The American journal of medicine
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Management of high-risk surgical patients with cholecystitis poses a significant clinical problem. These patients are often left with the options of permanent cholecystostomy tube drainage or high-risk surgery. Numerous attempts have been made over the past 4 decades to fulfill the need for a minimally invasive, definitive treatment option for such gallbladder disease. ⋯ Cryoablation, a thermal ablation modality that induces cell death through tissue freezing, has recently emerged as a promising potential option to treat gallbladder disease. Early studies have demonstrated good technical and clinical success, and a prospective trial is ongoing. This manuscript explains the clinical need for gallbladder cryoablation, briefly revisits historical minimally invasive treatments, describes cryoablation technology and why it is well suited for the gallbladder, and reviews the preclinical and clinical studies evaluating the safety and efficacy of gallbladder cryoablation.
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Observational Study
Retention of Point-of-care Ultrasound Skills among Practicing Physicians: Findings of the VA National Point-of-care Ultrasound Training Program.
Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. ⋯ Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
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Observational Study
Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction.
Complex medication regimens, often present in heart failure with preserved ejection fraction, may increase the risk of adverse drug effects and harm. We sought to characterize this complexity by determining the prevalence of polypharmacy, potentially inappropriate medications, and therapeutic competition (where a medication for 1 condition may worsen another condition) in 1 of the few dedicated heart failure with preserved ejection fraction programs in the United States. ⋯ In addition to confirming that polypharmacy was highly prevalent, we found that potentially inappropriate medications and therapeutic competition were also frequently present. This supports the urgent need to develop patient-centered approaches to mitigate the negative effects of complex medication regimens endemic to adults with heart failure with preserved ejection fraction.
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Observational Study
Adherence to stepped care for management of musculoskeletal knee pain leads to lower healthcare utilization, costs, and recurrence.
This study aimed to report compliance with stepped care management of patellofemoral pain and determine whether adherence to stepped care results in decreased recurrence and lower health care utilization. ⋯ These findings demonstrate the value of following stepped care guidelines for pain management in patients with patellofemoral pain.
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The 30-day direct oral anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. ⋯ A significant proportion of patients using direct oral anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate direct oral anticoagulant starter pack prescription and evaluate efforts to reduce this practice.