拉什大学

Background Pediatric patients who have suffered an acute traumatic injury are at an increased risk for developing mental health disorders, such as acute stress disorder (ASD). With traumatic injuries as the leading cause of emergency room visits and deaths in the pediatric population, ASD is expected to continue rising. The American College of Surgeons recently mandated screening for traumatic stress symptoms in pediatric Level I and Level II trauma centers. Objective The purpose of this quality improvement project was to achieve an 80% adherence rate for administration of a validated screening tool to pediatric patients admitted for a traumatic injury in an 18-month period. Methods The trauma social worker and trauma nurse practitioner administered the screening tool to eligible patients who suffered an acute traumatic injury. A patient's score was calculated from their questionnaire responses, determining the level of risk for developing mental health disorders. The percentage of eligible patients that received a screening tool, the patient's level of risk for developing acute stress symptoms, the mechanism of injury sustained, and the resources given to patients were collected and analyzed during the QI project (January 1, 2024 – June 30, 2025). Results Over an 18-month period, 118 patients completed screenings for ASD by receiving the Acute Stress Checklist for Kids-6. 25% of the patients who completed a screening tool showed symptoms for developing acute stress disorder. Of these 118 participants, 50 patients (42.3%) suffered an interpersonal injury, with 39 patients (33%) of the patients sustaining a firearm injury. Conclusions The results of this project suggest that implementing a process to ensure this hospital was identifying patients at risk for developing mental health problems, such as acute stress disorder, through administration of a validated screening tool allowed for goal adherence of screening tool administration.

Purpose Costs of outpatient hand procedures vary widely, and the influence of social determinants of health is not well characterized. Machine learning (ML) offers a way to quantify cost drivers and identify disparities. We sought to (1) assess whether ML models can accurately predict the costs of common outpatient hand procedures (2) identify cost determinants and (3) assess whether socioeconomic or racial disparities exist in cost patterns. Methods A retrospective cohort study was conducted using the New York State Ambulatory Surgery and Services Database (2015–2018) including patients undergoing open carpal tunnel release, endoscopic carpal tunnel release, trigger finger release, and distal radius fracture open reduction and internal fixation. ML models were trained to predict total procedure costs, and feature importance analyses identified key cost drivers. Associations between costs, Social Deprivation Index quintiles, and racial/ethnic composition were evaluated using Kruskal-Wallis and Dunn’s tests and Pearson/Spearman correlations. Results ML models trained on 61,460 patients demonstrated strong predictive performance. Patient zip code and hospital identifier were consistently top cost predictors. Significant disparities were observed: higher costs were associated with both high and low extremes of Social Deprivation Index, as well as higher proportions of Asian, Black, and Hispanic patients. In contrast, White patients were overrepresented in lower-cost quartiles. Conclusions ML accurately predicted procedure costs and revealed consistent socioeconomic and racial disparities in cost patterns for common outpatient hand surgeries. These findings highlight the need for value-based policies designed to reduce inequities and improve access to high-quality, affordable surgical care. Type of study/level of evidence Therapeutic III.

This review examines the unique cardiovascular disease patterns in older women, focusing on sex and age-specific pathophysiology, diagnostic challenges, and disparities in management. We aim to clarify how aging and hormonal transitions influence disease presentation and outcomes among women, and to identify gaps in cardiovascular care. Emerging data demonstrate that older women are disproportionately affected by HFpEF, coronary microvascular dysfunction, atrial fibrillation, and valvular heart disease. These conditions are influenced by vascular stiffness, myocardial remodeling, and systemic inflammation and often present with atypical symptoms leading to diagnosis delays. Contemporary studies highlight persistent gaps in timely diagnosis, referral for advanced therapies, and representation in clinical trials. Increasing attention is being directed toward frailty, multimorbidity, and patient-centered care models in this population. Recognizing age and sex-specific characteristics, increasing representation of older women in clinical trials, improving equitable access to diagnostic and therapeutic resources, and aligning treatment decisions with patient priorities are critical to narrowing existing gaps and improving long-term outcomes for older women with cardiovascular disease.

Psychodermatology, an emerging subspecialty at the intersection of dermatology, psychiatry, and psychology, addresses the bidirectional relationship between skin disease and mental health. Psychological stress, anxiety, and trauma can exacerbate dermatologic conditions, while chronic skin diseases often precipitate significant psychological distress, reduced quality of life, and psychiatric comorbidities. Despite mounting evidence of this burden, psychodermatologic care remains underrepresented in dermatology training, leading to underdiagnosis, suboptimal management, and fragmented care. This narrative review proposes a pragmatic, scalable framework for integrating mental health into dermatologic practice within the U.S. healthcare system, comprising three core components: routine psychological screening with defined score thresholds, standardized referral pathways, and tiered follow-up actions. This framework is intended to guide, rather than replace, clinical judgment and specialty psychiatric care. We outline validated screening tools, practical referral models adaptable to diverse settings, and strategies for maintaining interdisciplinary communication, including telehealth integration. The framework emphasizes cultural sensitivity, acknowledging global disparities, stigma, and variations in symptom expression that affect care delivery. Implementation considerations include the need for enhanced psychodermatology training in medical education, systemic and financial barriers to integrated care, and the potential cost-effectiveness of collaborative models. The proposed approach aims to normalize mental health screening in dermatology, reduce stigma, and improve patient outcomes through early identification, timely intervention, and coordinated management of psychocutaneous disorders. By offering a flexible yet structured model, this review provides a foundation for both immediate clinical adoption and future research into sustainable, equitable psychodermatologic care.

Peer Instruction (PI) has demonstrated benefits in STEM education, but its effectiveness as a distinct instructional method in health professions education remains uncertain. This systematic review identified 17 eligible studies implementing Mazur’s PI framework in medical and dental education, with 12 contributing to meta-analyses. PI yielded large within-session conceptual gains (Hedges’ g ≥ 1.48; p < 0.001) but showed no performance superiority over alternative instructional approaches (p = 0.082). 74