HCA healthcare journal of medicine最新文献

{"title":"Safety and Feasibility of Same-Admission Transcarotid Arterial Revascularization Prior to Heart Surgery for Patients Presenting With Concurrent, Severe Carotid Artery Stenosis, and Surgical Cardiac Disease.","authors":"Brittany Landavazo, Matthew D Kenny, Chandler Vernon, Nicolas Zea, David Nation, Bradley Boone, Jeffrey Apple, Kofi Quaye, Shir Yelovitch, Ryan S Turley","doi":"10.36518/2689-0216.2228","DOIUrl":"https://doi.org/10.36518/2689-0216.2228","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid artery stenosis and coronary artery disease are often co-morbid, with a prevalence of concurrent carotid and coronary artery stenosis approaching 50%. The optimal treatment for these patients has long been debated, with open carotid revascularization generally reserved for those with severe symptomatic carotid disease that precludes cardiac surgery. In this scenario, the role of less-invasive carotid artery stenting, particularly transcarotid arterial revascularization (TCAR), remains controversial and is not yet well studied. This study aims to present our outcomes and methodology for treating severe carotid stenosis with TCAR prior to cardiac surgery.</p><p><strong>Methods: </strong>A retrospective chart review of the previous 656 TCAR procedures performed from 2013 to 2024 identified 15 TCAR procedures conducted during the same hospital admission before cardiac surgery. The primary endpoint was 30-day stroke and myocardial infarction (MI). Secondary endpoints included operative time, cranial nerve (CN) injury, neck hematoma, length of stay, arterial dissection, and death.</p><p><strong>Results: </strong>Fifteen patients underwent TCAR before cardiac surgery. Of these, 73.33% were men, with a median age of 65.98 years. Eighty percent of the cohort was asymptomatic, and the majority of the cohort had greater than 80% stenosis. Bridging anticoagulation treatment included aspirin and either heparin infusion (60.0%, n = 9), intravenous antiplatelet therapy such as cangrelor or eptifibatide (33.33%, n = 5), or subcutaneous enoxaparin (6.67%, n = 1). No patients experienced MI, stroke, CN injury, neck hematoma, or arterial dissection within 30 days. There were no deaths within 30 days.</p><p><strong>Conclusion: </strong>In our initial experience with TCAR prior to cardiac surgery, there were no cerebrovascular complications, suggesting the feasibility of same admission TCAR and cardiac surgery. In our experience, a range of anticoagulation bridging therapies did not result in apparent stent thrombosis and can be employed until the cardiac surgeon deems it safe to initiate oral dual antiplatelet therapy. Further studies with larger datasets are required to support the broader adoption of TCAR prior to heart surgery in patients with concurrent, severe cardiac and carotid disease.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"67-74"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Waste Segregation Initiatives to Reduce Regulated Medical Waste: A Multi-Departmental Quality Improvement Project.","authors":"Emily M Su, Anuja L Sarode, Mohammed Sami, David R Nehring, Erica L Laipply, Mustafa Culcuoglu","doi":"10.36518/2689-0216.2174","DOIUrl":"https://doi.org/10.36518/2689-0216.2174","url":null,"abstract":"<p><strong>Background: </strong>Regulated medical waste (RMW) drives up health care costs, largely due to misclassification of general waste, especially in operating rooms (ORs), intensive care units (ICUs), and obstetrics and gynecology (OBGYN) departments. This study aimed to reduce RMW volume and costs at Akron City Hospital (ACH) through department-specific interventions aligning with Occupational Safety and Health Administration (OSHA) and Ohio Environmental Protection Agency guidelines.</p><p><strong>Methods: </strong>Periodic analyses compared hospital-wide aggregate RMW volume, pick-up frequency, and disposal costs before and after interventions. The ORs initiated interventions in October 2022, expanding to ICUs and OBGYN by February 2024. Strategies included staff education, flyers on red bag receptacles, and adjustments to container availability and size. Monthly data (January 2022 to June 2024) were analyzed using two-tailed heteroscedastic <i>t</i>-tests. Subsequently, an autoregressive integrated moving average (ARIMA) model was used to forecast monthly weights from July to December 2024.</p><p><strong>Results: </strong>Monthly total RMW weights at ACH dropped from 56 366 lbs in 2022 to 45 148 lbs in 2023 and 37 017 lbs in early 2024 (<i>P</i> < .001). Variability declined, with standard deviation (SD) decreasing from 6177 lbs (2022) to 4062 lbs (2023) and a small increase in variability in early 2024 (SD increased from 4062 to 4366 lbs, non-significant). Seasonal reductions were sustained across quarters. Corresponding RMW disposal costs decreased from $175 189.51 (2022) to $140 321.18 (2023) and $57 528.17 (6-month cost, 2024). Time series predictive analytics indicated stable monthly weights, and anomaly detection confirmed improved consistency post-intervention.</p><p><strong>Conclusion: </strong>Department-specific interventions significantly reduced RMW volume and costs while enhancing sustainability. Tailored education and operational adjustments offer a scalable model for sustainable waste management in health care, addressing both financial and environmental challenges.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentations of Cutaneous Disease in Various Skin Pigmentations: Keratosis Pilaris.","authors":"Henry Lim, Reem Ayoub, Madeleine Richards, Marshall Hall, Christian Scheufele, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.2102","DOIUrl":"https://doi.org/10.36518/2689-0216.2102","url":null,"abstract":"<p><p>Description Keratosis pilaris (KP) is a common benign disorder involving hyperkeratosis of the skin. It is associated with other common dry skin disorders such as atopic dermatitis and ichthyosis vulgaris. Lesions are clinically characterized as symmetrically distributed, monomorphic, folliculocentric, hyperkeratotic papules with a variable degree of perifollicular erythema. The appearance can be likened to spikey bumps that are commonly located on the arms, legs, and buttocks. Awareness of KP is important as every primary care clinician will see patients with this disorder. Identification can support the diagnosis of other associated skin diseases. Education about KP and its treatment may alleviate psychological distress and reduce symptoms. Common mimicking diagnoses include folliculitis, acne vulgaris, and milia. There are also uncommon atrophic variants of KP that result in scarring and alopecia. The clinical images in this review focus on identifying KP across the spectrum of skin tones.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"83-92"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentations of Cutaneous Disease in Various Skin Pigmentations: Tinea Corporis.","authors":"Braden Van Alfen, Navya Peddireddy, Marshall Hall, Henry Lim, Christian Scheufele, Garrett Furth, Dustin Wilkes, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.2256","DOIUrl":"https://doi.org/10.36518/2689-0216.2256","url":null,"abstract":"<p><p>Background Tinea corporis is a common superficial fungal infection caused by dermatophytes. It typically presents as well-defined, pruritic, annular papules and plaques with central hypopigmentation. The differential diagnosis includes pityriasis rosea, nummular dermatitis, plaque psoriasis, tinea versicolor, granuloma annulare, and discoid lupus. This article compares different presentations of tinea corporis in various skin types as classified by the Fitzpatrick scale. Recognizing varying presentations of tinea in patients of different skin tones will aid in early and appropriate diagnosis and treatment.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"93-103"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facing Dissection.","authors":"Aya E Cannon","doi":"10.36518/2689-0216.2484","DOIUrl":"https://doi.org/10.36518/2689-0216.2484","url":null,"abstract":"<p><p>Description The summer prior to beginning medical school, our anatomy professor prompted us to reflect on the experience of dissection and create an image based on our thoughts and feelings. I was thrilled by the assignment and immediately began listing my emotions. Excitement: For so long, I had worked toward this point, and now the quintessential medical school experience was within reach. I expressed my appreciation for the beauty and complexity of the human body through color and collage, using the vibrant layers to reflect the awe and range of emotions I felt. Nervousness: Despite my enthusiasm, I was faced with something entirely new and found myself with worries like \"don't mess up\" or \"there are so many tools.\" I thought of the pungent embalming fluid; would I be overwhelmed by it? But most of all, I felt gratitude. I imagined the lives our donors may have lived. What thoughts and feelings filled their brains, the very organs we now study? What actions did they carry out with their muscles? What were their cultures? As I completed the illustration, I filled it with \"thank-yous\" in many languages, a small gesture to honor the immense generosity of those who chose to teach us through their final, most selfless gift.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"115-116"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of the Fitzpatrick Scale in Clinical Practice.","authors":"Dana Olsen, Cecilia Nguyen, Marshall Hall, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.2207","DOIUrl":"https://doi.org/10.36518/2689-0216.2207","url":null,"abstract":"<p><p>Description Many skin diseases can manifest differently depending on the pigment of one's skin. The Fitzpatrick scale is a classification of phototypes (I-VI) that categorizes patients' skin based on its ability to tan and burn. Even though it is a simple questionnaire, the Fitzpatrick scale has numerous criticisms due to its dependence on patients' self-perception, variability in how questions are asked, limited range, and the underestimation of the risk of skin cancers. Alternatives to the Fitzpatrick scale include the melanin index, pigment protection factor, a visual color scale, and using artificial intelligence along with existing or new scales. Having a more accurate and precise tool to measure skin tone is imperative for research, education, and the patient care of individuals with diverse skin tones.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benign Transient Hyperphosphatasemia in Adults: Case Report and Literature Review.","authors":"Jose L Rodriguez Castro, Grettel Gonzalez Garcia, Daniel Heller, Bernardo J Reyes","doi":"10.36518/2689-0216.1835","DOIUrl":"https://doi.org/10.36518/2689-0216.1835","url":null,"abstract":"<p><strong>Background: </strong>Benign transient hyperphosphatasemia (BTH) in children is characterized by temporary highly elevated serum alkaline phosphatase (ALP) activity in the absence of liver or bone disease and a return to normal within 3 to 4 months. Since its first description in the 1950s, several cases of BTH in infants and children have been reported. Although there is no known etiology for this illness, it has been associated with viral infections. This condition has rarely been seen in the adult population, and there is scarce available information. The sialylation of the ALP isoenzymes decreases their renal clearance from the circulation; however, the pathophysiology behind the increased sialylation of the ALP is uncertain.</p><p><strong>Case presentation: </strong>This is a 62-year-old female with a history of hypertension who was seen for a routine checkup and was found to have elevated ALP. The patient reports a family history of primary biliary cirrhosis. Routine labs showed an isolated elevation of ALP at 1496 U/L (normal range is 44 to 147 U/L). A physical examination and review of systems revealed no evidence of liver disease or bone abnormalities. Lipase, thyroid-stimulating hormone (TSH), T3, T4, parathyroid hormone, vitamin D, electrolytes, and markers for autoimmunity and tumors were found within normal limits. The abdominal ultrasound, the computerized tomography (CT) with contrast of the abdomen, and the bone survey were unremarkable. Alkaline phosphatase electrophoresis showed equally elevated liver and bone isoenzymes with a typical pattern of BTH. Serial ALP levels showed normalization by week 8 from the initial abnormal level.</p><p><strong>Conclusion: </strong>Benign transient hyperphosphatasemia is a rare condition mostly seen in children, and it is even rarer for it to present in adults. It is speculated that BTH is caused by a transient decrease in the clearance of ALP. The adult presentation of BTH is poorly described in medical literature, limiting the ability of medical providers to make an early diagnosis and avoiding extensive investigations.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"105-109"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Fana'</i> (Annihilation).","authors":"Houyar Moghaddas","doi":"10.36518/2689-0216.2253","DOIUrl":"https://doi.org/10.36518/2689-0216.2253","url":null,"abstract":"<p><p>Description In Sufism, <i>fana'</i> refers to the dissolution of the self, the annihilation of the ego as one transcends individuality. While traditionally a spiritual concept, <i>fana'</i> also offers a powerful humanistic metaphor for psychological transformation. In both the poem and accompanying photograph, <i>fana'</i> explores the themes of ego death, grief, and the reshaping of identity: processes central to psychiatric practice, psychedelic therapy and the treatment of emotional fragmentation. The photograph captures an individual standing at the edge of a path, facing an untamed landscape, symbolizing the confrontation with the unknown self and the internal experience of surrender. This work invites reflection on how emotional rupture, identity instability, and deep longing can catalyze growth, and how, through embracing loss rather than resisting it, healing and renewal can quietly begin.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"111-113"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replicability of Highly Cited Comparative Studies in Orthopedic Journals.","authors":"Cody Ashy, William E Few, Gabriella A Rivas, Emily Brennan, Langdon Hartsock, Kristoff R Reid","doi":"10.36518/2689-0216.2188","DOIUrl":"https://doi.org/10.36518/2689-0216.2188","url":null,"abstract":"<p><strong>Introduction: </strong>Concerns are rising regarding the quality, validity, and reliability of clinical research findings in medical literature. This investigation sought to identify the most cited orthopedic clinical studies and assess the replicability of the findings reported.</p><p><strong>Methods: </strong>Web of Science was used to identify the top ten orthopedic surgery journals by impact factor from which primary comparative studies cited at least 250 times were identified. A second literature search identified follow-up studies relevant to the respective primary studies. Studies investigating the same intervention via parallel methodology were summarized and their conclusions compared to their respective highly cited primary study.</p><p><strong>Results: </strong>Seven primary highly cited clinical studies met inclusion criteria. A literature search identified and screened 1163 follow-up articles, of which 79 met inclusion criteria. Of these, 70.9% (56/79) of studies were randomized clinical trials, 7.6% (6/79) were multicenter in nature, and 67% (53/79) were classified as level I evidence. Average subject cohort size in the follow-up studies was 365 patients (range, 10-4564). The rate of coming to the same conclusion as the primary study was 45.5% (36/79). The rate of different conclusions from the primary studies was 26.6% (21/79). Additionally, 16.5% (13/79) found a weaker correlation, and 11.4% (9/79) neither agreed nor disagreed with the primary study. No significant association existed between study design, level of evidence, or study size and agreement or disagreement with the original paper (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>Less than 50% of replicating follow-up studies support the effects demonstrated by highly cited comparative studies in orthopedic literature, which is a lower rate than that reported by other areas of medicine. Difficulty performing large, high-level-of-evidence studies and publication bias likely contribute to this observation. Based on these findings we believe that replication of prior research, emphasis on research quality, and conscious awareness of the limitations of clinical research are critical to the quality of orthopedic literature.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"25-48"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Patients with Lower Extremity Amputation During Inpatient Rehabilitation and its Predictors for Home Discharge.","authors":"Se Won Lee, Duke Shen, Ning Cao","doi":"10.36518/2689-0216.2378","DOIUrl":"https://doi.org/10.36518/2689-0216.2378","url":null,"abstract":"<p><strong>Background: </strong>Lower limb amputations significantly impair the mobility and activities of daily living (ADLs) and frequently require inpatient rehabilitation with opioid analgesics to control pain. Largescale studies of clinical characteristics specific to rehabilitation outcomes after lower limb amputations are limited in the current literature. Identifying the associations between specific clinical characteristics and opioid analgesic use with home versus non-home discharge can help improve care for patients undergoing inpatient rehabilitation after lower-limb amputations.</p><p><strong>Methods: </strong>In this retrospective study, we examined 1611 patients from 58 inpatient rehabilitation units who underwent transfemoral or transtibial amputations between January 2021 and December 2022, identified using International Classification of Diseases (ICD) codes. Multivariable logistic regression was used to identify patient characteristics, including opioid use, associated with home discharge after inpatient rehabilitation for lower-limb amputation.</p><p><strong>Results: </strong>There were 1124 (69.8%) patients with transtibial amputations and 487 (30.2%) patients with transfemoral amputations. When compared with transtibial amputees, opioids were used more frequently (86.5% vs 82.1%, <i>P</i> = .032) and at higher oral morphine milligram equivalents (356 mg vs 241 mg, <i>P</i> = .019) at admission among transfemoral amputees. A total of 1223 patients (75.9%) were discharged home after inpatient rehabilitation. Patient characteristics independently associated with a lower likelihood of home discharge included a higher medical comorbidity index, adverse events during inpatient rehabilitation, intravenous (IV) opioid use at admission, and lower initial functional levels.</p><p><strong>Conclusion: </strong>Early identification of patients with clinical characteristics associated with a lower likelihood of returning home may facilitate the development of targeted rehabilitation strategies during inpatient rehabilitation.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 1","pages":"75-82"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}