Larkin Community Hospital (LCH) is a for-profit 146-bed general medical, surgical and psychiatric teaching hospital. In the last year with available data, LCH had about 7,523 emergency department visits and 5,792 admissions. Physicians at the hospital performed 794 inpatient and 739 outpatient surgeries.LCH is the only hospital in Miami-Dade County with an Area of Critical Need designation by the Florida Board of Medicine. The hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Hydatid disease, caused by Echinococcus granulosus, commonly affects the liver and can lead to complications such as rupture, secondary infection, and anaphylaxis. While surgery is the traditional treatment for complicated cases, minimally invasive techniques are emerging as viable alternatives. We report a case of a 27-year-old female with a history of gastritis and a pancreatic cyst who presented with acute diffuse abdominal pain and nausea. Imaging revealed an 11.8×8.8×5.2 cm cystic structure in the left hepatic lobe, consistent with a hydatid cyst, with free intraperitoneal fluid concerning for an impending or near rupture. The patient underwent percutaneous drainage of the cyst (puncture, aspiration, injection, and re-aspiration, PAIR technique), yielding 300 cc of serosanguinous fluid. She was started on albendazole therapy and closely monitored. Over nine days of hospitalization, her condition improved, drainage output decreased, and she was discharged in stable condition with a structured follow-up plan. Our report demonstrates that percutaneous drainage with adjunctive albendazole therapy is a feasible and effective alternative to surgery in hemodynamically stable patients with ruptured hepatic hydatid cysts. Further studies are warranted to refine patient selection criteria and optimize long-term outcomes.
The deltoid ligament provides medial ankle stability and resists external rotation, excessive pronation, and abduction by anchoring the medial malleolus of the tibia to the surrounding tarsal bones. It is frequently disrupted in ankle fractures, for which optimal management remains debated. This systematic review and meta-analysis evaluated the current evidence comparing surgical repair versus non-repair of the deltoid ligament in adult patients with ankle fractures. A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library identified prospective randomized controlled trials, with study selection conducted using Covidence by two independent reviewers, with a third reviewer resolving discrepancies. Five studies met the inclusion criteria and reported outcomes, including functional outcomes, postoperative complications, and return-to-work timelines. Meta-analysis demonstrated no significant difference in functional outcomes between repair and non-repair groups (mean difference (MD): 4.57; 95% confidence interval (CI): -3.03 to 12.17; p = 0.24) or return-to-work time (risk ratio (RR): 1.02; 95% CI: 0.65-1.60; p = 0.93); however, complication rates were significantly lower in patients undergoing deltoid ligament repair (RR: 0.43; 95% CI: 0.24-0.77; p = 0.004). While functional outcomes were comparable, deltoid ligament repair was associated with a reduced risk of postoperative complications, suggesting a potential benefit in selected patients, although larger randomized trials are needed to further define its role in ankle fracture management.
BACKGROUND:Wrong-limb blood pressure (BP) measurement is a persistent and preventable clinical error, particularly in patients with limb restrictions such as arteriovenous fistulas, post-mastectomy status, or vascular compromise. Despite documentation in electronic medical records, adherence to limb alerts remains inconsistent, placing patients at risk for complications including fistula thrombosis, lymphedema exacerbation, and vascular injury. Reliance on chart review alone may be insufficient in fast-paced clinical environments. This study evaluated whether a high-visibility limb alert sleeve could improve adherence to limb restrictions and reduce wrong-limb BP cuff placement attempts. METHODS:We conducted a randomized, within-subject crossover simulation study involving 50 clinical staff members, including nurses and ancillary personnel, recruited from inpatient, intensive care unit, surgical, and emergency department settings. Each participant completed both the chart-only and sleeve-present study conditions and therefore served as their own control. Participants obtained vital signs during two simulated patient encounters under different study conditions: (1) chart-only, in which limb restrictions were documented solely within the patient chart, and (2) sleeve-present, in which a high-visibility limb alert sleeve was placed on the restricted arm in addition to chart documentation. The order of conditions was randomized to minimize learning effects. The primary outcome was the rate of wrong-limb BP cuff placement attempts. Secondary outcomes included spontaneous recognition and correction of incorrect initial attempts. Paired statistical analysis was performed using McNemar's test, with significance defined as p < 0.05. RESULTS:Wrong-limb BP cuff placement attempts occurred in 30 of 50 encounters (60%) in the chart-only condition compared with one of 50 encounters (2%) in the sleeve-present condition (p < 0.0001). The paired absolute reduction in wrong-limb BP cuff placement attempts associated with the sleeve-present condition was 58.0% (95% CI: 44.3%-71.7%). The single incorrect attempt observed in the sleeve-present condition was recognized and corrected prior to cuff inflation. CONCLUSIONS:In this simulated clinical study, high-visibility limb alert sleeves significantly reduced wrong-limb BP cuff placement attempts compared with chart-based documentation alone. By providing an immediate visual cue at the point of care, the intervention may help address an important gap in recognition of limb restrictions during routine clinical workflow. Given its straightforward design and visibility at the point of care, the limb alert sleeve may represent a practical strategy to reduce preventable wrong-limb BP cuff placement attempts in patients with limb restrictions. Further studies in real-world clinical settings are warranted to confirm these findings and evaluate long-term effectiveness across broader patient populations.
The rapid worldwide adoption of robotic surgery often outpaces high-level comparative evidence. While evidence-based medicine relies on a hierarchical pyramid where causal inference resides at the apex, most of the scientific output is concentrated at the non-comparative base. It remains unknown whether the directional conclusions of these literature layers are symmetrically aligned. This study aimed to map the structural distribution of conclusions across the evidence hierarchy in visceral robotic surgery to evaluate potential narrative discordance. A stratified random sampling of intracavitary robotic surgery publications (thoracic, abdominal, and pelvic) was conducted from PubMed (1997–2026). Our sample size was calculated to achieve maximum representativeness (n = 800). Publications were equally partitioned into two pragmatic functional layers based on the presence of a control group: the Upper Hierarchy Zone (comparative layer, n = 400) and the Lower Hierarchy Zone (non-comparative layer, (n = 400). Directional orientations of author conclusions were operationally categorized as Favorable, Neutral, or Unfavorable. To ensure non-biased processing and scalability, semantic classification was executed via a Large Language Model (GPT-5.4), previously validated against a three-evaluator human pilot trial (absolute agreement 92
