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Introduction: Adult-onset Still's disease is a rare systemic autoinflammatory disease. We present a case of a young man with a constellation of symptoms and myopericarditis as a complication of this disease., Case: A 36-year-old Hispanic man with no significant past medical history developed a quotidian fever pattern following an upper respiratory tract infection. He initially presented with chest pain concerning for myocardial infarction and underwent cardiac catheterization, which revealed non-obstructive coronary artery disease. He was found to have myopericarditis, significant neutrophilic leukocytosis, and hyperferritinemia. He improved on high-dose corticosteroids but developed steroid-induced psychosis, and 4 months from symptom onset, he finally received tocilizumab, which eventually induced remission without adverse reactions., Discussion: Adult-onset Still's disease should be considered in a patient with fevers of undetermined origin. Due to its multisystemic involvement, adult-onset Still's disease is often a diagnosis arrived at after an extensive cardiac, hematologic, malignant, and infectious workup. Imaging, laboratory testing, and bone marrow biopsy were necessary to rule out alternative etiologies of this patient's presentation. Steroids are the mainstay of treatment because they are easily affordable, although the high risk of adverse effects makes them less desirable. Interleukin-1 inhibitors (anakinra or canakinumab) and interleukin-6 inhibitor tocilizumab are the steroid-sparing biologic agents of choice but are cost-prohibitive., Conclusion: Adult-onset Still's disease should be considered in the differential diagnoses of fever of undetermined origin. Early identification and initiation of treatment are critical to faster recovery and prevention of progression to severe complications. Steroids remain the standard first-line therapy and should be followed by disease-modifying steroid sparing drugs. The social determinants of health may preclude their timely initiation and should alert providers of proactive ways to avoid further delays., (© 2024. The Author(s).)

Background: Workplace violence persists in health care with nurses reporting physical and verbal abuse from aggressive patients causing emotional stress and lost workdays. The Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) was developed to measure risk for aggression in patients with behavioral health conditions in psychiatric and emergency department settings. The DASA-IV has not been validated with adult patients admitted to medical-surgical units., Objective: To determine whether DASA-IV scores are predictive of aggressive events in adults hospitalized on medical-surgical units., Methods: This multisite study used a case-control design. DASA-IV scores and acts of aggression were extracted from the medical record retrospectively to validate the appraisal's predictability. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to correlate DASA-IV scores with aggressive events., Results: DASA-IV assessments (N=156 999; mean [SD] 10.1 [10.7]/patient; range 1-220) were collected from 13 611 patients. Patients were primarily White (86.1%) and female (51.7%). Aggression (n = 509 patients; 3.7%) was significantly associated with older age, male sex, smoking, illicit drug use, and high DASA-IV scores. AUC of the ROC analysis for the DASA-IV showed a 97% probability (95% confidence interval [CI] 0.964-0.977) that an aggressive patient would have a higher score on the DASA-IV than a nonaggressive patient. Binary logistic regression predicted that for every point increase in the DASA-IV, there was a 3.51 (95% CI 3.38-3.63) times increased risk for aggression ( B   =  1.255, SE = 0.18, Wald = 4766.6, P  < .001)., Conclusions: This study is the first to validate use of the DASA-IV in medical-surgical populations, demonstrating predictive ability for aggressive incidents. The DASA-IV can be used successfully in medical-surgical populations for early identification of potential aggression., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In 2019, the Food and Drug Administration introduced 11 pictorial warning labels (PWLs) for inclusion on cigarette packages, created in compliance with court recommendations and tailored to increase knowledge of smoking harms. Several highlighted lesser-known risks of smoking. No behavioral studies have yet evaluated how risk content in PWLs impacts viewing patterns, recall, and knowledge of smoking harms., Methods: Seventy adults who reported smoking cigarettes daily (62.9% male, 57.1% African American, mean age = 50.3, mean cigarettes per day = 14.4) completed a single-session laboratory study. They were randomized to view a set of four PWLs depicting either lesser-known or well-known risks of smoking while having eye movements recorded, then completed post-exposure recall and knowledge measures., Results: Participants exposed to PWLs depicting lesser-known smoking risks viewed the text of the warning sooner and for longer than the image (p's <0.05); those exposed to PWLs depicting well-known risks viewed the image longer than text (p <0.001). PWL condition did not affect recall of text or image (p's >0.1). Those viewing lesser-known (vs. well-known) risks had greater knowledge of smoking causing lesser-known risks of bladder cancer, blindness, bloody urine, cataracts, diabetes, and head and neck cancer (p's <0.001)., Conclusions: Individuals viewing PWLs depicting lesser-known (vs. well-known) smoking risks visually engaged with the PWL text more than image, had similarly high recall of PWL content, and had greater knowledge of lesser-known risks of smoking. Findings suggest including lesser-known risk information on PWLs improves overall knowledge of smoking health risks., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Our experience in Monmouth County with surgical resection of single brain metastases followed by whole brain radiotherapy confirms the findings of a recent prospective randomized controlled study of this problem and demonstrates that patients treated with surgical resection followed by whole brain radiation live longer and have a better quality of life than those patients treated with radiotherapy alone. Best results are attainable if there is no evidence of disease activity at the primary site or systemically at the time the brain metastasis is diagnosed.