Swedish Hospital (formerly Swedish Covenant Hospital) is a 312-bed nonprofit teaching hospital located on the north side of Chicago, Illinois. The hospital offers over 50 medical specialties, including neurosurgery for the spine and brain, integrative cancer care, heart services (including electrophysiology), women's health services, childbirth and emergency services. The hospital has more than 600 physicians and 2,500 employees. The hospital is accredited by the American Osteopathic Association's Healthcare Facilities Accreditation Program.Swedish Hospital was founded in 1886, and historically affiliated with the Evangelical Covenant Church (also called, Swedish Covenant church, as its members in the 19th century were primarily Swedish). In 2019, it announced it would become part of NorthShore University HealthSystem.
BACKGROUND AND OBJECTIVES:Primary care continues to face pressure to improve clinical outcomes with limited resources. Point-of-care ultrasound (POCUS) offers potential value by improving diagnostic efficiency and procedural safety; yet early adoption in family medicine has been limited by faculty expertise, time constraints, and infrastructure barriers. In 2014, we developed a structured POCUS curriculum to address resident demand and programmatic gaps in family medicine training. METHODS:We implemented a 4-week required postgraduate year (PGY) one ultrasound rotation designed to function with limited faculty availability. The curriculum integrates asynchronous learning, simulation, supervised scanning with standardized patients and sonographers, structured image review, and competency assessment. Residents complete a defined number of scans in high-yield applications including cardiac, lung, abdominal aorta, venous thrombosis, musculoskeletal/soft tissue, and obstetric ultrasound. Longitudinal reinforcement was later added through quarterly hands-on sessions and a PGY-3 advanced ultrasound rotation emphasizing competency reassessment and near-peer teaching. RESULTS:Over 10 years, faculty capacity expanded primarily through training program graduates. An alumni survey (2015-2022 graduates; 58% response rate) demonstrated continued POCUS use in 44% of respondents, with higher utilization among rural physicians and billing rates exceeding national primary care averages. Common barriers included time constraints and equipment access, while skin/soft tissue, musculoskeletal, and procedural applications were most frequently used. CONCLUSIONS:A scalable, longitudinal POCUS curriculum in family medicine is feasible despite limited protected faculty time. Tailoring training to anticipated practice settings, emphasizing ambulatory-relevant applications, and addressing workflow and billing education may improve long-term adoption and sustainability.
Background:Ultrasound-guided nerve blocks (UGNBs) are increasingly incorporated into multi-modal analgesia in the Emergency Department (ED). Despite their growing adoption, there is no consensus defining when an Emergency Medicine (EM) clinician is competent to perform UGNBs. Training methods, assessment approaches, and credentialing standards remain highly variable across institutions. The objective of this study was to define competency in UGNBs for EM physicians through a modified Delphi method that included national experts in EM and Anesthesia. Methods:A comprehensive librarian-assisted literature review informed the development of a 123-item questionnaire covering four domains: defining competency, teaching methods, assessment methods, and ongoing professional practice evaluation. Twenty-seven experts (23 EM, 4 anesthesiology) representing 24 institutions participated in two rounds of electronic voting and discussion. Consensus was defined a priori as 80% agreement. Results:All 27 panelists (100%) completed both rounds. Of 123 items, 61 achieved consensus: 33 items related to defining competency, 14 to teaching methods, 8 to assessment methods, and 6 to ongoing professional practice evaluation related to UGNBs. There was significant debate regarding the minimum number of UGNBs to determine competency and whether UGNBs should be included as a core ultrasound privilege. Conclusion:This multidisciplinary modified Delphi provides the first national consensus defining competency in UGNBs for both practicing and EM physicians in training. The 61 consensus items offer a structured framework for residency curricula, faculty development, clinical privileging, and quality assurance. These recommendations may help guide forthcoming ACGME requirements and support safe, effective integration of UGNBs into emergency medicine training.
Medullary thyroid carcinoma is a neuroendocrine tumor derived from the parafollicular C cells of the thyroid gland. Progressive or atypical cervical symptoms after prior spine surgery may have vertebrogenic or nonvertebrogenic causes and warrant careful evaluation. A 57-year-old non-Hispanic White female with a history of anterior cervical discectomy presented with progressive right-sided neck swelling, throat tightness, dysphagia, and hoarseness. She first noticed a small lump on the right side of her neck approximately one year after her cervical procedure, with gradual enlargement over the following decade and more rapid progression later. Fine-needle aspiration and soft-tissue computed tomography of the neck showed findings concerning for malignancy. She subsequently underwent total thyroidectomy with cervical lymph node dissection, and histopathologic analysis confirmed medullary thyroid carcinoma with metastatic involvement of right cervical lymph nodes. This case highlights the importance of maintaining a broad differential diagnosis in patients with progressive cervical symptoms or neck masses after prior cervical spine surgery. Although no causal relationship can be established between anterior cervical discectomy and medullary thyroid carcinoma, clinicians should remain alert to nonvertebrogenic and potentially malignant causes when the clinical course is atypical or progressive.
NF-κB activating protein (NKAP) plays important roles in various cancers, including breast cancer. However, its expression and prognosis value in breast cancer remains uncertain. Gene expression profiling interactive analysis, Human protein atlas database, and University of Alabama at Birmingham Cancer data analysis portal database were used to predict the expression and prognostic value of NKAP in breast cancer. Immunohistochemistry, quantitative real time polymerase chain reaction (qRT-PCR) and western blot were performed to detect NKAP expression. The effects of NKAP on cell proliferation, migration and drug sensitivity were investigated in MDA-MB-231 and SK-BR-3 cells. NKAP protein expression differed in breast cancer tissues and paraneoplastic tissues based on the cancer genome atlas data. The high NKAP expression was significantly correlated with a poor prognosis in breast cancer patients. The results of immunohistochemistry, western blot assay, and qRT-PCR proved that NKAP was highly expressed in breast cancer tissues compared with paraneoplastic tissues. In addition, qRT-PCR results showed that high expression of NKAP was significantly correlated with the larger tumor size and higher TNM stage. Moreover, knockdown of NKAP significantly inhibited the proliferation, migration, and enhanced drug sensitivity of MDA-MB-231 and SK-BR-3 cells. NKAP is highly expressed in breast cancer tissues, and its high expression is closely associated with poor prognosis. NKAP also promotes proliferation, migration, and inhibits drug sensitivity of breast cancer cells.
