We report the case of a 52-year-old man undergoing routine screening colonoscopy who was found to have a 3-cm submucosal mass in the sigmoid colon. Initial biopsy demonstrated S100 positivity, raising suspicion for gangl...We report the case of a 52-year-old man undergoing routine screening colonoscopy who was found to have a 3-cm submucosal mass in the sigmoid colon. Initial biopsy demonstrated S100 positivity, raising suspicion for ganglioneuroma (GN). Endoscopic ultrasound revealed a large hypoechoic submucosal lesion, and due to concern for possible gastrointestinal stromal tumor, size, and partial obstruction, the patient underwent partial colectomy. Surgical pathology confirmed a polypoid GN without atypia. Colonic GNs are rare, benign tumors derived from neural crest cells that may mimic other subepithelial lesions. Complete excision is typically curative, and though recurrence is uncommon, some experts advise follow-up imaging to monitor.
Neonatal sepsis remains a leading cause of morbidity and mortality among newborns worldwide, despite recent advances in recognition and management. Both early-onset and late-onset sepsis present significant challenges fo...Neonatal sepsis remains a leading cause of morbidity and mortality among newborns worldwide, despite recent advances in recognition and management. Both early-onset and late-onset sepsis present significant challenges for neonates, particularly those born prematurely or with low birth weight. The severity and progression of the condition can be influenced by factors such as the timing of exposure, the host's immune response, and the virulence of the infecting pathogen. As intrapartum screening methods, novel diagnostic studies, and targeted antibiotic management strategies continue to evolve, it is essential for the practicing provider to understand the implications of this condition and to recognize and manage it appropriately.
Relative energy deficiency in sport (REDs) is a multisystem syndrome resulting from chronic low energy availability that impairs metabolic, reproductive, skeletal, cardiovascular, and psychological health in athletes of...Relative energy deficiency in sport (REDs) is a multisystem syndrome resulting from chronic low energy availability that impairs metabolic, reproductive, skeletal, cardiovascular, and psychological health in athletes of all genders. This article reviews the epidemiology and pathophysiology of REDs and outlines major complications, including low bone mineral density, stress fractures, infertility, and potential vascular dysfunction/cardiometabolic effects. Sex-specific considerations, including functional hypothalamic amenorrhea in females, are also explored. A practical diagnostic approach highlights focused history-taking, targeted laboratory evaluation, and application of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool Version 2 for risk stratification. Management strategies center on restoring adequate energy availability through nutritional rehabilitation and training modification, supported by psychological care, optimization of calcium and vitamin D, and selective use of hormonal or bone-active therapies in refractory cases. Because many at-risk athletes first present to primary care, this article focuses on equipping clinicians with the knowledge and tools needed to recognize, evaluate, and manage REDs and to coordinate multidisciplinary care to prevent long-term morbidity.
Lipoprotein(a) (Lp(a)) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), independent of traditional risk factors such as low-density lipoprotein cholesterol (LDL-C). Major societies...Lipoprotein(a) (Lp(a)) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), independent of traditional risk factors such as low-density lipoprotein cholesterol (LDL-C). Major societies now broadly recognize Lp(a) as an independent cardiovascular risk factor, recommending universal screening among adults or at least targeted screening among select higher-risk groups. This article synthesizes current knowledge of the biochemistry, pathophysiology, clinical significance, laboratory assessment, available management options, and emerging therapies for elevated Lp(a) levels. Many guidelines suggest that Lp(a) testing is ready for broader clinical implementation, and its integration into routine practice may assist health care providers in identifying individuals at elevated cardiovascular risk and tailoring preventive interventions accordingly.
OBJECTIVE: Peer-led discussion groups incorporating mindfulness-based tools have proven effective in improving clinician well-being in predominantly outpatient and nonclinical settings. In this study, peer-led discussion...OBJECTIVE: Peer-led discussion groups incorporating mindfulness-based tools have proven effective in improving clinician well-being in predominantly outpatient and nonclinical settings. In this study, peer-led discussion sessions were piloted in the inpatient setting with hospitalist advanced practice providers (APPs) and physicians, with the primary aim of increasing mindfulness, fostering connection, and testing intervention feasibility. METHODS: We piloted 27 peer-led discussion sessions from March 2022 through December 2023. Aims were assessed through voluntary anonymous surveys following 20 of the sessions (5 virtual, 15 in-person). RESULTS: A total of 86 survey responses were collected from attendees after 20 sessions. Survey responses showed participants felt the sessions created a space for mindfulness (86/86 responses, 100.0%), increased connection with colleagues (85/86, 98.8%), and were feasible to fit in the workday (81/86, 94.2%). CONCLUSION: The results of this exploratory pilot suggest that peer-led discussion sessions may be an effective and feasible way to increase mindfulness and foster connection among colleagues in inpatient hospitalist practice.
OBJECTIVE: Most physician associates (PAs) who leave their clinical jobs will pursue another clinical position, though a smaller subset leave clinical practice entirely. Job change research tends to focus on PAs who leav...OBJECTIVE: Most physician associates (PAs) who leave their clinical jobs will pursue another clinical position, though a smaller subset leave clinical practice entirely. Job change research tends to focus on PAs who leave their clinical roles for another clinical position; PA departure from clinical practice altogether is understudied. The purpose of this study was to explore the reasons behind why PAs leave clinical medicine to pursue nonclinical career options. METHODS: Interviews were conducted with nonclinical PAs to assess their reasons for leaving clinical practice. RESULTS: Although the reasons the study participants left clinical practice were multifactorial, burnout was widely expressed as a top contributor. Other reasons included but were not limited to lack of professional advancement opportunities, financial considerations, lack of flexibility, and poor work-life balance. CONCLUSIONS: Burnout was a key factor for leaving clinical practice, though other important reasons were also discovered. Understanding these factors could influence future PA retention plans and elucidate career trends in the profession.
Initially identified as a respiratory illness, COVID-19 has increasingly been linked to a range of neurologic complications, including myelitis, acute disseminated encephalomyelitis, and Guillain-Barré syndrome. Potentia...Initially identified as a respiratory illness, COVID-19 has increasingly been linked to a range of neurologic complications, including myelitis, acute disseminated encephalomyelitis, and Guillain-Barré syndrome. Potential signals of central nervous system involvement-either during active infection or in the postinfectious period-include ataxia and cognitive changes. Though rarely observed in the setting of COVID-19 infection, these neurologic symptoms can be serious, and therefore, providers should maintain a high index of suspicion for central nervous system involvement in patients with current or recent COVID-19 infection. This article presents a rare case of concurrent cerebellitis and corpus callosum cytotoxicity after SARS-CoV-2 infection.
More than one-fifth of the US population has hearing loss, a condition associated with higher risk of falls, depression, isolation, cognitive decline, dementia, and all-cause mortality. Treatment of hearing loss has been...More than one-fifth of the US population has hearing loss, a condition associated with higher risk of falls, depression, isolation, cognitive decline, dementia, and all-cause mortality. Treatment of hearing loss has been shown to correlate with decreased risk of cognitive decline, dementia, and mortality, as well as an improved quality of life. Surprisingly, however, fewer than 1 in 10 Americans with hearing loss use hearing aids. As the prevalence and burden of hearing loss grow, clinicians must understand factors influencing hearing aid use to increase treatment rates. This article reviews key barriers to hearing aid adoption-including low hearing health knowledge, inadequate screening, stigma, cost, and difficulty of use-and discusses recent changes that may influence these barriers.
Body dysmorphic disorder (BDD) is a psychiatric condition characterized by obsessive preoccupation with perceived flaws in appearance, causing significant dysfunction in daily life. BDD is often misdiagnosed due to patie...Body dysmorphic disorder (BDD) is a psychiatric condition characterized by obsessive preoccupation with perceived flaws in appearance, causing significant dysfunction in daily life. BDD is often misdiagnosed due to patient concealment and its overlap with other mental health disorders. Increasing clinician awareness can overcome the diagnostic challenges presented by BDD. Early-onset BDD, particularly in adolescents, is associated with an increased risk of comorbidities and suicide. BDD may present with subthreshold symptoms before meeting full diagnostic criteria or before the patient discloses symptoms, creating an opportunity for earlier detection in primary and specialty care. Although first-line treatment consists of cognitive behavioral therapy and serotonin reuptake inhibitors, additional research and therapies are needed as many patients do not achieve full symptom remission. Early recognition and accurate diagnosis of BDD are vital for improving quality of life and optimizing long-term patient outcomes.
Effective pain management without the risk of addiction, abuse, or dependence associated with opioids remains a key clinical challenge in patient care. Suzetrigine, a newly approved drug for acute pain management, is a n...Effective pain management without the risk of addiction, abuse, or dependence associated with opioids remains a key clinical challenge in patient care. Suzetrigine, a newly approved drug for acute pain management, is a nonopioid with a novel mechanism of action: it selectively targets voltage-gated sodium channels present only on peripheral, pain-sensing nerves. In phase 2 and 3 clinical trials, suzetrigine was found to be more effective for post-abdominoplasty and -bunionectomy pain than placebo and was noninferior to an opioid-acetaminophen combination for pain following abdominoplasty. The drug, which is taken twice daily for up to 14 days postoperatively, has shown no addiction or physical dependence risk to date in either animal or human studies. Suzetrigine expands options for acute pain management, and additional studies that further expanding on the drug's current indication are underway.
As physician associates (PAs) and advanced practice registered nurses (APRNs) have steadily increased in numbers within the clinical realm, attention needs to be given to their career development. Some institutions have...As physician associates (PAs) and advanced practice registered nurses (APRNs) have steadily increased in numbers within the clinical realm, attention needs to be given to their career development. Some institutions have created professional advancement models (PAMs) to address career development for these professionals. These programs have the potential to decrease burnout, improve professional satisfaction, and increase retention. However, for advanced practice providers (APPs) to be successful in PAMs or to excel professionally at institutions without PAMs, they need academic and leadership skills, which vary widely among individuals. In this article, we share a career development framework, developed at the University of Chicago, to foster workplace-based academic and leadership skills development among APPs. L.E.A.D. encompasses 1) leadership (L) roles and opportunities, 2) embedding (E) interests in existing structures, and 3) academic (A) development (D) to provide a framework for diversifying APP careers and enhancing professional satisfaction.
OBJECTIVE: To update the National Physician Associate Research Agenda by identifying research priorities aligned with current health care delivery, policy, and education needs. METHODS: A cross-sectional survey of 127 Am...OBJECTIVE: To update the National Physician Associate Research Agenda by identifying research priorities aligned with current health care delivery, policy, and education needs. METHODS: A cross-sectional survey of 127 American Academy of Physician Associates (AAPA) leaders assessed the importance of 20 predefined research topics using Likert-scale ratings. Open-ended responses related to the top five priorities underwent thematic analysis. RESULTS: Patient outcomes, cost-effectiveness, and access to care associated with physician associate (PA) utilization were rated as the top research priorities, followed by PA role expansion and readiness to practice. Qualitative themes highlighted the need for empirical evidence to drive legislative reform, strengthen public trust, and affirm the profession's legitimacy. Structural barriers such as billing constraints and scope-of-practice laws were also noted. CONCLUSIONS: These findings offer a leadership-informed roadmap to guide research that advances the PA profession's contributions to cost-effective care, health equity, and workforce resilience. By centering priorities on patient outcomes, access, role expansion, and readiness to practice, the agenda supports future research that drives innovation, informs policy, and sustains PA relevance in a dynamic health care system.
Advanced practice providers (APPs) are essential to health care delivery in the United States. As the nationwide physician shortage intensifies and scope-of-practice laws better align with APP training and skills, APPs w...Advanced practice providers (APPs) are essential to health care delivery in the United States. As the nationwide physician shortage intensifies and scope-of-practice laws better align with APP training and skills, APPs will play an increasingly vital role in delivering high-quality care. The transition to practice (TTP) period for novice and new-to-practice-area APPs is often associated with stress that may result in dissatisfaction and attrition at a significant cost to the institution. Structured onboarding and TTP programs are recognized as key drivers in developing APP confidence and clinical practice while reducing attrition. Organizational orientation, competency validation, protected learning time, and gradual ramp-up to full productivity are essential components to successful onboarding and TTP. This article explores an approach to developing and implementing a standardized onboarding and TTP program at a large regional community health system.