HCA healthcare journal of medicine最新文献

{"title":"The Placement of a Single-Incision Mini-Sling for the Treatment of Complete Intrinsic Sphincter Deficiency in an Adolescent Female: A Case Report.","authors":"Norman Bebla, Dylan Gallegos","doi":"10.36518/2689-0216.1672","DOIUrl":"https://doi.org/10.36518/2689-0216.1672","url":null,"abstract":"<p><strong>Introduction: </strong>Intrinsic sphincter deficiency (ISD) is associated with a patient history of urethral injury or childbirth. Suburethral sling placement for ISD has been found to be beneficial in patients with this diagnosis. ISD in the pediatric population is rare and surgical management may prove difficult. ISD requires intensive counseling on available treatment options for this unique population.</p><p><strong>Case presentation: </strong>This report is on the use of the single-incision mini-sling for complete ISD in an adolescent patient. The patient was a 15-year-old nulligravid female who was found to have idiopathic complete intrinsic deficiency based on a multi-channel urodynamic study. Despite conservative management, the patient opted for a surgical option instead. The patient underwent a single-incision mini-sling placement. At 3- and 6-month postoperative follow-up visits, the patient reported a subjective cure of stress urinary incontinence.</p><p><strong>Conclusion: </strong>Single-incision mini-sling is a minimally invasive surgical technique that may be a feasible treatment option to reduce urinary incontinence in pediatric patients with a diagnosis of ISD.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"465-467"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302585","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":"A Pilot Physician Mentoring Program in a Large Hospital System.","authors":"Crista C Keller","doi":"10.36518/2689-0216.1750","DOIUrl":"https://doi.org/10.36518/2689-0216.1750","url":null,"abstract":"<p><p>Description This article summarizes the development and implementation of a mentoring program designed to support and educate physicians new to practice in a large, outpatient hospital system. The program addresses organizational, operational, and financial elements of medical practice. Topics include efficiency and time management, coding education, leadership, and burnout. These topics are often not directly addressed in medical education, yet are crucial to physician well-being. The article describes the program structure, initial feedback, and recommendations for program replication and expansion.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"393-396"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302560","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":"A Clinical Review on Spinal Epidural Abscess: Epidemiology, Pathophysiology, Diagnosis, and Management for Emergency Medicine and Hospitalist Physicians.","authors":"Madeline A Guy, Jeffrey S Guy","doi":"10.36518/2689-0216.1676","DOIUrl":"https://doi.org/10.36518/2689-0216.1676","url":null,"abstract":"<p><p>Description Spinal epidural abscess (SEA), a critical surgical emergency, demands prompt recognition and intervention to prevent severe complications and fatalities. The incidence of SEA is notably increasing, particularly among individuals with diabetes, intravenous drug use, or a history of invasive spinal procedures. Although SEA can manifest through various clinical symptoms, the presence of its classic triad-back pain, fever, and neurological deficits-is noteworthy despite its occurrence in only 10% to 13% of cases. Identifying this triad is vital due to its high specificity for SEA, which is essential to guiding swift diagnostic and therapeutic actions in a condition where early intervention is critical. Magnetic resonance imaging is pivotal in diagnosing SEA, offering unmatched sensitivity and specificity compared to other imaging techniques. Immediate empirical antibiotic therapy and timely neurosurgical consultation, when required, form the foundation of SEA treatment. The prognosis significantly depends on the patient's initial neurological status, underlying health conditions, and the timeliness of their presentation, diagnosis, and treatment initiation. Given the complexity of SEA and the high risk of diagnostic delays, managing this condition involves substantial medicolegal considerations. Enhanced comprehension of SEA is imperative for improving patient outcomes and reducing health care resource burdens. Prompt and accurate diagnosis and appropriate interventions are essential for effectively managing this urgent condition.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"397-404"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302559","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":"Theory of a Well Mind.","authors":"Joan S Hyland","doi":"10.36518/2689-0216.1746","DOIUrl":"https://doi.org/10.36518/2689-0216.1746","url":null,"abstract":"<p><p>Description In psychiatry residency, we have a didactic within our curriculum that focuses on psychotherapy. This subject culminates in our third year when our program's psychotherapy supervisor asks each of us to create our own personal theory. It allowed us to explore and apply what we had learned up until this point and formulate our own understanding of why people are the way that they are, how people change, and how to facilitate that growth through our theory. Each of us chose to represent our theory in unique ways, reflective of our personalities. One tech-savvy resident used AI and images. Another used a relevant case involving themes of feminism and cultural competency. I represented my theory through poetry. This theory has elements of emotion-focused therapy, attachment theory, and cognitive behavior therapy. Engaging in this style of learning left me with fulfillment and a newfound satisfaction for what I had learned.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"489-490"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302586","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 and Radiological Identification and Management of SAPHO Syndrome.","authors":"Obyda Al-Housni, Jessica M Alonso, Matthew Thornburg, Enny Cancio","doi":"10.36518/2689-0216.1650","DOIUrl":"https://doi.org/10.36518/2689-0216.1650","url":null,"abstract":"<p><strong>Introduction: </strong>Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an autoinflammatory disease whose acronymic name stands for the symptoms commonly seen in the disease. These symptoms typically occur simultaneously, in different combinations, in patients during exacerbations of the disease. SAPHO syndrome is a rare disease, most frequently seen in patients aged 30 to 50. It is estimated to be found in 1 in 10 000 persons in White populations, with an even lower incidence seen in non-White populations.</p><p><strong>Case presentation: </strong>A post-menopausal woman with a medical history of SAPHO presented to the emergency department with left foot pain and chest pain with palpitation. She had chronic pustular rashes, located on the bilateral soles of the feet, bilateral palms, neck, and abdomen, which she stated appeared hours after the initial presentation of her pain. Chest X-ray readings showed osteitis and sclerosis of the sternocostoclavicular joint and first rib, a radiological finding of SAPHO syndrome. The patient was successfully treated with nonsteroidal anti-inflammatory drugs for pain relief and IV corticosteroids for the rheumatoid-like inflammatory aspect of SAPHO.</p><p><strong>Conclusion: </strong>While SAPHO syndrome is a rare disease, it is important to be aware of its manifestations and symptoms, such as the patient's rash, foot and chest pain, in addition to the dermatological symptoms appearing simultaneously. An early diagnosis can provide patients with accurate and appropriate treatment.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"449-452"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302578","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":"A Survey of Post-Graduate Satisfaction With Orthopaedic Residency Training at a Single Institution.","authors":"Jared L Sain, Craig R Louer, Robert J Esther, Christopher W Olcott","doi":"10.36518/2689-0216.1670","DOIUrl":"https://doi.org/10.36518/2689-0216.1670","url":null,"abstract":"<p><strong>Background: </strong>The Accreditation Council for Graduate Medical Education (ACGME) has called for self-study within residency programs. Post-graduate surveys allow the graduate to reflect upon their residency experience after years of autonomous practice. Despite their potential utility, a standardized assessment of residency training from the perspective of orthopaedic alumni does not exist. In this study, we aimed to create, analyze, and share with our alumni a post-graduate survey based on ACGME core competencies.</p><p><strong>Methods: </strong>The survey was developed by full-time orthopaedic faculty and reviewed by a survey methodologist to ensure clarity and an ideal survey format. In May 2020, the survey was emailed to all 90 graduates from 2000 to 2019. Respondents were polled on current clinical practice and satisfaction with program-specific initiatives, residency requirements, and learning environment issues based on a 7-point Likert scale. Respondents were also given the opportunity to provide open-ended responses. Data were collected within the survey platform and subdivided into 3 cohorts based on years since graduation.</p><p><strong>Results: </strong>The response rate was 71% (64/90). The likelihood of fellowship training increased with recency since graduation. Most respondents are in either private or health-system-owned practice but 23% work in an academic center.The oldest cohort had greater variability in clinical practice. Most program-specific initiatives received high satisfaction scores, but graduates within the past 5 years had the lowest satisfaction scores. Instruction of skills included in ACGME competencies received generally favorable reviews, but professional development skills, such as starting a practice and evaluating job opportunities, received low marks.The overall satisfaction with the program was high (86%) but was lowest among most recent graduates.</p><p><strong>Conclusion: </strong>The post-graduate survey demonstrates areas of strength and weakness and highlights dissatisfaction among recent graduates. The data will drive specific curricular changes within our program. The survey will be shared to promote self-study within other programs.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"415-425"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302574","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":"Man on the Mound: Pictures of a Pitcher in Pain.","authors":"Jean Medina, Matthew Campanella, Elliot Mendelsohn, Carl Mitchell, Murtaza Akhter","doi":"10.36518/2689-0216.1697","DOIUrl":"https://doi.org/10.36518/2689-0216.1697","url":null,"abstract":"<p><p>Description Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases. Here, we present the case of a young patient, suffering an atraumatic \"ball thrower's\" fracture. We present images of this exceedingly rare injury pattern and showcase original artwork with a proposed mechanism of injury.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"445-447"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302580","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":"Steroid-Dependent Recurrent IgA Vasculitis in a 19-Year-Old Woman.","authors":"Hannah Berrett, Shivangi Gohil, Rebecca Kurian, Patricia Neyman","doi":"10.36518/2689-0216.1660","DOIUrl":"https://doi.org/10.36518/2689-0216.1660","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A (IgA) vasculitis is common in children and typically resolves spontaneously. However, when presenting in adults, it is more likely to be severe and recurrent.</p><p><strong>Case presentation: </strong>We present the case of a 19-year-old female patient with recurrent steroid-dependent IgA vasculitis. She had a history of a prolonged episode of IgA vasculitis in childhood. She presented to our hospital with proteinuria and a painful, palpable purpuric rash on her bilateral lower extremities. She was treated with high-dose intravenous steroids. When steroids were tapered, the patient had a recurrence of her painful rash. Over several months, she developed steroid-induced hyperglycemia and worsening proteinuria.</p><p><strong>Conclusion: </strong>Recent studies have shown that corticosteroids have limited effect on long-term outcomes in IgA vasculitis, but steroid-sparing agents have potential for the treatment of recurrent steroid-dependent IgA vasculitis.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"453-458"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302583","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":"A Nation-Wide Survey of Program Directors at a Large Health Care Organization: Prevalence and Perceptions of Resident Wellness Activities.","authors":"Alexander W Marshburn, Gabrielle Riazi, Sabrina Menezes, Stephanie Ramirez, Gregory Guldner, Jessica C Wells, Jason T Siegel","doi":"10.36518/2689-0216.1808","DOIUrl":"10.36518/2689-0216.1808","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels.</p><p><strong>Methods: </strong>In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making.</p><p><strong>Results: </strong>Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%).</p><p><strong>Conclusion: </strong>The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 3","pages":"251-263"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629440","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":"Empowering Voices: Cultivating a Supportive Network From the Women in Medicine and Health Care Symposium.","authors":"Rutuja D Bhalerao, Kyle Mefferd, Jocelyn A Limas","doi":"10.36518/2689-0216.1801","DOIUrl":"10.36518/2689-0216.1801","url":null,"abstract":"<p><p>Description There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital's General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view the event as the first step in creating a supportive community.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 3","pages":"187-189"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629448","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}