HCA healthcare journal of medicine最新文献

{"title":"The Commonly Uncommon Presentation of Cerebral Venous Thrombosis: A Case Report.","authors":"Elizabeth Piwowarski, Kalyan Mantha, Martin Wegman","doi":"10.36518/2689-0216.1921","DOIUrl":"10.36518/2689-0216.1921","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral venous thrombosis (CVT) is notoriously misdiagnosed as more benign etiologies during the initial examination owing to its relative rarity, its wide variety of presenting symptoms and onset and progression patterns, and its frequent requirement for less commonly utilized imaging techniques in its diagnosis. Accordingly, most cases are identified only after repeated evaluations for symptom persistence or progression, or in cases involving prothrombotic states linked to the disease, such as pregnancy, puerperium, genetic or acquired thrombophilia, and infection.</p><p><strong>Case presentation: </strong>We present the case of a 29-year-old woman with a history of obesity and oral contraceptive use who was found to have an extensive cerebral venous thrombosis that required 4 emergency department visits and hospital admission with neurology consultation before the diagnosis was made.</p><p><strong>Conclusion: </strong>It is important for the clinician to identify the risk factors and presenting symptoms associated with CVT to facilitate timely treatment and decrease the risk of long-term complications, which are associated with significant morbidity and mortality. The aim of this case report is to bring increased awareness to this disease process for these reasons.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"287-291"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610486","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 Prevalence of Abdominal Compartment Syndrome in the State of Florida.","authors":"Jason M Clark, Laura Mena-Albors, Huazhi Liu, Darwin Ang","doi":"10.36518/2689-0216.1668","DOIUrl":"10.36518/2689-0216.1668","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal compartment syndrome (ACS) is associated with significant mortality. Multiple studies have evaluated the prevalence of ACS at individual institutions and/or for short durations. No study has looked at the change of prevalence over an extended time or included nonresearch institutions. This study aims to evaluate the trend in the prevalence of ACS over time within the state of Florida.</p><p><strong>Methods: </strong>This is a population-based retrospective study using deidentified data from the Florida's Agency of Healthcare Database between 2006 and 2021. A total of 16 217 617 patients were evaluated within the intensive care unit (ICU), with 4002 developing ACS. The primary outcome was the development of ACS. Secondary outcomes were mortality, ICU days, number of surgeries, hospital days, and complication rates.</p><p><strong>Results: </strong>Patients with ACS were typically younger (>64 yrs, 34.9% vs 55.3%, <i>P</i> < .0001), male (65.3% vs 51.2%, <i>P</i> < .0001), and more frequently diagnosed with shock compared to the overall ICU population. Patients with ACS were more likely to be self-pay (6.3% vs 5.5%, <i>P</i> = .02) and non-White. The reported prevalence of ACS increased from 53 per million (2006) to 402 per million (2021). Mortality for ACS ranged from 39.4% to 55.4% but remained unchanged during the study period. Hospital length of stay for ACS trended down from 29.8 days to 22.4 days during the study period, while it remained unchanged for all ICU patients (6.82 to 7.54 days).</p><p><strong>Conclusion: </strong>The prevalence of ACS has increased over the years within the state of Florida. Mortality and complication rates have remained relatively unchanged. Hospital length of stay has decreased during that same time period.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610487","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":"Unique Presentation of Vertebral Artery Dissection: A Case Report.","authors":"Rossen I Kirkov, Daniel Fisher","doi":"10.36518/2689-0216.1853","DOIUrl":"10.36518/2689-0216.1853","url":null,"abstract":"<p><strong>Background: </strong>Vertebral artery dissection (VAD) is a common cause of stroke within the younger patient population. It is usually associated with headache or neck pain, as well as signs and symptoms of a posterior circulation stroke, such as vertigo, dysarthria, and ataxia. However, there are very scarce reports of patients with this pathology presenting with focal neurologic deficits, which are more indicative of a cerebral stroke.</p><p><strong>Case presentation: </strong>This case involves a 46-year-old woman who presented to the emergency department (ED) with complaints of right-sided headache and neck pain, which had been ongoing for 1 week, with newly developed right upper and lower extremity weakness and numbness 2.5 hours prior to arrival. There was a questionable finding of a VAD on the initial computed tomography angiography (CTA). Tenecteplase (TNK) was administered, and the patient's symptoms improved rapidly. Follow-up magnetic resonance imaging showed no evidence of cerebral infarction but did confirm the VAD. The patient was eventually discharged on antiplatelet therapy.</p><p><strong>Conclusion: </strong>Vertebral artery dissection is an important diagnosis to consider in a patient presenting to the ED with neck pain and associated neurologic deficits. However, the patient's deficits in this scenario were more consistent with cerebral ischemia, and with a questionable CTA finding of dissection, the patient was treated with TNK. Currently, no official guidelines exist to recommend treatment of VAD with thrombolytics, as no randomized controlled trial has been done to show this is an effective and safe treatment. This case highlights a unique presentation of a VAD and adds to the growing support of using thrombolytics to treat VAD.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"275-278"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610502","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 Resident.","authors":"Angelina Hong","doi":"10.36518/2689-0216.1842","DOIUrl":"https://doi.org/10.36518/2689-0216.1842","url":null,"abstract":"<p><p>Description We are all passengers in this life, with unique trails and destinations but many common intersections along the way. I have always been fascinated by the multidimensional nature of the hospital-a place of hope, love, pain, mourning, reflection all at once, not only for patients, but also for friends, family, and employees. At times, journeys become so layered and intertwined that the lines between these different roles are blurred, seemingly dissolving the classical hierarchy we rely on to differentiate physicians, residents, nurses, patients etc. At the end of the day, we are all people persevering and growing the best we can, and this work attempts to express that shared experience.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"293-294"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610474","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":"Breath of Life.","authors":"Cindy Borum, Colleen Dowd, Meg Underwood, Shauna Graham, Terri Schmidt, Linda Myers","doi":"10.36518/2689-0216.2004","DOIUrl":"https://doi.org/10.36518/2689-0216.2004","url":null,"abstract":"<p><p>Description We meet for friendship, laughter, and spending time together. Each person paints a 6 × 6 inch tile, some more competent than others. Each person comfortably shares their painting without judgment, and we are proud of what our bond produces. The output keeps us going with a refreshing breath of life. You see, we also work together every day in health care.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"295-296"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610477","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":"Complications and Management of Idiopathic Multicentric Castleman Disease.","authors":"Kavanya Feustel, Jacob Keeling, Olivia Makos, Dmitriy Scherbak","doi":"10.36518/2689-0216.1774","DOIUrl":"10.36518/2689-0216.1774","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of idiopathic multicentric Castleman disease (iMCD) is poorly understood compared to the other subtypes of MCD, which has contributed to limited treatment options and poor prognosis for iMCD patients. The pathogenesis of iMCD is thought to be mediated in part by dysregulation of interleukin (IL)-6.</p><p><strong>Case presentation: </strong>We present a case report of a 39-year-old Caucasian man with siltuximab-refractory iMCD. He presented with severe lower extremity lymphedema and wounds. His disease progressed through standard-of-care siltuximab. Due to his severe disease-related morbidity, he contracted recurrent infections, often complicated by sepsis. Ultimately, he required a left lower extremity amputation.</p><p><strong>Conclusion: </strong>The first-line and only United States Food and Drug Administration-approved therapy for iMCD is siltuximab, an anti-IL6 agent. However, it is clear that the pathogenesis of iMCD is more complex than strictly an IL-6-driven disease as siltuximab only showed a 34% durable response rate in clinical trials. Cytokine and proteomic profiling have shown normal IL-6 levels in many patients with iMCD. Further efforts to understand the mechanisms and etiology of iMCD are needed, particularly for siltuximab-refractory patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"269-274"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610480","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":"Care Alert Program in Chronic Emergency Department Using Patients: Expanded Study.","authors":"Jonathan Leggett, Kaitlyn Phelps, David Nuñez, Brent Wright, Erica Gibbons, Jonathan Bryan, Brian Griggs","doi":"10.36518/2689-0216.1896","DOIUrl":"10.36518/2689-0216.1896","url":null,"abstract":"<p><strong>Introduction: </strong>The Care Alert Program (CAP) is designed to help navigate encounters with patients who are high utilizers of Emergency Department (ED) resources. The CAP intends to address the needs of this challenging patient population by designing individualized care plans that are approved by a multidisciplinary committee. The patient populations that frequently use ED resources often have chronic medical conditions, a poor understanding of their conditions, unrealistic expectations regarding treatment, a lack of outpatient resources, and present with multiple complaints when using ED resources.</p><p><strong>Methods: </strong>The CAP was adopted by our facility in the spring of 2020. The present study is an expanded version of a previously published pilot project conducted in 2020-2021, in which we demonstrated a decrease in both ED visits and admission rates.</p><p><strong>Results: </strong>In this expanded study, we reviewed 46 CAP cases and determined the mean percentage of patient ED visits decreased by 42.3% in this patient population. Average hospital admission rates decreased by 50.4% during the initial 8 months after enrollment into the CAP.</p><p><strong>Conclusion: </strong>Implementing the CAP is an effective way reduce hospital admission rate and average ED visits amongst high utilizers.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"233-237"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610478","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":"Unraveling the Threads: A Case Report on Confusional Migraine and the Intricate Dance Between Psychiatry and Neurology.","authors":"Mabit C Gonzalez, Manjula Kottapalli","doi":"10.36518/2689-0216.1898","DOIUrl":"10.36518/2689-0216.1898","url":null,"abstract":"<p><strong>Background: </strong>Migraine affects about 1 billion people worldwide and is associated with a significant negative impact on personal and occupational functioning. Migraine accompanied by aura is seen in about 15% of migraineurs. Visual aura is the most common type of aura. Much less common though are auras that involve higher mental function, such as confusional state. The confusional state may manifest with a wide variety of cortical dysfunction, such as speech impairment, increased alertness, agitation, and amnesia, often lasting longer than a typical migraine aura.</p><p><strong>Case presentation: </strong>The authors present the unique case of a 29-year-old patient with episodic and transient bizarre behavioral symptoms in the context of migraine headaches.</p><p><strong>Conclusion: </strong>Our patient's presentation is suggestive of acute confusional migraine, which poses several diagnostic complexities and illustrates the difficulties with symptomatology that might have a medical/organic component versus a psychiatric one. The literature on this topic is lacking, and further research into this condition is warranted to optimize comprehensive patient care.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"279-282"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610503","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":"Automated Dispensing Cabinet Stocking Schedule and Inventory Management Optimization.","authors":"Daniel Elkes, Victoria Timmons","doi":"10.36518/2689-0216.1822","DOIUrl":"10.36518/2689-0216.1822","url":null,"abstract":"<p><strong>Background: </strong>Prior practice in a 523-bed community hospital required automated dispensing cabinets (ADCs) to be replenished daily by early afternoon to ensure accurate drug ordering. Because of the tight time window, technicians frequently refilled ADCs during peak medication administration times. After a positive report from a smaller facility in the health system, the study facility implemented a quality improvement project to optimize the ADCs. This involved new processes of every-other-day ADC replenishment staggered via shift-specific workflows, and a dedicated technician was assigned to optimize ADC inventories.</p><p><strong>Methods: </strong>Monthly reports of ADC refilling and dispensing transactions were compiled from inpatient, nonprocedural units. Data on stock-out transactions, when a nurse attempts to remove a medication from an empty ADC pocket, were obtained from facility reports from the same machines. Based on hospital policy for standard medication administration times, peak times were identified. For these time windows, an overlap ratio was calculated by dividing the relative frequencies of refill and dispense transactions. The average overlap ratios were calculated for the pre- and post-implementation periods. Stock-out transactions were tracked monthly, and a 95% confidence interval was constructed for all months before implementation.</p><p><strong>Results: </strong>Post-implementation, monthly stock-out counts significantly decreased by 38% within 6 months. While there was no change in medication dispensing patterns, there was a major shift in refilling activity patterns. Overlap during morning peak times decreased, but overlap increased during the evening peak times due to the rearrangement of technician shift times and workflows.</p><p><strong>Conclusion: </strong>After implementation of the new process and ADC inventory optimization, refill habits significantly changed, leading to reduced technician-nurse overlap during the morning medication pass, likely due to the spread out replenishment schedule. Dispensing habits did not change during the study period, and while there was a significant decrease in stock-outs post-implementation, there was insufficient data to assess effects of the new refilling processes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"225-232"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610475","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":"Efficacy and Safety of Lotilaner Ophthalmic Solution 0.25% in Demodex Blepharitis: A Systematic Review.","authors":"Stephanie P Fabara, Thalia Fabara, Akankcha Alok, Nausheen Khuddus","doi":"10.36518/2689-0216.1985","DOIUrl":"10.36518/2689-0216.1985","url":null,"abstract":"<p><p>Description <i>Demodex</i> blepharitis is a chronic eyelid inflammation caused by <i>Demodex</i> mites, which are ubiquitous skin parasites. Lotilaner, a newly United States Food and Drug Administration (FDA)-approved drug, is an antiparasitic agent that selectively inhibits parasite-specific γ-aminobutyric acid chloride channels, inducing spastic paralysis and death of <i>Demodex</i> mites. It is applied as an ophthalmic solution, 0.25%, twice a day for 6 weeks, and it has a long half-life and high lipophilicity, facilitating the penetration of the drug into the eyelash follicles and meibomian glands where the mites reside. This study systematically reviewed 6 clinical trials that compared lotilaner with placebo for <i>Demodex</i> blepharitis. The primary efficacy endpoint was complete collarette cure, defined as collarette grade 0 on the upper lid of the analysis eye. The secondary efficacy endpoint was decreased mite density with mite eradication, defined as 0 mites per lash on the analysis eye at day 42. The results showed that lotilaner treatment was significantly more effective than the control in achieving both endpoints, with a maximum reduction of 94.7% in mite density at day 43. The treatment effect persisted for at least 2 months after the end of treatment. Lotilaner was also safe and well tolerated, with no serious adverse events reported. For primary care providers, this study underscores the importance of recognizing collarettes as a key diagnostic marker for <i>Demodex</i> blepharitis during routine examinations. Lotilaner ophthalmic solution, 0.25%, offers a novel, effective therapy for this condition, enabling earlier intervention and improved outcomes for patients. Further investigation in larger trials is warranted to confirm these findings and refine their clinical application.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"213-223"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610482","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}