Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains one of the most technically challenging procedures in interventional cardiology due to the complex anatomy and diverse lesion characteristics. These lesions account for approximately 15–25% of all PCI cases and are associated with higher rates of restenosis and adverse clinical outcomes compared to non-bifurcation lesions. Despite advancements in stent technology and procedural techniques, managing bifurcation lesions requires a tailored strategy that considers patient factors, lesion morphology, operator expertise, and outcome goals. This review introduces the Patient, Lesion, Operator, Technique, and Outcomes (PLOTO) framework, an innovative, algorithmic, and systemic approach to bifurcation PCI. Emphasis is placed on lesion assessment, including Medina classification, bifurcation angle, calcification, and imaging guidance, and the choice between provisional and two-stent strategies. Practical recommendations and evidence from contemporary studies are integrated to guide optimal procedural planning and execution, aiming to simplify complexity while enhancing clinical results.

Background: Hand hygiene is the most crucial practice for reducing the transmission of infections in healthcare settings. Despite substantial data highlighting its importance, healthcare institutions frequently struggle to maintain high hand hygiene compliance rates among healthcare workers (HCWs). Low HCW hand hygiene compliance can lead to an increase in healthcare-associated infections, longer hospital stays, antimicrobial resistance, and higher healthcare costs. Low compliance can also have regulatory and reimbursement implications for healthcare systems. This highlights the urgent need for innovative interventions focused on improving HCW hand hygiene compliance. Methods: We piloted a novel program at Brown University Health (BUH) that enabled patients and visitors to audit HCW hand hygiene using an online interface. This trial was implemented in an iterative fashion in 1 outpatient clinic and 5 inpatient units over 5 months (Figure 1). A poster with program information and a QR code linked to the audit form was placed in each room and/or handed to patients/visitors. Patients/visitors were instructed to scan the QR code with their phones to access the audit form, which included three questions about their location (inpatient/outpatient), if HCWs performed hand hygiene (yes/no), and if they would feel comfortable asking staff to perform hand hygiene (yes/no). The form was available in English, Spanish, and Portuguese. Responses were recorded securely and anonymously in the online platform and monitored by Infection Control. Additionally, HCWs on these units received a survey to provide feedback on this program. Results: Patients and visitors recorded 98 hand hygiene audits of staff during the program trial: 72 from the outpatient clinic and 26 from the inpatient units (Table 1). HCW hand hygiene compliance observed by patients/visitors was 92% in both inpatient and outpatient settings, resulting in an overall compliance rate of 92% during the pilot program. Figure 1 shows HCW hand hygiene compliance rates as measured by trained BUH staff in the pilot units and clinic during 2024 in relation to the implementation of this program. We found that after the start of education and implementation of the patient/visitor hand hygiene auditing program in these units, compliance generally increased and remained above pre-intervention levels. Conclusions: This pilot program demonstrates the feasibility and potential effectiveness of engaging patients and visitors in hand hygiene interventions. The results of this pilot suggest that this novel approach warrants further investigation and broader implementation as part of larger efforts improve HCW hand hygiene compliance and reduce healthcare-associated infections.

Introduction: The present study assessed the impact of the disposable Simplera Sync™ sensor with the MiniMed™ 780G (MM780G) advanced hybrid closed-loop (AHCL) system on type 1 diabetes (T1D) glycemic metrics, insulin delivery, and safety. Materials and Methods: Youths (aged 7-17 years) and adults (aged 18-80 years) with T1D were enrolled in this single-arm, nonrandomized study at 24 sites in the United States. Participants began with an ∼2-week run-in period where hybrid closed-loop (HCL; auto basal only) or open-loop insulin delivery was used, followed by an ∼3-month study period with AHCL activated. Glycemic outcomes and insulin delivery during the last 6-7 weeks of the study, when settings were optimized at investigator's discretion, were compared with the run-in. Glycemic outcomes with the use of recommended optimal settings (ROS, 100 mg/dL glucose target with a 2-h active insulin time) were explored. Results: Time in automation was high (>93%) and mean time in range (TIR) increased from 54.4% ± 15.7% to 71.4% ± 9.9% (P < 0.001) in youths and from 66.5% ± 12.6% to 80.2% ± 8.1% (P < 0.001) in adults, primarily due to reduced time above range. Youths had a slight increase in time below range (TBR <70 mg/dL) from 1.6% ± 1.7% to 1.9% ± 1.4% (P < 0.001), while adults had no significant difference in TBR. For ROS users, TIR was 74.7% ± 9.3% in youths and 83.8% ± 7.4% in adults. Throughout the study ∼60% of total daily insulin dose was automated (auto basal and auto correction) in both cohorts. There were two cases of severe hypoglycemia and one episode of diabetic ketoacidosis (not related to the device). Conclusions: MM780G use with the Simplera Sync sensor is safe and demonstrated improved glycemic outcomes in both pediatric and adult participants with T1D, compared with the run-in period.

Background/Objectives: Infants admitted to neonatal intensive care units (NICUs) face challenges in achieving successful oral feedings. During oral feedings, these infants commonly present with suck–swallow–breathe incoordination, with approximately 30% developing dysphagia, leading to feeding aversion, prolonged hospitalization, and increased parental stress. Cold liquid feeding has demonstrated benefits in improving feeding safety in adults with dysphagia; however, its application in neonates is relatively limited. This study aimed to examine global neonatal feeding practices, with a specific emphasis on cold milk feeding as an intervention for dysphagia. Methods: A cross-sectional global electronic survey was distributed via professional society listservs and closed online professional group forums targeting neonatal providers and feeding therapists from June 2023 to June 2024. The survey assessed institutional feeding protocols, oral feeding practices, and the use of cold milk for infants with dysphagia. Responses were analyzed descriptively. Results: A total of 210 complete responses were received from level IV (51%), level III (42%), and level II (5%) NICUs. While 30% of the respondents were aware of cold milk feeding as a dysphagia intervention, only 15% of the total respondents reported using it in practice. Among the 32 institutions implementing cold milk practices, only one had an established protocol. Additionally, 72% reported having a feeding protocol in place, often incorporating cue-based tools. Most respondents (87.5%) did not allow oral feeding during nasal continuous positive airway pressure (nCPAP), whereas 78% permitted it during high-flow nasal cannula (HFNC) support. Conclusions: Although the awareness of cold milk feeding in neonates is increasing, its implementation remains limited and lacks standardization. Significant variability exists in oral feeding practices, particularly regarding feeding during respiratory support. This underscores the need for further research and evidence-based guidelines to ensure safe and consistent care for preterm infants.

Over the last half-century, mortality from renal cell carcinoma (RCC) has seen a dramatic reduction, while 5-year survival rates have reached an all-time high (34% to 75%). A 77-year-old female with Stage 4 RCC (cT3c, cN1, cM1) presented with acute onset chest and back pain. Imaging revealed interval enlargement of a left renal mass with propagation of tumor thrombus (TT) throughout the left renal vein, intrahepatic and suprahepatic inferior vena cava (IVC) with extension into the right atrium (RA). The patient successfully underwent a high-risk open left nephrectomy with caval thrombectomy, retroperitoneal lymph node dissection, and atrial thrombectomy. Approximately, 1% of RCC cases involve the right atrium, and radical nephrectomy with vena caval thrombectomy remains the most effective treatment for cavoatrial TT, with 5-year survival rates between 30% and 72%. While patients with renal vein involvement have better survival rates than those with IVC involvement, advanced TT cases (Types III and IV) often require extracorporeal circulation. Though the patient understood the prognosis of her RCC, discussing the risks of a complex procedure versus not intervening was challenging. Despite a typical median survival of 12months for level IV tumor thrombus (TT), she remains stable 28months post-surgery. Although the 5-year survival rate for renal cell carcinoma (RCC) has increased from 34% to 75%, the disease still adversely affects patients' quality of life. A multidisciplinary approach is essential when managing metastatic RCC, particularly involving the heart. Despite the associated risks, surgical intervention is more effective in prolonging life by preventing sudden cardiac death due to embolic events.

Mesenteric malperfusion is a rare complication of aortic dissection associated with high mortality. Diagnosis requires a high degree of suspicion as treatment is time-sensitive, necessitating early revascularization to prevent bowel necrosis, sepsis, and multi-organ failure. Advances in endovascular techniques have improved outcomes and survival over traditional approaches. Management of type A aortic dissection with mesenteric malperfusion has shifted from central aortic repair first to a two-stage approach with revascularization and delayed aortic repair. Thoracic endovascular aortic repair has become the standard treatment for type B aortic dissection with mesenteric malperfusion. However, finding the balance between aortic repair and treating mesenteric malperfusion remains a challenge. This review highlights current strategies and promising research into new endovascular techniques and refining treatment pathways.