Tidelands Health

This article presents an updated framework from the Society of Hospital Medicine for individual learning objectives related to key procedures in hospital medicine. Building upon the 2017 framework, these objectives have been revised to reflect evolving clinical evidence, advancements, and shifts in hospital medicine practice patterns. The methodology included a comprehensive literature review, expert consensus panels, and feedback from practicing hospitalists across diverse clinical settings. The updated learning objectives address procedural competencies for the most common interventions in hospital medicine, including arthrocentesis, emergency procedures, interpretation of chest radiographs and electrocardiograms, lumbar puncture, paracentesis, thoracentesis, and vascular access. These revised learning objectives provide a framework to guide curricular development, continuing medical education, and hospital medicine practitioners in developing and maintaining procedural competence essential for high-quality inpatient care.

Acupuncture is gaining popularity and wider acceptance as a treatment modality within the field of sports medicine. Our objective was to provide a comprehensive review of the existing literature pertaining to acupuncture in sports medicine to shed light on approaches utilized in acupuncture while revealing its personalized nature and its impact on athletes’ preparation, performance, and recovery. We evaluated acupuncture research in the context of medicine and sports-related injury treatment, assessing its impact on athletic performance across demographics of athletes. Athletes participating in most sports have shown positive outcomes from acupuncture interventions. Acupuncture improves peak oxygen levels, maximum heart rate, delayed-onset muscle soreness, pain, swelling, explosive force production, and joint mobility. Furthermore, the efficacy of acupuncture appears to be similar regardless of age and sex. Lastly, the acceptance of acupuncture is influenced by cultural factors, with Western and traditional East Asian cultures exhibiting distinct perspectives on its rationale and mechanisms of action. Traditional East Asian acupuncturists typically employ qi and meridian theories in their acupuncture practices, with the recent incorporation of Western concepts. Acupuncture shows promise as an effective treatment for musculoskeletal pain and neuropathies in athletes across different age groups and for addressing injuries in various sports. Our comprehensive review will enhance our understanding of acupuncture’s potential as a complementary or distinct therapeutic approach compared to conventional therapies. Additionally, our review explores its specific applications within different sports and delves into the cultural dimensions involved in integrating this practice into modern sports medicine.

PURPOSEThe prospective Neoadjuvant Breast Registry Symphony Trial compared the 80-gene molecular subtyping signature with clinical assessment by immunohistochemistry and/or fluorescence in situ hybridization in predicting pathologic complete response (pCR) and 5-year outcomes in patients with early-stage breast cancer.METHODSStandard-of-care neoadjuvant chemotherapy combined with trastuzumab or trastuzumab plus pertuzumab was given to patients with human epidermal growth factor receptor 2 (HER2)–positive tumors (n = 295). pCR was the primary end point, with secondary end points of distant metastasis-free survival and overall survival at 5 years.RESULTSAmong clinically defined HER2-positive (cHER2) tumors, the 80-gene assay identified 29.5% (87 of 295) as Luminal-Type (cHER2/gLuminal), 14.9% (44 of 295) as Basal-Type (cHER2/gBasal), and 55.6% (164 of 295) as HER2-Type (cHER2/genomically classified as HER2 [gHER2]). Patients with cHER2/gHER2 tumors had a higher pCR rate (61.6%) compared with non-gHER2 tumors (26.7%; P < .001). Dual targeting for cHER2/gHER2 tumors yielded a higher pCR rate (75%) compared with those treated with single HER2-targeted therapy (54%; P = .006). For cHER2/gBasal tumors, the 42.9% pCR rate observed with dual targeting was not different from that with trastuzumab alone (46.4%; P = .830). Among those with cHER2/gBasal tumors, 5-year distant metastasis-free survival (68.6%; 95% CI, 49.1 to 81.9) was significantly worse than in patients with cHER2/gLuminal tumors (88.9%; 95% CI, 78.0 to 94.6) and cHER2/gHER2 tumors (87.4%; 95% CI, 80.2 to 92.2; P = .010), with similar corresponding overall survival differences.CONCLUSIONThe 80-gene assay identified meaningful genomic diversity in patients with cHER2 disease. Patients with cHER2/gHER2 tumors, who benefitted most from dual HER2-targeted therapy, accounted for approximately half of the cHER2 cohort. Genomically Luminal tumors had low pCR rates but good 5-year outcomes. cHER2/gBasal tumors derived no benefit from dual therapy and had significantly worse 5-year prognosis; these patients merit special consideration in future trials.

BackgroundOver the past two decades, society has had to combat three extremely pathogenic coronaviruses that have all carried detrimental effects on the human population.[1,2] Coronaviruses are a family of viruses that are understood to cause illnesses which can vary from the common cold to severe diseases such as Middle Eastern Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).[1][2][3][4] Current literature suggests that each of the mentioned coronavirus outbreaks originated from an animal source, the first (SARS-CoV) is said to have transmitted from civet cats in 2002, (MERS-CoV) is said to have transmitted from camels in 2012 and the novel (SARS-CoV2), the virus responsible for coronavirus 2019 (COVID-19) is said to have been transmitted from bats in 2019 [4][5][6].Both of the SARS associated coronaviruses have been linked to originating in China and MERS in Saudi Arabia, however all three members of the coronavirus family began to rapidly infect individuals throughout the globe and have collectively been responsible for hundreds AbstractAs coronavirus disease 2019 (COVID-19) infections and related deaths continue to negatively impact the world, methods for adequate personal protection and hygiene remain a crucial topic of discussion.In the United States of America, current recommendations related to hand hygiene include washing hands with soap and water or to use a hand sanitizer with approved FDA ingredients when soap and water are not readily accessible.Today, a novel technology that utilizes a proprietary formula consisting of reengineered amorphous colloidal hydrated silica in combination with minimal amounts of agency approved inert and active ingredients has proven to not only be effective on contact but continues to protect long after it has dried.This technology was developed over a decade ago and over that period has proven to be both safe and effective.As the world is faced with yet another global pandemic the need for proven biocidal solutions are vital.The purpose of this short literature is to lay out the facts associated with both alcohol-based and non-alcohol-based hand sanitizers and present the findings demonstrated by microSURE Hand and Skin Sanitizer in a bio safety level-3 (BSL-3) laboratory, when tested directly against Severe Acute Respiratory Syndrome coronavirus 2 (SARS Co-V2), the virus responsible for causing .The details presented throughout this paper will provide insight as to why Benzalkonium chloride (BZK) must not be overlooked when deciding on the best method for protecting your body from harmful microbes and protecting your skin from potential damage.

To investigate the use of the Lucy ® Stereotactic Phantom (Standard Imaging, Inc.) for Gamma Knife Perfexion radiosurgery quality assurance of the imaging, treatment planning, and dose delivery processes. End-to-end testing of the Perfexion and Gamma Plan version 10.1 has not been previously examined in literature. The phantom was imaged using both the CT and T1- and T2-weighted MR sequences used for treatment planning. For imaging, the isocentric volume insert and fiducial markers were positioned within the phantom. Scans were transferred to the Gamma Plan treatment planning system and were evaluated for geometric and fusion accuracy. A plan was created to deliver 12Gy to the 50% isodose line to the 5.25cm3 volume. During dose delivery, Gafchromic EBT2 film was positioned in the film insert to replicate the position of the target volume. Dose results were analyzed using RIT software (Radiologic Imaging Technology, Inc.). Image fusion integrity was inspected by overlaying the MR and CT markers (5 fiducial markers spaced 5mm apart) and visually examining the resulting volume insert overlap between the three scans. Geometric accuracy was evaluated by contouring three volumes using Gamma Plan contouring tools. Agreement within 1.1%, 6.7% and 12.2% of the actual volumes was seen with the T1-weighted, T2-weighted, and CT images, respectively. The volume-based acquisition and 1mm slice thickness of the T1-weighted sequence resulted in the most accurate measurement. Geometric measurements along two dimensions showed acceptable accuracy for all imaging modalities within 1.6%. Dosimetry results agreed well with the planned dose. The EBT2 film was calibrated for absolute dose measurements using a dose calibration curve for 0.1-30 Gy and the calibration curve was verified to have <3% error above 1Gy. The Lucy phantom allows for comprehensive quality assurance testing of the Gamma Knife Perfexion radiosurgery process.