%, n = 3) and unplanned reoperations (1.7%, n = 13) were observed within 30 days. The incidence of deep vein thrombosis was 1.2%, and the incidence of pulmonary embolism was 0.7%. Surgical site infections were rare (<i>Figure 1</i>).</p><p><strong>Conclusion: </strong>IMN is a safe and effective surgical option for treating metastatic femoral lesions, providing a favorable safety profile. Further research is recommended to explore thromboembolic risks and optimize preventive strategies.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"247-252"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in antiobesity medications.","authors":"Tonia Yee Vinton","doi":"10.1080/08998280.2025.2469990","DOIUrl":"https://doi.org/10.1080/08998280.2025.2469990","url":null,"abstract":"","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"304"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing ad hoc team performance with emotional intelligence.","authors":"Bobbie Ann Adair White, Michael G Healy, Britlyn D Orgill, Alejandro C Arroliga","doi":"10.1080/08998280.2025.2463274","DOIUrl":"https://doi.org/10.1080/08998280.2025.2463274","url":null,"abstract":"<p><p>Ad hoc teams in healthcare systems are beneficial from an organizational lens. Despite the benefits of ad hoc teams, clinical faculty have reported concerns due to a short time to coalesce prior to taking care of complex patients in areas such as the intensive care unit, trauma bay, or operating room. Evidence around ad hoc teams is scarce, so we extrapolated key findings from adjacent literature to establish a foundation for ad hoc team members' individual readiness. We propose that it is critical for team members to be individually prepared, and we borrow from literature focused on building emotionally intelligent (EI) teams. Thus, all team members should develop their EI to ensure that they will demonstrate self-awareness, empathy, transparency, adaptability, and collaboration. If each team member shows up with a high level of EI, the team should be able to read the situation, anticipate the needs of other team members, and adapt as needed, ensuring a positive outcome for the patient and team.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"354-357"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future practice plans of internal medicine fellowship graduates: a focus on pulmonary and critical care medicine.","authors":"Hamza Alzghoul, Akram Khan, Sherie Gause, Osama Alzoubi, Raju Reddy","doi":"10.1080/08998280.2025.2466372","DOIUrl":"https://doi.org/10.1080/08998280.2025.2466372","url":null,"abstract":"<p><strong>Background: </strong>The practice patterns of pulmonary and critical care medicine (PCCM) graduates are not well described. We aimed to describe the career paths sought by PCCM fellowship graduates entering the workforce.</p><p><strong>Methods: </strong>Using the Fellowship and Residency Electronic Interactive Database, we examined data on the career paths of trainees graduating from internal medicine fellowship programs for 2022.</p><p><strong>Results: </strong>Our study found that 712 trainees completed PCCM fellowship during 2022. Approximately 17% of PCCM graduates opted to pursue additional subspecialty training. Among those opting to enter practice, approximately 40% and 39% of PCCM graduates preferred academic practice and private practice, respectively. Among those opting for private practice, 48% chose group practice. Among all internal medicine subspecialties, there was a trend toward more graduates entering academia compared to historical averages. Notably, only 2.5% of PCCM graduates entering private practice opted to work in a rural setting. A similar trend was noted in other subspecialties. All specialties showed low percentages for practicing in underserved areas.</p><p><strong>Conclusion: </strong>PCCM fellowship graduates exhibited a preference for academic practice and a reduced likelihood of pursuing further subspecialty training. The percentage of internal medicine subspecialists practicing in underserved areas remains low.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"235-240"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting and managing arrhythmic mitral valve prolapse.","authors":"Praveen K Rao, Anumeha Tandon, Haojie Wang, Britton Blough, Randall Rosenblatt, William C Roberts, Dan M Meyer","doi":"10.1080/08998280.2025.2464465","DOIUrl":"10.1080/08998280.2025.2464465","url":null,"abstract":"<p><p>We describe a case of likely arrhythmic mitral valve prolapse (MVP) resulting in cardiac arrest, cardiopulmonary resuscitation, and initiation of extracorporeal membranous oxygenation. The case provides the clinical stimulus to review what knowledge exists, and what data gaps remain, to guide clinicians toward a proactive approach in managing arrhythmic mitral valve prolapse, a rare but potentially fatal condition. Since MVP is rare, performing several imaging modalities on every patient in whom there is a clinical suspicion would have a low yield. However, raising awareness of concerning features on history, electrocardiogram, and transthoracic echocardiography could improve the utility of more advanced imaging studies.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 4","pages":"548-552"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender disparities, prognostic indicators, and survival differences in pulmonary typical carcinoid: a SEER database analysis.","authors":"Asim Ahmed, Abdul Qahar Khan Yasinzai, Bisma Tareen, Agha Wali, Marjan Khan, Lukman Tijani, Asad Ullah","doi":"10.1080/08998280.2025.2464454","DOIUrl":"https://doi.org/10.1080/08998280.2025.2464454","url":null,"abstract":"<p><strong>Background: </strong>Typical carcinoid is a subtype of neuroendocrine neoplasia of the lung making up <1% of all lung cancers and 2% of resected lung tumors. This study assessed the impact of demographic features, racial and gender disparities, and tumor characteristics on survival in patients with typical carcinoid tumors.</p><p><strong>Methods: </strong>Data were extracted from the SEER database from 2000 to 2018. Multivariate Cox regression analyses were used to analyze the survival based on demographic and clinical factors.</p><p><strong>Results: </strong>We identified 11,713 cases of typical carcinoid tumors of the lungs. The mean age was 61.8 years (standard deviation, 14.7), and the tumors affected predominantly women (70.1%) and White (89.4%) individuals. The overall 5-year survival rate was 84.3% (95% confidence interval [CI] 83.5-85.2). The 5-year survival rate for those treated with systemic therapy was 49.8% (95% CI 43.5-55.9). Those treated with surgery had a 5-year survival rate of 97.2% (95% CI 96.7-97.6), and those treated with radiation had a 5-year survival rate of 71.9% (95% CI 60.3-80.6). Combination therapy provided a survival rate of 86.9% (95% CI 64.6-95.6).</p><p><strong>Conclusion: </strong>Surgery was the most common treatment modality and offered the best prognosis. On multivariate analysis, age >60, male gender, distant spread, and liver metastases were associated with worse prognosis.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"241-245"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital clinical decision support to improve care and to save costs: a pilot survey of the views of frontline healthcare professionals.","authors":"George West, Jonathan Foo, Dragan Ilic, Kieran Walsh","doi":"10.1080/08998280.2025.2465055","DOIUrl":"https://doi.org/10.1080/08998280.2025.2465055","url":null,"abstract":"<p><strong>Introduction: </strong>There has been much discourse about the features and impact of clinical decision support. However, until recently, there has been less evidence on <i>how</i> healthcare professionals use decision support to provide evidence-based care or on the potential cost savings that could emerge from its use. This study attempted to fill this gap by asking healthcare professionals to what extent they value digital clinical decision support as a means to apply evidence-based care and to save costs.</p><p><strong>Methods: </strong>Frontline resident doctors were invited to complete an online semistructured questionnaire on if, and how, they used a clinical decision support resource to obtain and apply information to provide evidence-based care and/or to save costs.</p><p><strong>Results: </strong>Among the respondents, 93% agreed or strongly agreed that the clinical decision support helped them obtain information to provide evidence-based care, and 93% agreed or strongly agreed that they could apply the information obtained from the resource to provide evidence-based care. Half of the respondents agreed or strongly agreed that using the resource helped them save healthcare costs.</p><p><strong>Discussion: </strong>The results strongly support the idea that the doctors used the resource to provide evidence-based care; the results related to cost savings were not as strong.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"229-232"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative blood pressure in Mohs micrographic surgery.","authors":"Howard K Steinman","doi":"10.1080/08998280.2025.2464468","DOIUrl":"https://doi.org/10.1080/08998280.2025.2464468","url":null,"abstract":"","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"277"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"There's more fun than work: Neurologist Walter Shelden's atypical work-life balance in early 20th century medicine.","authors":"Nathaniel P Rogers, Christopher J Boes","doi":"10.1080/08998280.2025.2466393","DOIUrl":"https://doi.org/10.1080/08998280.2025.2466393","url":null,"abstract":"<p><p>Walter DeWitt Shelden (1870-1946), Mayo Clinic's first neurologist, set himself apart from his early 20th century peers. Despite his professional achievements, Shelden modeled a remarkable work-life balance, an uncommon trait among physicians of his time. His diverse interests outside of neurology included tree cultivation, woodworking, and golf. Shelden worked with famed golf course architect Albert Warren Tillinghast on the development of the golf course at Rochester Golf and Country Club, where he personally planted thousands of trees, exemplifying his dedication to his passions outside of medicine. His life serves as an early example of successfully integrating work with personal interests.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"358-361"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of observed versus resected pancreatic neuroendocrine tumors.","authors":"Caroline Breit, Bobby Dow, Masen Ragsdale, Rachel Jefferies, Pallavi Patil, Catherine H Davis","doi":"10.1080/08998280.2025.2463289","DOIUrl":"https://doi.org/10.1080/08998280.2025.2463289","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic neuroendocrine tumors (pNETs) are a rare group of tumors with a wide range of clinical presentations. pNETs may present as incidentally discovered slow-growing tumors or as more aggressive tumors with metastatic potential. The mainstay of treatment is surgical resection; however, some have argued that observation can be considered for small, nonfunctional tumors. The objective of this study was to compare patients with pNETs who underwent initial resection versus observation to better understand tumor characteristics that favor either treatment approach.</p><p><strong>Methods: </strong>A retrospective review was performed of patients diagnosed with pNETs at a tertiary referral center from 2018 to 2023. Information on the patient and tumor, disease and treatment course, and outcomes was collected.</p><p><strong>Results: </strong>Forty-three patients were included in the study; 33% underwent initial resection, 37% underwent observation, and 30% underwent surgical resection following a period of observation (delayed resection). Patients who underwent initial resection were more likely to be younger with fewer comorbidities and have symptomatic or functional tumors. Patients with tumors >2 cm were more likely to have a postoperative complication. In a subgroup of patients with incidentally discovered tumors ≤2 cm, 33% underwent delayed resection and did not experience any postoperative complications; 66% underwent observation, and none had progression of their disease over the follow-up period of 17 months.</p><p><strong>Conclusion: </strong>While surgical resection remains the mainstay of treatment for pNETs, a period of observation in select individuals with small, incidentally discovered pNETs may also be considered safe. Management with surgical resection or initial observation must be an individualized decision and may be optimally supported with formal multidisciplinary tumor board discussion.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"213-219"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}