Best Practices for Optimizing Patients Undergoing Surgical Procedures to Prevent Postoperative Venous Thromboembolism: A Quality Improvement Project.

Introduction Current studies suggest that both chemical and mechanical venous thromboembolism (VTE) prophylaxis is underused, which is concerning due to the potential lethality of VTEs. The Caprini risk score is a preoperative VTE risk assessment that determines a patient's risk of enduring a VTE. The objective of this study was to examine postoperative cases of VTE to determine if accurate VTE risk stratification was performed and whether appropriate VTE prophylaxis was administered. Methods A retrospective analysis was conducted on 23 reported cases of VTE that occurred at a Central Florida hospital from April 1, 2021, to March 31, 2022. Relevant demographic and medical information was gathered from each patient chart to calculate an individual Caprini risk score and determine the type of chemical VTE prophylaxis that was received. Results Out of 23 reported cases of VTE in surgical patients, 17 were ultimately determined to have suffered VTE associated with their hospitalization and surgery. Thirteen out of 17 (76%) received appropriate perioperative chemical deep vein thrombosis (DVT) prophylaxis based on the calculated Caprini risk score and corresponding recommendations. Four out of 17 (24%) were determined to have received insufficient perioperative chemical DVT prophylaxis. Conclusion Consistent utilization of a DVT/pulmonary embolism (PE) risk stratification tool, such as the Caprini risk score calculator, is essential in the prevention of postoperative VTE. Hospitals can improve the utilization of such a tool and thereby reduce the number of embolic events by making it more visible and accessible to the overseeing provider in the electronic medical record (EMR).

Jean-Martin Charcot: Pioneer of Neurology.

Jean-Martin Charcot, born on November 29, 1825, in Paris, France, is known as the father of neurology. During a time when neurology was not yet a recognized medical specialty, Charcot's pioneering contributions significantly advanced the field. Charcot's use of the anatomo-clinical method, which correlates clinical symptoms with anatomical findings, led to the discovery and characterization of numerous neurological conditions, including multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Charcot's joint, and Charcot-Marie-Tooth (CMT) disease. His methodical approach to documenting clinical signs and conducting post-mortem examinations revolutionized neurological research and diagnosis, laying the groundwork for modern neurology. The anatomo-clinical methods continue to be a vital tool in neurological research and practice today. Charcot's work extended beyond clinical practice, influencing the study of neurology through his role as an educator and mentor to many, including Sigmund Freud. Despite some controversies and a reputation for being difficult to work with, Charcot's legacy endures, with his initial discoveries fostering greater awareness and the development of therapies for various neurological disorders.

Elizabeth Bagshaw: Pioneer of Canadian Women's Health.

Dr. Elizabeth Bagshaw, an esteemed figure among Canada's female physicians, devoted over seven decades to advancing obstetrics and reproductive health. She defied conventional norms by pursuing medical education and graduating from the Ontario Medical College for Women in 1905. Throughout her illustrious career, Bagshaw demonstrated exceptional perseverance, navigating familial obligations following her father's untimely passing during her academic pursuits.  Establishing her practice in Hamilton, Ontario, Bagshaw delivered over 3,000 neonates, frequently offering pro bono care to immigrant populations. Notably in 1932, Bagshaw assumed the role of Medical Director of Canada's first birth control clinic, challenging restrictive legislation and paving the way for the legalization of contraception in 1969. Bagshaw's efforts provided women with vital reproductive health services and information, significantly impacting public attitudes and legislation.  Beyond her medical practice, Bagshaw also played a pivotal role in mitigating public health crises, including the Spanish flu, and ventured into politics with a city council campaign in 1934, supported by The Women's Civic Club. Her extensive contributions earned her numerous accolades, including posthumous induction into the Canadian Medical Hall of Fame in 2007.  Bagshaw's enduring legacy is reflected in the Elizabeth Bagshaw Clinic, which continues to offer reproductive and abortion care in a confidential and supportive setting. Bagshaw's pioneering work significantly advances health equity and women's reproductive rights, leaving a lasting impact on healthcare worldwide. Her life and achievements underscore her role as a tireless advocate for women's health and a transformative influence in medical history.

Mitral Valve Repair in a 15-Month-Old Child With Kingella kingae Endocarditis.

Kingella kingae, a Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, K. kingae (HACEK) organism, is commonly found in the oropharynx. Although it rarely causes endocarditis, it can pose a significant risk to young children. We report a case of K. kingae endocarditis in a previously healthy 15-month-old male who initially presented with symptoms of an upper respiratory infection. Blood cultures taken at 60 hours revealed the presence of K. kingae. Subsequent echocardiogram and brain MRI demonstrated large vegetation on the mitral valve and septic emboli in the right occipital and left posterior parietal lobes. The patient was treated with intravenous ceftriaxone and underwent mitral valve repair with annuloplasty. This case illustrates the presentation of K. kingae endocarditis with initial respiratory symptoms and the subsequent identification of the infection through blood cultures and imaging. For pediatric patients presenting with upper respiratory symptoms, there may be clinical benefit to noninvasive ultrasound imaging to help rule out atypical pathologies like endocarditis.

Ureteral Metastasis From Prostate Cancer: A Report of Two Cases.

Prostate adenocarcinoma (PCa) is the second most common cause of cancer in men, but metastases to the ureter are exceedingly rare. Here, we present two cases with differing clinical symptoms and treatment courses but ultimately the same diagnosis. The two cases presented here had differing clinical presentations: one with lower urinary tract symptoms and the other with hydronephrosis. Systemic therapy with a luteinizing hormone-releasing hormone (LHrH) agonist appears to help with clinical outcomes in both cases reported here. Although such cases are extremely rare, consideration as a differential and early detection can impact a patient's clinical outcomes. For patients with PCa that present with obstructive urinary symptoms, there may be a clinical benefit to perform a thorough metastatic work-up for seeding to other parts of the urinary tract.

Dr. Newton Shaffer (1846-1928): Renowned Orthopedic Surgeon and Founder of the American Orthopaedic Association.

An unsung hero of American orthopedic surgery is the largely forgotten Dr. Newton Melman Shaffer (1846-1928). Upon graduating from medical school at New York University, Shaffer began his career training at the Hospital for the Ruptured and Crippled in 1867. Shaffer then went on to practice at St. Luke's Hospital and New York Orthopaedic Dispensary and Hospital where he became chief. Here, Shaffer made major contributions to the field in treating clubfoot and tuberculosis. He then declared orthopedics as a separate entity from general surgery at the 10th International Medical Congress. He helped start the American Orthopaedic Association to push for the recognition of American orthopedics to the international community. In 1900, Shaffer opened the first state-run hospital for underprivileged children requiring rehabilitation. During his career, Shaffer advocated for conservative orthopedic treatments, aided in the invention of medical devices, contributed largely to academic orthopedics, and successfully advocated for the inception of the field of orthopedic surgery.