Gaston Memorial Hospital

Metastases to the dura and adjacent parenchyma occur in 1%-2% of patients with prostate cancer. Dural metastases manifest as subdural fluid collections and present as a chronic subdural hematoma. We present a patient with advanced prostate cancer who experienced a fall and a traumatic brain injury. Computer tomography (CT) of the brain revealed a bilateral subdural hematoma (SDH). During the follow-up examination, the patient's mental status declined, and a follow-up brain CT showed an expansion of the SDH. Brain MRI with contrast demonstrated dural lesions suspicious for metastasis to the dura. Histopathologic examination of the lesions confirmed metastatic prostate adenocarcinoma. While uncommon, leptomeningeal-dural metastatic lesions stemming from prostate adenocarcinoma should be suspected in patients with known prostate cancer who present with subdural collections. This is even more significant if the patient with prostatic adenocarcinoma has sustained a recent head injury and presents with a subdural hematoma on neuroimaging. Brain MRI provides more data towards the differential diagnosis of these lesions and should be an essential part of the diagnostic workup. Biopsy and histopathologic examination of these lesions are indicated in the diagnostic workup of these uncommon lesions.

Abstract Cost can be a barrier to achieving health equity for guideline‐directed medical therapy; however, ambulatory care pharmacists who provide services in primary care settings can assist in reducing these barriers. Strategies to reduce drug cost should be tailored to patient‐specific factors including insurance type, drugs being prescribed, and availability of local and national assistance programs. Pharmacists can use a team‐based approach, when possible, to promote health equity in drug access due to cost. The authors provide recommendations that can be incorporated into clinical practice and improve health equity.

Catheter ablation of recurrent atrial arrhythmias following pulmonary vein isolation can be challenging given the complex nature of previously ablated tissue, and managing these already complex cases may be rendered more difficult by the impact of wavefront directionality on mapping catheter orientation, which can make the accurate identification of arrhythmogenic substrate more difficult to achieve. In this report, a 72-year-old man with a history of symptomatic paroxysmal atrial fibrillation and prior pulmonary vein isolation (PVI) underwent repeat ablation. Importantly, this case study demonstrates how a direction-independent high-density mapping catheter (Advisor™ HD Grid; Abbott, Chicago, IL, USA) can identify fractionated low-voltage zones that may be missed when using a standard linear ablation catheter.

Emergency medicine residents are required to accurately log all procedures, yet it is estimated that many procedures are not logged. Traditional procedure logging platforms are often cumbersome and may contribute to procedures not being logged or being logged inaccurately. We designed a mobile procedure logging application (app) that uses quick response (QR) codes to input patient information quickly and accurately. The app integrates with our current procedure log database while maintaining information privacy standards. It scans the QR code displayed for patient identification, automatically extracting pertinent patient information. The user selects the procedure performed and the app uses data analytics to recommend logging other related procedures.A mobile procedure logging app using QR codes decreases time needed to log procedures and eliminates data entry errors. Improving the speed and convenience of procedure logging may decrease the discrepancy between performed and logged procedures. A similar app can be integrated into any residency program and may improve assessment of resident procedural competency.

Background and Objectives. Breast cancer has been the most common cancer affecting women in Jordan. In the process of implementing breast cancer prevention and early detection programs, individualized risk assessment can add to the cost-effectiveness of such interventions. Gail model is a widely used tool to stratify patients into different risk categories. However, concerns about its applicability across different ethnic groups do exist. In this study, we report our experience with the application of a modified version of this model among Jordanian women. Methods The Gail risk assessment model (RAM) was modified and used to calculate the 5-year and lifetime risk for breast cancer. Patients with known breast cancer were used to test this model. Medical records and hospital database were utilized to collect information on known risk factors. The mean calculated risk score for women tested was 0.65. This number, which corresponds to the Gail original score of 1.66, was used as a cutoff point to categorize patients as high risk. Results A total of 1786 breast cancer patients with a mean age of 50 (range: 19–93) years were included. The modified version of the Gail RAM was applied on 1213 patients aged 35–59.9 years. The mean estimated risk for developing invasive breast cancer over the following five years was 0.54 (95% CI: 0.52, 0.56), and the lifetime risk was 3.42 (95% CI: 3.30, 3.53). Only 210 (17.3%) women had a risk score >0.65 and thus categorized as high risk. First-degree family history of breast cancer was identified among 120 (57.1%) patients in this high-risk group. Conclusions Among a group of patients with an established diagnosis of breast cancer, a modified Gail risk assessment model would have been able to stratify only 17% into the high-risk category. The family history of breast cancer contributed the most to the risk score.