The Robert Wood Johnson University Hospital (RWJUH) is an American 965-bed hospital with campuses in New Brunswick (Robert Wood Johnson University Hospital New Brunswick), and Somerville, New Jersey (Robert Wood Johnson University Hospital Somerset), and serves as a flagship hospital of RWJBarnabas Health.RWJUH New Brunswick is the flagship cancer hospital of the Rutgers Cancer Institute of New Jersey and the principal hospital of Rutgers University's Robert Wood Johnson Medical School. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women's and children's care including The Bristol-Myers Squibb Children's Hospital at RWJUH, which has several areas of pediatric care. The hospital is also a Level 1 trauma center and serves as a national resource in its ground-breaking approaches to emergency preparedness..
OBJECTIVES:Systemic sclerosis-associated heart involvement (SHI) is an enigmatic disease manifestation associated with high mortality. The Scleroderma Clinical Trials Consortium (SCTC) Cardiac Working Group developed SHI classification criteria to enable systematic investigation of this condition. METHODS:An international, interdisciplinary working group was assembled. Using consensus methods and existing literature, provisional SHI classification criteria items were developed. Continuous consensus exercises and a discrete choice experiment were performed to reduce items and derive individual item weights. The sensitivity and specificity of the classification criteria were tested in an independent cohort (n = 168) of SHI (cases) and non-SSc heart disease (controls). RESULTS:The working group agreed that the SCTC SHI Classification Criteria should identify the direct effects of SSc on the heart and exclude the complications of other SSc manifestations or cardiac comorbidities. The final classification criteria include 23 items measuring cardiac fibrosis, inflammation, arrhythmias and small vessel vasculopathy. No single item is pathognomonic for SHI, with a requirement for the presence of abnormalities across multiple histopathological, imaging, serological, and imaging domains to be present to secure a diagnosis. A classification criteria score of ≥11 identified SHI with a sensitivity of 78% and specificity of 96%, with an area under the curve of 0.87 (0.80-0.93). This threshold correctly identified >90% of cases of SHI. CONCLUSION:The newly derived SCTC SHI Classification Criteria have high sensitivity and specificity for SHI. Application of these criteria will enable standardized classification of patients in studies to facilitate future investigation of this important disease manifestation.
Background It has been well established that mortality associated with cardiogenic shock is as high as 50-70%. Furthermore, prompt recognition and management of cardiogenic shock early in the course of shock leads to the most impactful reduction in patient mortality and morbidity. The Society for Cardiovascular Angiography & Interventions (SCAI) has introduced a since validated staging system for classification of cardiogenic shock. We sought to synthesize the key elements of the SCAI staging system to generate a mnemonic that is easy to remember and implement at the bedside-termed “HELP-US”. We then compared the number of cardiogenic shock cases as indicated by ICD 10 diagnosis code at our tertiary hospital pre- and post- implementation of the “HELP-US” cardiogenic shock recognition campaign. Methods The cardiogenic shock committee collaborated with the nursing education department to create a campaign on recognizing Cardiogenic Shock. This mnemonic was shared with all of the nursing sand clinical staff to help them remember the signs and symptoms of cardiogenic shock. Clinicians were educated on the 5 stages of cardiogenic shock according to the SCAI guidelines, and a learning module with test questions was created for all nursing staff. Results There has been an increase in the number of cardiogenic shock patients in the 4th quarter of 2024. The number of patients per month in the 4th quarter is about 50, as opposed to the beginning of the year at about 40 per month. Despite complexity of cardiogenic shock patients with high case mix index, we have seen a slight decrease in the overall mortality rate for cardiogenic shock since the implementation of the cardiogenic shock team. Conclusion To enhance provider recognition of signs and symptoms of cardiogenic shock, we have devised our own “HELP-US” mnemonic which captures the central tenets of the SCAI staging system. Through education and enhanced awareness, we have seen an increase in the reported number of cardiogenic shock cases as well as a reduction in patient mortality.
Background Oral melanoma is a rare form of melanoma that typically presents as a black‐brown macule or nodule with variable pigmentation and occasional depigmented areas. Oral melanoma typically affects the maxillary gingiva, palate, and retromolar trigone, and tends to be aggressive with high propensity for distant spread and poor prognosis. We report a patient with metastatic visceral melanoma who, upon presentation for dental care, was found to also have advanced gingival melanoma with bone involvement. This may support the oral cavity as the primary site and represents a missed opportunity for early diagnosis. Case Description A 61‐year‐old male presented to the emergency department with 20 pound weight loss and groin pain. Imaging work‐up demonstrated liver masses, retroperitoneal lymphadenopathy, and lung nodules suspicious for metastatic disease. He returned to the emergency department 3 weeks later with a toothache and was instructed to follow up in the dental clinic in the hospital for tooth extractions. At this visit, discoloration of the gingiva was noted in the anterior maxilla (Teeth #6–9), and a biopsy confirmed the likely primary malignant site: oral melanoma. Practical Implications This case highlights the importance of detecting melanoma in the oral cavity. Although rare, oral melanoma has a low five‐year survival rate, and dentists must conduct a thorough head and neck exam with proper referral and follow up for any suspicious lesions.
