Arrowhead Regional Medical Center

Language barriers remain a critical yet understudied determinant of health inequity in the United States. Many patients who speak limited English, particularly within Hispanic and Latinx communities, experience compounded barriers related to immigration policy, mistrust, and systemic undercounting that reduce access to care and participation in public health. These conditions also restrict medical trainees’ opportunities to develop culturally and linguistically concordant communication skills. Strengthening medical education through language-concordant training, medical Spanish instruction, and integrated public health curricula can help rebuild trust and advance equity for linguistically diverse populations amid an increasingly restrictive policy environment.

ObjectivePre-clerkship medical students often struggle with anticipatory fear of experiences involving patient death. Various multi-session interventions have shown promise in alleviating these fears. In this study, we investigated the impact of a single-session intervention centered on physician storytelling and peer-to-peer discussion on coping skills and anticipatory fear surrounding patient death.MethodsA total of 21 second-year pre-clerkship medical students participated in the study. Students participated in a 90-minute session involving pre-recorded interviews of physicians sharing experiences with patient death. During several points throughout the session, students discussed their reflections in small groups. Serial pre- and post-session surveys evaluated anticipatory fears related to patient death and self-efficacy to cope with death using the Thanatophobia Scale and Bugen’s Coping With Death Scale, respectively. Data were analyzed for significance using the paired t-test.ResultsStatistically significant improvements were noted in both the Thanatophobia Scale and Bugen’s Coping With Death Scale scores immediately after the session. Mean thanatophobia scores improved from a pre-session score of 23.9 to a post-session score of 21.5 (p = .030). Mean Bugen’s Coping With Death Scale scores also improved from a pre-session score of 38.3 to a post-session score of 43.0 (p = .003).ConclusionWhile anticipatory fears of patient death are common among pre-clerkship medical students, many medical schools may struggle to find space to address this concern in their already packed curricula. This study suggests a feasible and effective method for addressing this aspect of undergraduate medical education.

ABSTRACTThe purpose of this case report is to highlight anticoagulation management of phlegmasia cerulea dolens, particularly in a patient with a recent ischemic stroke that underwent hemorrhagic transformation. In select cases, delayed anticoagulation after appropriate neurological clearance can be a viable approach to prevent thrombotic progression while minimizing hemorrhagic risk.

Nuclear protein in testis (NUT) carcinoma is a rare and aggressive malignancy characterized by NUT gene rearrangement. Previously classified as NUT midline carcinoma, this malignancy was reclassified to NUT carcinoma in order to reflect that it can occur outside midline structures of the body. This case report follows a 43-year-old male presenting with a nasopharyngeal mass invading the frontal brain region, ultimately diagnosed as NUT carcinoma. Here, we detail the clinical and molecular characteristics of this tumor to contribute to the growing body of literature on this rare malignancy, while acknowledging potential diagnostic challenges and therapeutic considerations.

Tracheoinnominate fistulas (TIFs) are rare but lethal complications of tracheostomy placement. Prevention of death by hemorrhagic shock requires early recognition and definitive surgical management. We present two cases of TIFs managed with endovascular techniques using a unique percutaneous access strategy. The first case involved a 36-year-old man with profound hypoxic brain injury after cardiac arrest owing to cocaine use, who underwent percutaneous tracheostomy for chronic ventilator management. On postprocedure day 16, he developed severe hemorrhage from the tracheostomy site. The tracheostomy was removed, the patient was intubated, and the Utley maneuver was performed for temporary hemostasis. Retrograde percutaneous access of the right common carotid artery allowed delivery of a 10 × 39 mm GORE VBX stent to the innominate artery, successfully controlling hemorrhagic shock with no change in neurological status. The second case involved a 69-year-old woman with cirrhosis, atrial fibrillation on apixaban, and respiratory failure, who presented with a 400-mL herald bleed from her tracheostomy. Imaging showed a vascular connection to the trachea at the balloon cuff level. Retrograde percutaneous access of the right brachial artery was used to deliver a 9 × 29 mm GORE VBX stent to the innominate artery. Post procedure, the brachial artery was repaired with a polytetrafluoroethylene graft. The patient stabilized and was eventually discharged. Hemorrhage from a TIF remains a lethal complication, but endovascular approaches can provide rapid hemorrhage control in unstable patients with survival outcomes comparable with prior reports in similar high-risk populations. Percutaneous access for stent graft delivery can be obtained from various sites.

This systematic review examines the psychiatric medications approved by the Food and Drug Administration (FDA) for sleep-wake disorders within the past 17 years, from 2008 through 2024, to describe the mechanism of action, indications, evidence for efficacy, dosing, and adverse effects for each medication, as well as the medications that are in the pipeline for approval in phase 3. Studies published from January 1, 2008, until December 31, 2024, were identified from the PubMed database using the keywords "sleep*" AND "disorder*" OR "psychopharm*" AND "medic*" OR "pharm*." An independent, focused analysis was conducted, and a consensus was reached on the studies to be included in this systematic review. Key findings were derived from the full text and tables of the selected studies. From January 1, 2008, to December 31, 2024, the FDA approved 14 medications for sleep-wake disorders and three pipeline medications as of December 31, 2024, currently in phase 3 clinical trials. Through this comprehensive systematic review, stakeholders-including clinicians, researchers, policymakers, and patients-can gain insights into the current treatment landscape and anticipate future therapeutic innovations. This review serves as a resource for guiding treatment decisions and optimizing care for patients with sleep-wake disorders.

Surgical management of lung cancer has evolved over the last two decades from open thoracotomy to video-assisted thoracoscopic surgery (VATS) and, more recently, robotic-assisted thoracoscopic surgery (RATS). We present our initial experience with RATS and hypothesize that overall outcomes will be improved compared to VATS and will result in overall cost savings. A retrospective review of prospectively collected data was conducted on all patients who underwent RATS over the first year and a half since robotic surgery was introduced, compared to VATS over the two years prior to the initiation of robotic surgery in our institution. Demographics, operative, and postoperative data were obtained, and statistical analysis was performed using a t-test. Patients undergoing RATS (n = 42) were older (70.31 +/- 8.89 vs. 64.64 +/- 12.53, p = 0.018) compared to the VATS group (n = 48). RATS operative times were longer, 190.26 minutes compared to 127.84 minutes (P=0.001) in the VATS group. Estimated blood loss (EBL) was significantly lower in the RATS group (74 ml versus 208 ml; p < 0.05). The mean length of stay was shorter in the RATS group (3.88 versus 6.22 days; p < 0.05). All postoperative outcomes were similar, including complications and 30-day mortality (RATS, 2.1%, versus VATS, 4.2%; p > 0.05). There were no statistical differences in length of intensive care unit (ICU) stay (0.3 versus 1.2 days; p > 0.05) or number of lymph nodes harvested (4.21 versus 3.81; p > 0.05). RATS is safe and technically feasible, and short-term outcomes are comparable to those of the conventional VATS approach.

Bell's palsy typically causes one-sided facial paralysis, while bilateral involvement (facial diplegia) is uncommon. The following case is presented of a middle-aged woman who developed simultaneous facial diplegia diagnosed as Bell's palsy. Further complicating the diagnostic picture were MRI findings of temporal lobe abnormalities, recent Botox injection, and unspecified finger nodules. Diagnostic tests excluded other causes of bilateral facial paralysis. The patient was treated with antivirals and steroids and had a full recovery. This case shows the rare occurrence of facial diplegia in Bell's palsy, emphasizing the importance of considering this diagnosis, even in atypical presentations.

To examine gender, racial, and ethnic representation trends among US academic neurology faculty between 1972–2021.