Scripps Health is a nonprofit health care system based in San Diego, California. The system includes five hospitals and 19 outpatient facilities, and treats a half-million patients annually through 2,600 affiliated physicians.The system also includes clinical research and medical education programs.The Scripps name dates to 1924 when philanthropist Ellen Browning Scripps established Scripps Memorial Hospital and the Scripps Metabolic Clinic in La Jolla, California. Scripps Mercy Hospital joined the system in 1995, and was founded in 1890 making it San Diego's oldest hospital. Other facilities are Scripps Green Hospital, Scripps Memorial Hospital Encinitas, the Scripps Clinic and Scripps Coastal Medical Center.In 2002, Scripps Health switched its hospital buying agent from Novation to MedAssets. Scripps Health had issues with fees that Novation had collected from medical supply companies. Scripps estimated that the agreement with MedAssets would save $20 to $25 million per year of the $212 million the hospital network spent annually on supplies.The company was ranked 37th by Forbes magazine on its 2011 list of the "100 Best Companies to Work For", citing the company's retirement program and contribution.
BACKGROUND:Morel-Lavallee lesions are traumatic closed degloving injuries. Operative intervention remains the primary treatment approach. However, high-quality postoperative outcomes data are limited. This study aimed to determine the rate of wound complications associated with Morel-Lavallee lesions and identify risk factors for postoperative wound complications. METHODS:A prospective, multicenter, observational study (2021-2024) was conducted across 15 trauma centers. Adult patients with a Morel-Lavallee lesion who underwent operative management were included. The primary outcome was incidence of wound complications, defined as cellulitis, deep wound infection, skin necrosis, necrotizing soft tissue infection, and organized hematoma. Multivariable logistic regression was performed to identify predictors of wound complications. RESULTS:Among 134 patients who underwent operative intervention for Morel-Lavallee lesions, 27 (20.1%) developed a postoperative wound complication. Wound complications included skin necrosis (n = 10, 7.5%), deep wound infection (n = 9, 6.7%), cellulitis (n = 7, 5.2%), organized hematoma (n = 7, 5.2%), and necrotizing soft tissue infection (n = 3, 2.2%). In patients with wound complications, more frequent mechanisms of injury were bicycle collision (14.8% vs. 1.9%, P = .004) and pedestrian struck by motor vehicle (37.0% vs. 15.0%, P = .010). On multivariable analysis, only pedestrian struck by motor vehicle mechanism of injury (odds ratio 3.44, 95% CI 1.29-9.17, P = .014) was an independent predictor of increased wound complications when also controlling for closure of dead space, current tobacco use, and diabetes. CONCLUSION:More than one fifth of patients undergoing operative management of Morel-Lavallee lesions developed a postoperative wound complication. The only independent predictor of wound complications was pedestrian struck by motor vehicle mechanism of injury. These findings may help guide patient counseling.
The middle ear is an anatomic region that many pathologists may not feel comfortable reviewing. A variety of neoplastic and non-neoplastic lesions may occur in this anatomically complex space, but specimens are uncommon so the full spectrum of alterations remains obscure. This study was prompted by anecdotally encountered cases of unexpected S100 and PAX8 expression in middle ear specimens which led to diagnostic confusion.Twelve cases of otitis media were studied. In each case there was no clinical or radiological suspicion for neoplasia. Immunohistochemistry for S100 and PAX8 were performed on each case, with SOX10 and CD1a also done on a subset.Varying degrees of S100 immunoexpression was seen in the middle ear stroma of 12 cases, while the same cells were negative for SOX10 (0 of 11) and CD1a (0 of 3) in all cases tested. PAX8 was positive in the cuboidal middle ear epithelium in 11 of 11 tested cases. Expression was seen both in the lining surface components as well as in areas of glandular metaplasia.S100 is unexpectedly positive in middle ear stroma, a finding which can lead to diagnostic confusion, particularly for nerve sheath tumors. PAX8, on the other hand, is unexpectedly positive in middle ear epithelium, a pitfall for diagnosing various neoplasms, especially endolymphatic sac tumor of the inner ear. Awareness of these immunoexpression patterns will help avoid misdiagnoses. In particularly difficult cases, additional immunohistochemistry and clinical/radiographic correlation can clarify the diagnosis.
This review highlights extracorporeal cardiopulmonary resuscitation (ECPR), the rapid deployment of veno-arterial extracorporeal membrane oxygenation as salvage therapy for refractory cardiac arrest. The goal is to bridge patients to recovery or advanced therapies, with outcomes dependent on patient selection (witnessed arrest, shockable rhythm, younger age, and limited comorbidities) and minimizing "low flow" time. ECPR is now applied across intraprocedural, critical care, and out-of-hospital settings. Initiation after failed early resuscitation requires precise choreography, with survival hinging on experienced, well-rehearsed teams capable of rapid, coordinated responses tailored to the arrest context.
PURPOSE:To evaluate the feasibility of developing an artificial intelligence application for real-time specimen adequacy assessment during ultrasound-guided fine needle aspiration of the thyroid gland using small, locally derived datasets and open-source AI tools. MATERIALS AND METHODS:1,244 photomicrographic images of thyroid needle aspiration slides were used to develop training and testing datasets for a YOLOv5 convolutional neural network model. In silico performance was tested for standard metrics. The model was deployed in an application featuring a live, augmented reality microscopy display. Hands-on testing was performed using a set of 50 blinded patient specimens tested in duplicate (N=100) by human observers with no prior formal training in pathology. RESULTS:On an independent static image test set, the CNN achieved an AUROC of 0.954 (95% CI, 0.922-0.986) using images acquired with a dedicated microscope camera, with sensitivity 0.969, specificity 0.933, and accuracy 95.5%. Using images acquired with a smartphone camera, performance improved to an AUROC of 0.983 (95% CI, 0.965-1.000), with sensitivity 0.980, specificity 1.000, and accuracy 98.8%. In a simulated clinical workflow, human users assisted by the augmented reality AI tool demonstrated 96% concordance with the reference standard FNA adequacy assessment. CONCLUSION:An augmented reality microscopy tool based on a small-model CNN showed feasibility for performing real-time assessment of thyroid FNA specimen adequacy. Such a tool can enable telecytologic support of FNA assessment in radiologic facilities without an on-site pathologist.
AIMS:Traditional cardiac pacing and defibrillation devices rely on leads connected to a subcutaneous pulse generator, which can result in complications such as vascular damage, infection, or lead failure. Advances in technology have led to the development of leadless pacemakers, which combine the battery, circuitry, and electrodes into a single self-contained unit, and extravascular implantable cardioverter-defibrillators (ICDs), which position electrodes outside the vasculature. These innovations offer promising alternatives for patients requiring both defibrillation and pacing, particularly those unable or unwilling to accommodate traditional leads. However, the interactions between extravascular ICDs and leadless pacemakers remain largely unexplored and currently lack regulatory approval for combined use. This study evaluates the interactions between leadless pacemakers and extravascular ICDs to assess their simultaneous operation. METHODS AND RESULTS:In-silico simulations, saline-tank experiments, and Monte Carlo simulations were conducted to evaluate device interactions, focusing on ventricular fibrillation (VF) detection during pacing conditions. Ventricular fibrillation detection was unaffected by pacing pulse widths ≤0.24 ms, with a pacing pulse-to-VF amplitude ratio of ≤2 considered safe. Wider pulse widths or higher outputs progressively increased the risk of VF undersensing. Experiments confirmed that pacing pulses ≤3 V and ≤0.24 ms minimally impacted VF detection. Proximity of device affected pacing pulse amplitude sensed by the ICD, but pacemaker orientation did not. Monte Carlo simulations indicated a 0-4% probability of undesired interactions under clinically relevant conditions. CONCLUSION:Extravascular ICDs and leadless pacemakers may safely coexist, with a low observed risk of VF undersensing in our study. Further clinical studies are needed to confirm these findings.
