Logan Regional Hospital

Bipolar disorder is a severe mental illness, and rates of diagnosis have risen in recent years. Accurately diagnosing bipolar disorder can be difficult when a patient is not actively manic, as screening questionnaires are not reliable diagnostic tools, patient self-report can be unreliable, and bipolar symptoms overlap with other psychiatric conditions. Much has been written about the overlap between bipolar disorder and borderline personality disorder, but many other disorders present with similar symptoms, including unipolar depression. Accurate diagnosis is important to ensure optimal treatment and patient outcomes. The goal of this article is to provide an evidence-based approach to diagnosing bipolar disorder and distinguishing it from other psychiatric disorders in clinical settings. Using the mnemonic "DIGFAST" (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleeplessness, talkativeness), we review the DSM-5-TR diagnostic criteria for mania. Distinguishing features include the episodic nature of elevated/irritable moods, severity of symptoms, and the simultaneous occurrence of multiple manic symptoms. Insight is typically impaired in bipolar disorder, and collateral information can help improve diagnostic clarity. Hypomanic symptoms can be distinguished from other conditions by their duration and accompanying changes in functioning. A thorough clinical interview is the most important asset in making an accurate diagnosis of bipolar disorder.

Inferior vena cava (IVC) agenesis is a rare congenital anomaly that has been implicated in up to 5% of unprovoked deep vein thrombosis (DVT) cases in young men under 30 years old. We present the case of a 28-year-old obese Caucasian male who arrived at our hospital with significant pain and swelling in his right lower extremity. The patient had no prior medical history or family history of DVT or cardiovascular conditions. A venous Doppler ultrasound revealed an extensive right lower extremity DVT. Further imaging with a computed tomography (CT) pulmonary embolism (PE) protocol scan of the chest and abdomen identified IVC agenesis along with pulmonary emboli in the left central pulmonary arteries. A hypercoagulability workup was positive for a heterozygous Factor V Leiden (FVL) mutation, an additional thrombophilic risk factor. The patient was initially managed with an intravenous heparin drip and was later transitioned to long-term direct Factor Xa inhibitor therapy. To our knowledge, this is the first reported case of extensive venous thromboembolism (VTE) due to concurrent IVC agenesis and FVL mutation successfully treated with direct Factor Xa inhibition. This case highlights the complexity of managing patients with multiple thrombogenic risk factors and raises a discussion on the rationale for lifelong anticoagulation in such individuals.

ABSTRACT There is often a disparity for new hospital librarians between formal Library Information Science (LIS) education and the skills required for doing the job. To bridge the gap, new medical library professionals search out Medical Library Association (MLA) classes and webinars, find courses on the Internet, or link to National Library of Medicine (NLM) training. The MLA Hospital Library Caucus tasked an Education Task Force to ascertain what new librarians needed to help them in their early careers. The Task Force created a survey, which was sent to hospital librarians with less than 5 years’ experience. Respondents were asked to rate their top five duties and responsibilities and indicate with which they needed help. Using the results of the survey as a guide, the task force created a LibGuide for new hospital librarians.

A ttention-deficit/hyperactivity disorder (ADHD) is common, with an estimated worldwide prevalence of 5.29% among children and adolescents and 2.5% among adults. 1 DSM-5-TR classifies ADHD as a neurodevelop mental disorder, "a group of conditions with onset in the developmental period [that] typically manifest early in development, often before the child enters school." 2 Because of the expectation that ADHD symptoms emerge early in development, the diagnostic criteria specify that symptoms must have been present prior to age 12 to qualify as ADHD. However, recent years have shown a significant increase in the number of patients being diagnosed with ADHD for the first time in adulthood. One study found that the diagnosis of ADHD among adults in the United States doubled between 2007 and 2016. 3 First-line treatment for ADHD is the stimulants methylphenidate and amphetamine/dextroamphetamine. In the United States, these medications are classified as Schedule II controlled substances, indicating a high risk for abuse. However, just as ADHD diagnoses among adults have increased, so have prescriptions for stimulants. For example, Olfson et al 4 found that stimulant prescriptions among young adults increased by a factor of 10 between 1994 and 2009. The increased prevalence of adult patients diagnosed with ADHD and taking stimulants frequently places clinicians in a position to consider the validity of existing diagnoses and evaluate new patients with ADHD-related concerns. In this These steps can help ensure accurate diagnosis and optimal outcomes

Background MYCN-amplified RB1 wild-type (MYCNARB1+/+) retinoblastoma is a rare but clinically important subtype of retinoblastoma due to its aggressive character and relative resistance to typical therapeutic approaches. Because biopsy is not indicated in retinoblastoma, specific MRI features might be valuable to identify children with this genetic subtype. Purpose To define the MRI phenotype of MYCNARB1+/+ retinoblastoma and evaluate the ability of qualitative MRI features to help identify this specific genetic subtype. Materials and Methods In this retrospective, multicenter, case-control study, MRI scans in children with MYCNARB1+/+ retinoblastoma and age-matched children with RB1-/- subtype retinoblastoma were included (case-control ratio, 1:4; scans acquired from June 2001 to February 2021; scans collected from May 2018 to October 2021). Patients with histopathologically confirmed unilateral retinoblastoma, genetic testing (RB1/MYCN status), and MRI scans were included. Associations between radiologist-scored imaging features and diagnosis were assessed with the Fisher exact test or Fisher-Freeman-Halton test, and Bonferroni-corrected P values were calculated. Results A total of 110 patients from 10 retinoblastoma referral centers were included: 22 children with MYCNARB1+/+ retinoblastoma and 88 control children with RB1-/- retinoblastoma. Children in the MYCNARB1+/+ group had a median age of 7.0 months (IQR, 5.0-9.0 months) (13 boys), while children in the RB1-/- group had a median age of 9.0 months (IQR, 4.6-13.4 months) (46 boys). MYCNARB1+/+ retinoblastomas were typically peripherally located (in 10 of 17 children; specificity, 97%; P < .001) and exhibited plaque or pleomorphic shape (in 20 of 22 children; specificity, 51%; P = .011) with irregular margins (in 16 of 22 children; specificity, 70%; P = .008) and extensive retina folding with vitreous enclosure (specificity, 94%; P < .001). MYCNARB1+/+ retinoblastomas showed peritumoral hemorrhage (in 17 of 21 children; specificity, 88%; P < .001), subretinal hemorrhage with a fluid-fluid level (in eight of 22 children; specificity, 95%; P = .005), and strong anterior chamber enhancement (in 13 of 21 children; specificity, 80%; P = .008). Conclusion MYCNARB1+/+ retinoblastomas show distinct MRI features that could enable early identification of these tumors. This may improve patient selection for tailored treatment in the future. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Rollins in this issue.

BackgroundPaired Reading (PR), Neurological Impress Method (NIM), Dyad Reading (DR), and Read Two Impress (R2I) share a fundamental trait – paired synchronous oral reading between a higher‐level tutor and a lower‐level tutee. Collectively, we refer to these practices as Synchronous Paired Oral Reading Techniques (SPORT). This historical narrative review investigates the origin, development, and current state of SPORT.MethodsFive academic databases were searched for reports of SPORT from the years 1960–2021. This process yielded 3972 results, from which 456 full‐text articles were assessed for eligibility. Finally, 77 publications were reviewed to inform this historical narrative.ResultsFour distinct waves of SPORT research dating back to 1966 were identified in the review. These waves are characterised by popularity in the United Kingdom and United States, evolving theoretical frameworks, varying configurations and implementations, and concerted focus on reading achievement. Consistently positive outcomes are reported in the SPORT literature, specifically in oral reading fluency and reading comprehension.ConclusionsThe theory and practice of SPORT have evolved significantly throughout its extensive history. We call for a fifth wave of SPORT research to consolidate the findings of the last 60 years, develop new lines of inquiry, and implement novel and varied applications of SPORT.