HCA healthcare journal of medicine最新文献

{"title":"COVID-19 Disease Characterization and Outcomes Comparison in Pediatrics.","authors":"Rachel Rowland,&nbsp;Abigail Schauble,&nbsp;Brendon Cornett","doi":"10.36518/2689-0216.1522","DOIUrl":"https://doi.org/10.36518/2689-0216.1522","url":null,"abstract":"<p><strong>Background: </strong>It has been reported that children experience less severe COVID-19 symptoms than adults; however, the literature that supports this idea is evolving. The purpose of this study was to retrospectively characterize hospitalized COVID-19-positive pediatric patients with a focus on the assessment of risk factors for poorer outcomes, mortality, and evaluation of interventions utilized and associated clinical outcomes.</p><p><strong>Methods: </strong>We conducted a multi-center retrospective chart review of patients 18 years old or younger who were COVID-19 positive and admitted to any US HCA Healthcare Pediatric service line between January 1, 2020, and November 30, 2020. We identified 6081 children across 4 states and included them in our data analysis. Negative Binomial Regression was used to measure the associations between characteristics abstracted from medical records and length of hospital stay.</p><p><strong>Results: </strong>Of the total cohort, 2.7% had at least one comorbidity. The majority of patients were discharged shortly after admission with 93.6% of patients spending less than 48 hours as an inpatient. The mortality rate during the study period was 0.1%. Factors found to be significantly associated with an increased length of stay were time in the intensive care unit (ICU), surgeries, developmental disorders, diabetes, post-traumatic stress disorder (PTSD), suicidal ideation, and type of admission.</p><p><strong>Conclusion: </strong>The results of this cohort show there was a low disease burden at baseline and during hospitalization in pediatric patients positive for COVID-19. However, as the pandemic continues, future studies that further describe COVID-19 in children will be crucial to fully understand the disease course.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519631/pdf/26890216_vol4_iss4_283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174882","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":"Eruptive Sebaceous Hyperplasia: A Case Report and Review of the Literature.","authors":"Carsten Z Steinmetz,&nbsp;Amanda Getz,&nbsp;Andras Schaffer,&nbsp;Stephen K Richardson","doi":"10.36518/2689-0216.1524","DOIUrl":"https://doi.org/10.36518/2689-0216.1524","url":null,"abstract":"<p><strong>Introduction: </strong>Eruptive sebaceous hyperplasia (ESH) is a benign process characterized by the acute onset and rapid proliferation of sebaceous glands, typically on the face. Although historically attributed to cyclosporine therapy, the preponderance of reports over the past 2 decades suggests a more complex etiology. There is increasing thought a combination of multiple medications as well as a genetic component contribute to ESH's clinical presentation. Despite these theories, the exact cause of ESH in immunosuppressive therapy is poorly understood.</p><p><strong>Case presentation: </strong>To our knowledge, we report the third case of ESH arising in multimodality immunosuppressive therapy, consisting of tacrolimus, mycophenolate mofetil, and prednisone, affecting a renal transplant patient. Our patient began cyclosporine monotherapy at an early age but did not see eruption of lesions until years later after following a multimodal therapy.</p><p><strong>Conclusion: </strong>We discuss the association of ESH with other medical conditions and treatments. We hope this case sheds light on a possible complication of multimodal immunosuppressive therapy in renal transplant patients. This will allow patients and providers to be better informed of the pros and cons of different treatment options for immunosuppressive therapy in renal transplant patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519630/pdf/26890216_vol4_iss4_315.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175291","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":"An Acknowledgement to the <i>HCA Healthcare Journal of Medicine</i>'s Reviewers and Editors for the First Half of 2023.","authors":"Bruce Deighton,&nbsp;Hossein Akhondi,&nbsp;Barbara L Gracious,&nbsp;David Scott Lind,&nbsp;Graig Donini","doi":"10.36518/2689-0216.1686","DOIUrl":"10.36518/2689-0216.1686","url":null,"abstract":"<p><p>Description The <i>HCA Healthcare Journal of Medicine</i> would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members. We also announce our inclusion in PubMed Central.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519636/pdf/26890216_vol4_iss4_263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156428","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":"Acute Esophageal Necrosis and Duodenal Disease in the Setting of Recently Initiated Chemotherapy.","authors":"Kulveer Dabb,&nbsp;Ryan Jansen van Rensburg,&nbsp;Heba Yusuf,&nbsp;Daniel Klein,&nbsp;Alexander D Lake,&nbsp;Mohamed Kaif","doi":"10.36518/2689-0216.1517","DOIUrl":"10.36518/2689-0216.1517","url":null,"abstract":"<p><strong>Introduction: </strong>Acute esophageal necrosis (AEN), commonly referred to as \"black esophagus\" or Gurvits syndrome, is a rare condition characterized by diffuse black mucosa in the distal esophagus. Most often, the patient is an older male with multiple comorbidities, presenting with upper gastrointestinal bleeding. The exact pathogenesis is unclear, but it is often thought to be secondary to acute vascular hypo-perfusion or ischemia of the esophageal mucosa in critically ill patients with certain secondary comorbid conditions such as renal insufficiency, diabetes mellitus, dyslipidemia, coronary artery disease, malnourishment, alcohol abuse, or association with an underlying malignancy.</p><p><strong>Case presentation: </strong>We present a case of AEN in a 78-year-old female following the recent start of a chemotherapy regimen with carboplatin and paclitaxel two weeks prior. The patient underwent EGD and was found to have AEN throughout the entirety of her esophagus with necrosis and eschars seen up to the second part of the duodenum. The patient initially improved after receiving blood transfusions, being made nil-per-os, and starting proton pump inhibitor (PPI) therapy, but she ultimately died given the severity of her clear cell uterine cancer and other comorbidities.</p><p><strong>Conclusion: </strong>Although it is rare that initiation of chemotherapy leads to AEN, it should be considered as a potential etiology.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519627/pdf/26890216_vol4_iss4_309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171708","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":"Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review of Randomized Controlled Trials.","authors":"Shin Jeong,&nbsp;Tunmi A Anwoju,&nbsp;Oscar A Olavarria,&nbsp;Natalia Cavagnaro,&nbsp;Naila H Dhanani,&nbsp;Nicole B Lyons,&nbsp;Zuhair Ali,&nbsp;Mike K Liang","doi":"10.36518/2689-0216.1469","DOIUrl":"https://doi.org/10.36518/2689-0216.1469","url":null,"abstract":"<p><strong>Background: </strong>During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of life (QOL). Pooled risk ratios with 95% confidence intervals were obtained through random effect meta-analyses.</p><p><strong>Results: </strong>Of 579 screened articles, 6 publications of 5 RCTs were included. No significant difference in major complications (10.6% vs 10.4%, RR=1.05, 95% CI=0.51-2.14, <i>P</i>=.90) or recurrences (9.0% vs 10.6%, RR=0.92, 95% CI=0.32-2.61, <i>P</i>=.87) were found between groups. Fascial defect closure decreased the risk of seromas (22.9% vs 34.2%, RR=0.60, 95% CI=0.37-0.97, <i>P</i>=.04) and may decrease the risk of eventrations (6.7% vs 9.0%, RR=0.74, 95% CI=0.37-1.50, <i>P</i>=.41) at the expense of potentially increasing the risk of SSI (3.2% vs 1.4%, RR=1.89, 95% CI=0.60-5.93; <i>P</i>=.28). Reporting of pain and QOL scores was inconsistent.</p><p><strong>Conclusion: </strong>While most individual RCTs demonstrated benefit with fascial defect closure during minimally invasive VHR, our meta-analysis of fascial defect closure demonstrated only a statistically significant difference in seromas compared to bridged repair. Large, multi-center RCTs are needed.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519634/pdf/26890216_vol4_iss4_267.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175958","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":"An Unusual Presentation of Infective Endocarditis.","authors":"Ethan J Peterson,&nbsp;Jordan Jackson,&nbsp;Syed M Zaidi,&nbsp;Jorge Perez","doi":"10.36518/2689-0216.1455","DOIUrl":"https://doi.org/10.36518/2689-0216.1455","url":null,"abstract":"<p><strong>Introduction: </strong>Leukocytoclastic vasculitis is the inflammation of small blood vessels due to leukocyte migration that comprises a wide range of differentials. It can be caused by autoimmune disorders, infections, neoplasms, or certain medications and warrants prompt recognition and therapy for optimal patient outcomes.</p><p><strong>Case presentation: </strong>Here we present a case of a 37-year-old male who presented with a painful, petechial rash on his torso and extremities. Skin biopsy revealed leukocytoclastic vasculitis, thereby prompting a comprehensive investigation into the underlying etiology leading to the diagnosis of <i>Pseudomonas aeruginosa</i> infective endocarditis.</p><p><strong>Conclusion: </strong><i>Pseudomonas aeruginosa</i> is a rare cause of infective endocarditis with a high mortality and morbidity rate. This case highlights the importance of taking a thorough history and physical along with a complete workup of vasculitis as the underlying cause can be life-threatening.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519628/pdf/26890216_vol4_iss4_297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177633","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":"Who Left the Hospital Against Medical Advice During the Early COVID-19 Pandemic?","authors":"Bryan Werner,&nbsp;Se Won Lee","doi":"10.36518/2689-0216.1530","DOIUrl":"10.36518/2689-0216.1530","url":null,"abstract":"<p><strong>Background: </strong>Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.</p><p><strong>Methods: </strong>This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with subsequent AMA discharge.</p><p><strong>Results: </strong>These patient characteristics included being younger than 50; identifying as male sex; having non-white ethnicity, including both Black and Hispanic; having either Medicaid or no health insurance; and the presence of specific medical comorbidities. The identified medical comorbidities were substance abuse, renal failure, deep vein thrombosis, hypertension with heart failure, hypertension with chronic kidney disease stage 5, rheumatoid arthritis or collagen vascular diseases, alcohol abuse, chronic pulmonary disease, hypertensive encephalopathy, and solid tumor.</p><p><strong>Conclusion: </strong>This study confirms some of the findings in previous studies looking at AMA discharges and has some interesting findings as it relates specifically to the COVID-19-infected patient population. An additional understanding of the factors leading to AMA discharges can help providers and administrators prevent suboptimal discharge outcomes in the future.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519635/pdf/26890216_vol4_iss4_291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171813","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":"COVID: The Sound of Silence.","authors":"Saptarshi Biswas","doi":"10.36518/2689-0216.1681","DOIUrl":"https://doi.org/10.36518/2689-0216.1681","url":null,"abstract":"<p><p>Description COVID brought its toll of deaths. Something the human race has not experienced in recent times. Something almost unimaginable in the modern world! But having joined a new hospital and moved to a sleepy old town, COVID gave me a sense of solitude I have not experienced for eons. There are times you wonder at the endless ocean in front of you and communicate with your inner soul.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519632/pdf/26890216_vol4_iss4_327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180639","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":"Reducing Unnecessary Acid Suppression Use in Hospitalized Patients: A Description of Targeted Strategies Implemented Across a Large Health System.","authors":"Elizabeth H Wiggins, L Hayley Burgess, Joan Kramer","doi":"10.36518/2689-0216.1471","DOIUrl":"10.36518/2689-0216.1471","url":null,"abstract":"<p><strong>Background: </strong>Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during transitions of care. In this article, we aim to describe the impact of targeted quality improvement strategies to reduce unnecessary acid suppression use in hospitalized patients across a large health system.</p><p><strong>Methods: </strong>Beginning January 1, 2018, focused quality improvement strategies to prevent unnecessary initiation and continuation of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) were implemented throughout a large health system. Targeted strategies were initially tested as part of the PPI deprescribing Institute for Healthcare Improvement (IHI) International Innovators Network initiative and were expanded to include H2RAs for hospitalized patients. Strategies to decrease PPIs and H2RAs during hospitalization included standardization of stress ulcer prophylaxis care pathways, evidence-based order set modifications, technology-driven support, and clinical pharmacy metric performance to goal. PPI/H2RA days of therapy (DOT) per 1000 patient days were measured from the first quarter (1Q) of 2017 to the fourth quarter (4Q) of 2021 to determine if implemented strategies resulted in improvement.</p><p><strong>Results: </strong>After quality improvement strategies were implemented, the number of PPI/H2RA DOT was reduced by 7.9 days per 1000 patient days each quarter over 4 years. The average PPI/H2RA DOT per 1000 patient days decreased from 592 (1Q 2017) to 439 (4Q 2021). In the fourth quarter of 2018, 45 hospitals (28%) achieved a 10% reduction in combined PPI/H2RA DOT per 1000 patient days, and 121 hospitals (97%) attained the goal of greater than 25% of eligible patients deprescribed PPI/H2RA for ICU patients in the fourth quarter of 2019. In the fourth quarter of 2020, 97 hospitals (87%) met the metric of 40% or more of eligible patients deprescribed from PPI/H2RA in or after an ICU stay, and 85 hospitals (87%) reached 50% or more of eligible patients deprescribed PPI/H2RA in or after an ICU stay in 4Q2021.</p><p><strong>Conclusion: </strong>Targeted quality improvement strategies decreased unnecessary PPI and H2RA use for a large health system over 4 years. Continually evaluating measured results along with establishing a new clinical pharmacy metric goal each year to encourage further improvement contributed to deprescribing success.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10324858/pdf/26890216_vol4_iss2_125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799594","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":"Implementation of Clinical Pharmacy Surveillance Technology and a Pharmacy Practice Model Re-Design Across a Multi-State Health System.","authors":"Elizabeth H Wiggins,&nbsp;Joan Kramer,&nbsp;L Hayley Burgess,&nbsp;Carley Warren","doi":"10.36518/2689-0216.1391","DOIUrl":"https://doi.org/10.36518/2689-0216.1391","url":null,"abstract":"<p><strong>Background: </strong>Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure outcomes that support return on investment. The overall goal of clinical surveillance technology implementation in this quality improvement project was to extend the pharmacists' reach and to improve patient safety and clinical outcomes with greater operational efficiencies.</p><p><strong>Methods: </strong>In 2013, a clinical pharmacy surveillance tool was piloted and expanded over the next 2 years to 154 hospitals across the health system. Over the next 6 years, the number of hospitals utilizing the technology, the number of drug therapy modifications, the time to pharmacist intervention, clinical pharmacy metric results, and return on investment were tracked.</p><p><strong>Results: </strong>From 2015 to 2021, the number of hospitals with clinical surveillance technology implemented grew to 177 hospitals. During this same time, the number of frontline clinical pharmacist drug therapy modifications more than doubled, and the time for pharmacists to respond to alerts decreased from 13.9 to 2.6 hours. Since 2015, the percentage of patients on vancomycin de-escalated by 3 days of therapy has increased by 12% and the percentage of patients with a UTI treated with fluoroquinolone decreased by 25%. Hard and soft dollar savings resulted in an annual return on investment of 1:12.9.</p><p><strong>Conclusion: </strong>After implementing the redesigned pharmacy services model, pharmacists were more efficient and patient outcomes improved.</p>","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/PMC10324869/pdf/26890216_vol4_iss2_111.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167671","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}