HCA healthcare journal of medicine最新文献

{"title":"Time for a New Whole-Person Care Pathway for Chest Pain Admissions.","authors":"Dana Kajan, Sabbir Mirza, Alexander M Ruiz, Anthony De-Gennaro, Mohamad S Saad","doi":"10.36518/2689-0216.2424","DOIUrl":"10.36518/2689-0216.2424","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) visits for chest pain are common and costly, and ED workup often shows no clear cardiac etiology in low-risk patients. Emerging evidence suggests that social determinants of health (SDOH) such as loneliness, social isolation, and food insecurity contribute to cardiovascular outcomes and chest pain presentations.</p><p><strong>Methods: </strong>We interviewed 114 patients (>18 years) presenting with chest pain and a thrombolysis in myocardial infarction (TIMI) score less than 4 at our community teaching hospital ED. Structured questionnaires assessed the SDOH triad of loneliness, social isolation, and food insecurity. Dependent variables included systolic blood pressure (SBP) at admission, body mass index (BMI), ejection fraction (EF) within 6 months of admission, and 30-day readmissions. Correlation analyses examined significant associations between SDOH and cardiometabolic outcomes.</p><p><strong>Results: </strong>Loneliness was prevalent in 71% of our surveyed participants (mean age of 64, 53% male, 47% female). Loneliness had a strong positive correlation with poorly controlled admission SBP and a negative correlation with EF. Higher social isolation scores had a negative correlation with EF. Food insecurity was prevalent in 71% of participants, and it had a moderate but positive correlation with higher BMI. Thirty-day readmission of patients with a prior ED hospitalization for cardiac examination was 7% across all the etiologies included in this study.</p><p><strong>Conclusions: </strong>Because SDOH are potently present in patients who visit EDs with chest pain, locally designed screening cards should be part of the workup. The rise of the loneliness, social isolation, and food insecurity syndemics should raise our awareness to manage those risk factors individually, institutionally, and systemically.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"289-296"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586228","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":"Using Mohs Micrographic Surgery to Treat a Large, Pedunculated Trichoblastoma on the Upper Cutaneous Lip.","authors":"Richard G Bindernagel, Addie Walker, Richard Miller","doi":"10.36518/2689-0216.1964","DOIUrl":"10.36518/2689-0216.1964","url":null,"abstract":"<p><p>Description Trichoblastomas are uncommon adnexal tumors that usually occur on the face. We report a case of a 62-year-old White man with a large, asymptomatic, slow-growing lesion that had been on his right upper cutaneous lip for 15 years. A 2 cm pink, pedunculated nodule with telangiectasia was seen on examination. A shave biopsy was consistent with trichoblastoma: a circumscribed-appearing dermal tumor of basaloid cells arranged in cords and islands within a cellular stroma, focal epidermal connection, and papillary mesenchymal bodies. The patient elected for treatment with Mohs micrographic surgery (MMS) given the length of time that the tumor had been neglected as well as its large size, location in cosmetically sensitive area, and ability to deeply invade beyond clinical margins. The tumor was cleared after 2 stages, and a rotation flap was performed. Approximately 2 months later, the patient had achieved excellent cosmesis and was satisfied with the surgical outcome. This case highlights the utility of MMS to treat large (and in our case, neglected) facial trichoblastomas. Despite being benign tumors, trichoblastomas that are large and long-standing may have improved outcomes with MMS, especially given their ability to invade deeply beyond clinical margins. As a result of MMS, patients with large facial trichoblastomas can achieve tumor clearance and the best possible cosmetic outcome.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"307-309"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586231","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":"Diastole.","authors":"Charlaine Chen","doi":"10.36518/2689-0216.2559","DOIUrl":"https://doi.org/10.36518/2689-0216.2559","url":null,"abstract":"<p><p>Description Diastole is the space between heartbeats. It is in this space that the heart actively rests, refills. These periods of relaxation are what allow the next heartbeat to occur. A heart without diastole is in heart failure. In medical training, we are raised on the myth that constant effort equals devotion, that rest is a luxury. A sense of guilt riddles me when I take a sick day, or when I feel I am not doing enough, fast enough. This work is a meditation on the nature of rhythm, and the rhythm of nature. These quiet spaces are not signs of weakness, but rather deliberate, and vital. In this piece I visualize this feeling of stillness. An exhalation. It is a reminder to myself to listen to the wisdom of the heart. And it is permission, unapologetically, to rest, refill, continue.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"361-362"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586223","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":"Assessment and Intervention for Health Behavior Change in Primary Care Across the Lifespan: A Guide for Residents in Primary Care Specialties.","authors":"Stacy A Ogbeide, Alexis Ramos, Bridget Murphy, Angel Ogbeide","doi":"10.36518/2689-0216.2321","DOIUrl":"10.36518/2689-0216.2321","url":null,"abstract":"<p><p>Description More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered dietitians, behavioral health clinicians, oral health clinicians, and health educators have an important role in primary care to co-manage the patient population, but often, the primary care setting underutilizes these other health care team members. Therefore, if the PCC understands how the psychological and behavioral aspects of health behavior change and chronic disease management fit within a team-based care model, care may improve. Team-based care has been implemented and studied in many ways, but with the Accreditation Council for Graduate Medical Education recently necessitating significant behavioral health training and practice opportunities for medical residents in primary care residency training programs, new and innovative approaches to training medical residents in behavioral health are needed to meet the health behavior change needs of their future populations upon graduation. This article provides an overview of health behavior change theories and translates theory into primary care practice within medical education through case examples. Our goal is to provide PCCs in primary care specialties such as Family Medicine, Pediatrics, and Internal Medicine with evidence-based and inventive behavioral treatment approaches to increase their ability to holistically treat chronic conditions in primary care through collaboration with other health care team members as well as train upcoming PCCs in these important practices.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"331-336"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586064","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 PhD in Graduate Medical Education: Leveraging Doctoral Training for Educational Innovation.","authors":"Rémy Roe","doi":"10.36518/2689-0216.2417","DOIUrl":"10.36518/2689-0216.2417","url":null,"abstract":"<p><p>Description The field of Graduate Medical Education (GME) increasingly employs PhD-trained professionals in roles including simulation directors, education researchers, program coordinators, and assessment specialists. These professionals bring valuable expertise in educational theory, research methodology, and interdisciplinary perspectives that complement physician leadership. However, role ambiguity, hierarchical positioning, and underutilization of scholarly expertise remain common challenges. This article examines the growing population of PhD-trained professionals in GME, identifies their unique contributions, and proposes strategies for better integration. Recommendations include clarifying faculty appointments, recognizing doctoral credentials appropriately, leveraging interdisciplinary expertise in strategic planning, providing protected time for scholarship, and building professional community. As GME programs expand, effectively integrating diverse scholarly expertise represents a significant opportunity for educational innovation. Programs that embrace this reality will lead in educational innovation and position themselves at the forefront of GME excellence. Organizations willing to integrate diverse scholarly perspectives will shape the future of medical education.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"349-356"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586162","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":"Enhancing Clinical Care Quality Through 1-on-1 Quality Improvement Education in Family Medicine.","authors":"Jude K A des Bordes, Shira K Goldstein, Nahid J Rianon","doi":"10.36518/2689-0216.2336","DOIUrl":"10.36518/2689-0216.2336","url":null,"abstract":"<p><strong>Background: </strong>Ongoing improvement and evaluation of clinical care are essential to maintaining high standards. The Accreditation Council for Graduate Medical Education (ACGME) requires all accredited family medicine programs to provide quality improvement (QI) education. Given competing educational demands, residency programs must adopt innovative approaches to teaching QI. This article describes an individualized approach to QI education that we implemented in our family medicine residency program and the outcome of its evaluation.</p><p><strong>Methods: </strong>Guided by a logic model and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this quasi-experimental 1-group pre-test-post-test study (July 2022-June 2023) involved all second-year family medicine residents during a protected QI month. Residents participated in a 1-on-1 session with a QI expert, completed a 10-item baseline knowledge survey, received 4 weekly mentoring meetings to develop a QI charter to address resident-selected quality gap, and completed an online QI module. Knowledge was reassessed at the month's end, and an end-of-year survey evaluated perceptions and sustainability.</p><p><strong>Results: </strong>The program achieved 100% reach with the participation of all 12 residents. Knowledge scores improved from 6.25 (±2.2) to 9.0 (±0.95) out of 10 (<i>P</i> < .001). Adoption was high, with all residents completing the module and a QI charter; implementation fidelity was 100%. Ten residents (83%) completed the end-of-year survey, unanimously reporting improved understanding of QI and confidence to lead future projects.</p><p><strong>Conclusion: </strong>An individualized mentoring approach to QI education was feasible and effective, enhancing resident knowledge and readiness to design targeted improvement initiatives.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"337-347"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586197","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":"Autoimmune Hemolytic Anemia Associated With Leptospirosis: A Rare Complication.","authors":"Anum Waqar, Furqan Mazhar, Mahrukh Afzal, Sadia Razzaq, Sana Ijaz","doi":"10.36518/2689-0216.2369","DOIUrl":"10.36518/2689-0216.2369","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune hemolytic anemia (AIHA) is rare but potentially life-threatening complication of leptospirosis, a zoonotic infection caused by the <i>Leptospira</i> species. Autoimmune hemolytic anemia occurs when the immune system targets red blood cells, resulting in hemolysis and anemia. The relationship between leptospirosis and AIHA is uncommon and often under-recognized, which can delay diagnosis and management. This case highlights the importance of considering hematologic complications in leptospirosis.</p><p><strong>Case presentation: </strong>A 23-year-old male presented with low-grade fever, productive cough, shortness of breath, jaundice, and pallor for 15 days. On examination, he was pale and icteric with bilateral chest crepitations. Laboratory studies showed severe anemia (hemoglobin 5.5 g/dL), elevated lactate dehydrogenase (1027 U/L), hyperbilirubinemia, thrombocytopenia, and peripheral smear evidence of hemolysis. A direct Coombs' test was strongly positive. <i>Leptospira</i> immunoglobulin M serology confirmed the diagnosis. The patient was managed with broad-spectrum antibiotics (piperacillin-tazobactam and doxycycline) and high-dose corticosteroids (1 mg/kg/day). He improved clinically with stabilization of hemoglobin and a resolution of symptoms.</p><p><strong>Conclusion: </strong>This case demonstrates a rare immune-mediated manifestation of leptospirosis presenting as AIHA without hepatic or renal failure. Clinicians should maintain a high index of suspicion for hematologic complications in leptospirosis. Early recognition and timely initiation of corticosteroid therapy alongside antibiotics can improve patient outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"327-330"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586128","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 Case of Bilateral Upper and Lower Oral Cavity Cysts in a Newborn.","authors":"Frances Rodriguez Lara, Jillian L Chen, Jennifer N Shehan, Jessica R Levi","doi":"10.36518/2689-0216.2358","DOIUrl":"10.36518/2689-0216.2358","url":null,"abstract":"<p><strong>Background: </strong>Oral mucosal lesions in newborns have a broad differential diagnosis, ranging from benign, transient conditions to potential early signs of systemic disease. Most of these lesions are resolved without intervention, but delayed recognition can lead to complications, such as airway obstruction. Early identification is crucial for appropriate management. This case report discusses an unusual presentation of multiple oral mucosal cysts in a newborn, emphasizing the challenges of diagnosis and management.</p><p><strong>Case presentation: </strong>A 1-day-old male was evaluated at Boston Medical Center for cystic oral lesions identified during newborn screening. The infant was born at 36 weeks and 2 days' gestational age via vaginal delivery. His mother reported no feeding, breathing, or crying issues. On exam, there were 4 small cysts on the left lateral hard palate consistent with Epstein pearls. There were also 1 cm pedunculated cystic lesions on the lingual surface of the mandibular gingiva and on the lateral hard palate. Although unclear, the cysts were diagnosed as congenital gingival cysts and close follow up was recommended. At 4 months, lesions were asymptomatic and reduced significantly in size.The differential diagnosis for neonatal oral cysts is broad. Epstein's are common, self-limiting lesions, while gingival cysts may present as larger, keratin-filled cysts that also typically resolve spontaneously. Congenital epulis, though rare, are pedunculated masses requiring surgical removal. Given the uncertain diagnosis of this patient's lesions, the optimal choice of management was unclear. Although biopsy or surgery could provide definitive diagnosis, given that the lesions were asymptomatic, observation was continued.</p><p><strong>Conclusion: </strong>Oral mucosal lesions in newborns may raise parental concern, but most are benign and self-limiting; however, variabilities in presentation can make proper diagnoses difficult without histopathological confirmation. This case highlights the importance of observation, careful monitoring, and avoiding unnecessary surgical interventions.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"317-320"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586078","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":"Trends in Emergency Department Utilization After Metabolic and Bariatric Surgery in the United States.","authors":"Andrew Sanders, Isabella Moncada, Sabrina Avanzato, Michelle Fakler, Michael Dombek, R Wesley Vosburg","doi":"10.36518/2689-0216.2159","DOIUrl":"10.36518/2689-0216.2159","url":null,"abstract":"<p><strong>Background: </strong>In this article, we sought to understand the factors associated with emergency department (ED) utilization by patients after metabolic and bariatric surgery (MBS). The hopes were that modifiable risk factors could be identified to reduce ED visits after MBS.</p><p><strong>Methods: </strong>We analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (MBSAQIP) which is comprised of data from all nationally accredited bariatric centers in the United States. For our study, we included a population of 681 743 patients having undergone the 2 most common MBS procedures: sleeve gastrectomy (SG) and gastric bypass (GBP). Using logistic regression analysis, we identified key factors related to ED visits within 30 days of these procedures.</p><p><strong>Results: </strong>In our dataset, 7.1% of MBS patients had at least 1 ED visit, which is consistent with prior bariatric surgery studies. The most common reasons for ED visits were dehydration, urinary tract infections (UTIs), and surgical site infections (SSIs). Common comorbidities among the groups included conditions such as hypertension, sleep apnea, gastroesophageal reflux disease, and diabetes. The median time for the first ED visit was 11 days postoperatively. Our statistical analysis revealed significant associations between ED visits and dehydration, UTIs, and superficial SSI, but not with sex, race, robotic assistance, or trainee (resident) involvement.</p><p><strong>Conclusion: </strong>The short time span between MBS surgery and postoperative ED visits suggests the need for outpatient follow-up to alleviate unnecessary ED visits. Further, our analysis identified the most frequent diagnosis that should guide the development of systematic follow-up protocols that can be used to identify those patients which may require additional post-surgical care.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"273-280"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586233","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":"Navigating Complex Esophageal Perforations: A Case-Specific Approach to Successful Outcomes.","authors":"Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S Brar","doi":"10.36518/2689-0216.2216","DOIUrl":"10.36518/2689-0216.2216","url":null,"abstract":"<p><p>Description Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the patient to recover without the need for surgical intervention. This case underscores the importance of a stepwise, individualized endoscopic approach in managing complex esophageal perforations. A combination of SEMS, endoscopic suturing, and fixation techniques can enhance closure success and prevent complications, reducing the need for surgery.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"7 3","pages":"311-315"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586212","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}