HCA healthcare journal of medicine最新文献_第10页

Complete Clearance of Pustular Psoriasis After A Single Dose of Risankizumab. 单剂量利桑单抗后脓疱性牛皮癣完全清除。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1480

Ashleigh E Hermann, Stephen E Weis

{"title":"Complete Clearance of Pustular Psoriasis After A Single Dose of Risankizumab.","authors":"Ashleigh E Hermann, Stephen E Weis","doi":"10.36518/2689-0216.1480","DOIUrl":"https://doi.org/10.36518/2689-0216.1480","url":null,"abstract":"Introduction: Psoriasis is a chronic, multifactorial, inflammatory skin disease with several subtypes, including pustular psoriasis. Pustular psoriasis is characterized by pustules forming lakes of pus on the skin. Pro-inflammatory pathways, such as the interleukin (IL)-17/IL-23 axis, have been shown to play a significant role in the pathogenesis of psoriasis. Biologic therapies directed towards these pro-inflammatory pathways have effectively treated plaque psoriasis, but fewer treatments have shown similar efficacy for pustular psoriasis.Case presentation: We present a 45-year-old Black female who presented to the dermatology clinic with generalized pustular psoriasis affecting approximately 70% of her body surface area. She also noted joint stiffness and pain that was worse after inactivity. Her disease did not respond to previous treatment, which was using adalimumab for 6 months. She also had no response to a 3-month course of apremilast.Two weeks after receiving her first dose of risankizumab, she had complete clearance of her pustular psoriasis, affecting 0% of her body surface area. She also noted significant improvement in her joint pain.Conclusions: There is little data regarding the efficacy of IL-23 inhibitors in treating generalized pustular psoriasis. To date, our case is the only reported instance in the literature showing rapid clearance of pustular psoriasis after 1 injection of risankizumab. This case illustrates that IL-23 inhibitors play an essential role in the rapid clearance of pustular psoriasis.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324879/pdf/26890216_vol4_iss2_209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799593","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}

引用次数: 0

Interprofessional Education: Models That Promote Shared Clinical Decision-Making. 跨专业教育:促进共享临床决策的模式。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1618

James David Nash

引用次数: 0

A Guide to Writing Quality Case Reports. 撰写高质量案例报告指南。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1485

Robert Chait, Graig Donini, Michael G Flynn

引用次数: 0

Supersensitivity Psychosis with Acute Dystonia. 过敏性精神病伴急性肌张力障碍。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1465

Tatiana Nunez, Gabriella Meyerson, Mays Alani, Shahid Elahi, Enrique Vargas

{"title":"Supersensitivity Psychosis with Acute Dystonia.","authors":"Tatiana Nunez, Gabriella Meyerson, Mays Alani, Shahid Elahi, Enrique Vargas","doi":"10.36518/2689-0216.1465","DOIUrl":"https://doi.org/10.36518/2689-0216.1465","url":null,"abstract":"Introduction: Supersensitivity psychosis is a phenomenon that occurs with chronic usage of antipsychotics secondary to treatment resistance. At this time, there are no standardized guidelines regarding the management of supersensitivity psychosis.Case presentation: We present a case of a patient with schizoaffective disorder who developed supersensitivity psychosis and acute dystonia in response to discontinuing psychotropic medications, including high-dose quetiapine and olanzapine. The patient presented with excessive anxiety, paranoia, bizarre thoughts, and generalized dystonia affecting the face, trunk, and extremities. We treated the patient with olanzapine, valproic acid, and diazepam, which alleviated the psychosis back to baseline and significantly improved the dystonia. Despite compliance, the patient returned for inpatient stabilization due to depressive symptoms and worsening of the dystonia. During the second admission, the patient required further modification of psychotropics and supplemental electroconvulsive therapy.Conclusion: In this paper, we discuss the proposed treatment of supersensitivity psychosis, including the role that electroconvulsive therapy may play in alleviating supersensitivity psychosis and associated movement disorders. We hope to expand the knowledge of additional neuromotor manifestations in supersensitivity psychosis and the management of this unique presentation.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10327954/pdf/26890216_01042023_57.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9808350","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}

引用次数: 1

Operationalizing a Medication Safety Gap Assessment for a Large Health System. 大型卫生系统药物安全缺口评估的实施。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1566

Carley Warren, Joan Kramer, L Hayley Burgess

{"title":"Operationalizing a Medication Safety Gap Assessment for a Large Health System.","authors":"Carley Warren, Joan Kramer, L Hayley Burgess","doi":"10.36518/2689-0216.1566","DOIUrl":"https://doi.org/10.36518/2689-0216.1566","url":null,"abstract":"Background: Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices (ISMP) has advocated for several best practices in acute care facilities derived from reports of patient harm.Methods: The medication safety best practices chosen for this assessment were based on the 2020 ISMP Targeted Medication Safety Best Practices (TMSBP) and health system-identified opportunities. Each month, for 9 months, select best practices were covered with associated tools to assess the current state, document the gap, and close identified gaps.Results: Overall, 121 acute care facilities participated in most safety best practice assessments. Of the best practices assessed, there were 8 practices that more than 20 hospitals documented as not implemented and 9 practices where more than 80 hospitals had fully implemented them.Conclusion: Full implementation of medication safety best practices is a resource-intensive process that requires strong change management leadership at a local level. As noted by the redundancy in published ISMP TMSBP, there is an opportunity to continue improving safety in acute care facilities across the United States.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324865/pdf/26890216_vol4_iss2_167.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167668","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}

引用次数: 0

Transpyloric Feed in Reflux-Associated Apnea in Preterm Newborns: A Prospective Study. 早产新生儿反流性呼吸暂停的经幽门喂养:一项前瞻性研究

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1417

Tamoghna Biswas, Tapas K Sabui, Somosri Roy, Rakesh Mondal, Shubhabrata Majumdar, Sudipta Misra

{"title":"Transpyloric Feed in Reflux-Associated Apnea in Preterm Newborns: A Prospective Study.","authors":"Tamoghna Biswas, Tapas K Sabui, Somosri Roy, Rakesh Mondal, Shubhabrata Majumdar, Sudipta Misra","doi":"10.36518/2689-0216.1417","DOIUrl":"https://doi.org/10.36518/2689-0216.1417","url":null,"abstract":"Background: The etiological correlation between gastroesophageal reflux (GER) and apnea is controversial. We conducted a prospective interventional study designed to address the controversy.Methods: Preterm neonates with apnea at a tertiary care center, who had clinical features of GER without any other comorbidities likely to cause apnea, were included in the study. The enrolled neonates underwent continuous transpyloric tube feeding for 72 hours. The primary outcome measure was the difference in the number of apneic episodes pre- and post-initiation of nasoduodenal (ND) feeding. Secondary outcome measures included the incidence of necrotizing enterocolitis, other gastrointestinal disturbances, and mortality.Results: Sixteen preterm neonates were included in the study. A substantial proportion (n =11, 68.8%) of the included neonates had a reduction in the number of apneic episodes. There was a significant decrease in the mean number of apneic episodes from 1.75 (±0.837) to 0.969 (±0.957) (P=.007). The median number of apneas was 1.5 (IQR 0.875) before and 0.5 (IQR 0.875) after ND feeds. There were no serious adverse events observed that were attributable to transpyloric feeding.Conclusion: This prospective study suggests that in a selected group of preterm neonates with reflux- associated apnea, transpyloric feeding can be an effective therapeutic modality.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332374/pdf/26890216_vol4_iss3_229.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812353","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}

引用次数: 0

Resolved Peristomal Erosive Papulonodular Dermatitis Mimicking Nevoid Hyperkeratosis of the Nipple and Areola. 模拟乳头和乳晕空洞角化过度的溶解性瘤周糜烂性丘疹性皮炎。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1336

Christa M Tomc, Daniel A Nguyen, Joseph S Susa, Stephen E Weis

{"title":"Resolved Peristomal Erosive Papulonodular Dermatitis Mimicking Nevoid Hyperkeratosis of the Nipple and Areola.","authors":"Christa M Tomc, Daniel A Nguyen, Joseph S Susa, Stephen E Weis","doi":"10.36518/2689-0216.1336","DOIUrl":"https://doi.org/10.36518/2689-0216.1336","url":null,"abstract":"Introduction: Nevoid hyperkeratosis of the nipple and areola (NHKNA) is a rare cutaneous entity with a distinct clinical and histological presentation. The type II form of this condition can result from various dermatoses, such as irritant contact dermatitis. Erosive papulonodular dermatitis is a chronic irritant dermatitis that often occurs in areas of occlusion and maceration, such as peristomal skin. Pseudoverrucous papules and nodules are a variant of erosive papulonodular dermatitis and have a non-specific histologic pattern of reactive hyperplasia.Case presentation: We present a case of a patient with resolved peristomal erosive papulonodular dermatitis who presented status-post ileostomy reversal with clinical and histologic findings classically seen in NHKNA.Conclusion: In type II NHKNA, treatment of the primary dermatosis typically leads to resolutions. In the case of our patient, removal of the offending agent via colostomy reversal and barrier protection led to the resolution of the lesions.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332379/pdf/26890216_vol4_iss3_243.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9804813","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}

引用次数: 0

Locked Within. 锁内。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1614

Ambrosia Washington

引用次数: 0

Best Practice Proposal to Enhance Application of the Standardized Antimicrobial Administration Ratio (SAAR). 加强标准化抗菌药物给药比(SAAR)应用的最佳实践建议。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1560

Jill M Butterfield-Cowper

{"title":"Best Practice Proposal to Enhance Application of the Standardized Antimicrobial Administration Ratio (SAAR).","authors":"Jill M Butterfield-Cowper","doi":"10.36518/2689-0216.1560","DOIUrl":"https://doi.org/10.36518/2689-0216.1560","url":null,"abstract":"Description A core element of hospital antibiotic stewardship programs is the tracking of outcomes. It is recommended that hospitals do this by reporting to the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option. With this, hospitals can access the Standardized Antimicrobial Administration Ratio (SAAR) for various antibiotic groupings and locations. While there are benefits to the SAAR, several limitations reduce the interpretation and utility of SAAR values. In particular, the SAAR cannot inform users of antimicrobial appropriateness. This article describes an antimicrobial days of therapy (DOT) report that was developed by a tele-stewardship infectious diseases pharmacist. This article proposes that a DOT report, such as the one described, is used in combination with SAAR values to better assess where improvements in antimicrobial prescribing are needed and track the progress of interventions. If not reporting to the NHSN AU Option, this type of report can help meet antimicrobial stewardship standards from The Joint Commission.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324863/pdf/26890216_vol4_iss2_095.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799588","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}

引用次数: 0

Implementing AUC Monitoring in a Pharmacist-Managed Vancomycin Dosing Protocol: A Retrospective Cohort Study. 在药剂师管理的万古霉素给药方案中实施AUC监测:一项回顾性队列研究。

HCA healthcare journal of medicine Pub Date : 2023-01-01 DOI: 10.36518/2689-0216.1502

Brandon L S Robinson, Blake Bennie, Mahmoud Nasiri, Kieu Nguyen, Reba Forbess, Mallory Gessner-Wharton, Cassie Robertson

{"title":"Implementing AUC Monitoring in a Pharmacist-Managed Vancomycin Dosing Protocol: A Retrospective Cohort Study.","authors":"Brandon L S Robinson, Blake Bennie, Mahmoud Nasiri, Kieu Nguyen, Reba Forbess, Mallory Gessner-Wharton, Cassie Robertson","doi":"10.36518/2689-0216.1502","DOIUrl":"https://doi.org/10.36518/2689-0216.1502","url":null,"abstract":"Background: Consensus guidelines on the therapeutic drug monitoring of vancomycin published in 2020 recognize that using the calculated area-under-the-curve (AUC) to guide dosing maximizes clinical efficacy and minimizes risk when compared to traditional trough-based dosing. The purpose of this study was to determine whether AUC monitoring results in reduced acute kidney injury (AKI) rates in adult patients receiving vancomycin for all indications.Methods: In this study, patients 18 years or older who received pharmacist-managed vancomycin therapy were selected using pharmacy surveillance software from 2 timeframes. Patients were excluded if they received less than 48 hours of therapy or had unstable renal function or hemodialysis at baseline. The primary outcome measured was the incidence of AKI in each group of patients.Results: Data were collected for 121 patients in each group. Concomitant nephrotoxins used in each group, as well as the sources of infection, were similar between groups. AUC monitoring did not result in a significant decrease in AKI rate (16.5% in AUC group, 14.9% in trough group; P = .61). However, patients who received AUC monitoring were more likely to be therapeutic at first follow-up compared to the trough monitoring group (43.2% in AUC group, 33.9% in trough group; P = .03). AUC monitoring also resulted in lower trough levels and total daily doses, with no difference in mortality or length of stay.Conclusion: AUC monitoring did not result in an observed decrease in AKI rate. Despite this, the AUC monitoring protocol was effective at reaching the goal AUC of 400-600 mg*hour/L and did not increase mortality or length of stay.","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324877/pdf/26890216_vol4_iss2_157.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9810446","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}

引用次数: 0