HCA healthcare journal of medicine最新文献

{"title":"A New Paradigm in Hospital Medicine: Evaluating the Effects of Geographical Cohorting on Health Care Delivery.","authors":"Vasu Gupta, Bhupinder Singh, Kanishk Aggarwal, Ayushi Garg, Rhea Kanwar, Fnu Anamika, Inder Preet Kaur, Rohit Jain","doi":"10.36518/2689-0216.1865","DOIUrl":"10.36518/2689-0216.1865","url":null,"abstract":"<p><strong>Background: </strong>Geographical cohorting in hospital settings represents a significant shift from traditional patient rounding practices and aims to enhance the efficiency of health care delivery. This model assigns hospitalists to a particular inpatient unit, where most of their patients are located. While this model has several benefits, including streamlining health care procedures, optimizing resource allocation, and fostering better provider communication, its implementation is not without its challenges.</p><p><strong>Methods: </strong>Our methodology for researching geographical cohorting involved a comprehensive literature review of peer-reviewed studies, surveys, and retrospective analyses. We utilized academic databases, such as PubMed, JSTOR, and Google Scholar, to identify relevant articles. Keywords used in the search included \"geographic cohorting,\" \"geographic rounding,\" \"hospitalist,\" \"patient outcomes,\" \"provider satisfaction,\" and \"hospital-acquired infections.\"</p><p><strong>Conclusion: </strong>Geographical rounding has been associated with a reduction in the incidence of hospital-acquired infections and other adverse outcomes, suggesting its potential to create a safer patient care environment. However, problems such as increased interruptions, indirect care time, and the possibility of diminished interpersonal communication highlight the intricacy involved in successfully implementing such a model. The adoption of geographical cohorting is further complicated by operational problems, such as the necessity for major operational expenditure and patient flow management. Notwithstanding these difficulties, research has shown mixed results regarding geographic cohorting, with some studies suggesting potential advantages, such as enhanced interdisciplinary collaboration and a decline in provider burnout. However, its impact on patient outcomes, like in-patient stay and satisfaction, is inconsistent.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"23-30"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607452","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 \"Wearing Off\" Phenomenon for Rasagiline, Entacapone, Carbidopa, and Levodopa in the Setting of Parkinson's Disease.","authors":"Ryan Cromwell, Tevin Um","doi":"10.36518/2689-0216.1718","DOIUrl":"10.36518/2689-0216.1718","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease is a primary neurological dysfunction syndrome in which the body's natural production of dopamine is reduced. Therapeutic intervention for this disease primarily includes medications that increase the body's natural production of dopamine. These medications can have side effects, requiring constant titration based on the patient's symptoms.</p><p><strong>Case presentation: </strong>We report a case study of a 75-year-old man diagnosed with Parkinson's disease who had a profound acute exacerbation of psychological symptoms following modifications to his dopaminergic treatment regimen. Initially, the patient was prescribed carbidopa/levodopa, rasagiline, and carbidopa/levodopa/entacapone. However, the treatment plan was adjusted due to the worsening of symptoms. The dose of carbidopa/levodopa was reduced, and rasagiline and Stalevo were stopped. Although the patient initially saw a temporary improvement, the patient later had hallucinations, delusions, agitation, dyskinesias, and akathisia. The laboratory testing and CT scan results showed no significant abnormalities.</p><p><strong>Conclusion: </strong>This case highlights the importance of accurate dosage and vigilant supervision of Parkinson's disease medications' \"wearing off\" phenomenon. The patient's varying reaction to changes in medication and the subsequent appearance of psychiatric symptoms highlights the need for an individualized approach to managing Parkinson's disease. Collectively, these symptoms suggest that clinicians should consider the possibility of non-linear connections between dopaminergic therapy and symptom control. To effectively address the intricate relationship between motor symptoms and psychiatric manifestations, it is imperative to implement a multidisciplinary team approach in future management. This approach would involve closely monitoring and adapting treatment strategies.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"71-74"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607206","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 Second Half of 2024.","authors":"Juan A Sanchez, Graig Donini","doi":"10.36518/2689-0216.2196","DOIUrl":"https://doi.org/10.36518/2689-0216.2196","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.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"3-5"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607459","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":"Synthetic Versus Biologic Mesh for Complex Open Ventral Hernia Repair: 3-Year Follow-Up of a Pilot Randomized Controlled Trial.","authors":"Naila H Dhanani, Nicole B Lyons, Kyung Hyun Lee, Oscar A Olavarria, Aris R Arakelians, Julie L Holihan, Lillian S Kao, Ali Siddiqui, Connor Hogan, Tunmi Anwoju, Zuhair Ali, Mike K Liang","doi":"10.36518/2689-0216.1761","DOIUrl":"10.36518/2689-0216.1761","url":null,"abstract":"<p><strong>Background: </strong>Biologic mesh is often used in complex hernia repair, but there has been limited clinical evidence to date to support this practice. The aim of this study was to compare clinical and patient-reported outcomes of biologic versus synthetic mesh for complex open ventral hernia repair (OVHR) at 3 years.</p><p><strong>Methods: </strong>Patients from a single center, randomized, controlled, pilot trial comparing biologic versus synthetic mesh in complex OVHR were followed for 3 years. The primary outcome focused on major complications, namely mesh infections, hernia recurrences, reoperations, and deaths. Secondary outcomes included surgical site infections, surgical site occurrences, and patient-reported outcomes. Outcomes were assessed using frequentist generalized linear models.</p><p><strong>Results: </strong>A total of 87 patients (44 biologic mesh, 43 synthetic mesh) were randomized, and 61 patients (70%; 28 biologic and 33 synthetic) completed 3-year follow-up. Baseline demographics were similar in both groups. No significant differences were seen in major complications (50% vs 30%, <i>P</i> = .123), mesh infection (14% vs 3%, <i>P</i> = .144), recurrence (39% vs 24%, <i>P</i> = .214), reoperation (14% vs 9%, <i>P</i> = .531), or mortality (4% vs 0%, <i>P</i> = .459) between the 2 arms. A single death occurred as a result of bacteremia in a patient with hepatocellular carcinoma. Similarly, no significant differences were seen in secondary or patient-reported outcomes. Both groups demonstrated clinically important improvements in quality of life and pain scores at 3 years.</p><p><strong>Conclusion: </strong>This study failed to find benefits with biologic mesh as opposed to synthetic mesh in complex OVHR at 3 years when comparing both clinical and patient-reported outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"43-50"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607182","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 Subcutaneous Inguinal Hematoma Mimicking Ovarian Torsion: A Case Report.","authors":"Chrystal Stallworth, Timothy Kremer, Victoria Panzanaro","doi":"10.36518/2689-0216.1710","DOIUrl":"10.36518/2689-0216.1710","url":null,"abstract":"<p><strong>Background: </strong>Ovarian or adnexal torsions occur when an ovary rotates around one of the supporting ligaments, often the infundibulopelvic (IP) ligament. This rotation can cause the blood flow to the ovary to be hindered, and this decrease in perfusion can often present as adnexal pain, nausea, and vomiting. A significant risk factor for developing an ovarian torsion is the presence of an ovarian mass, such as a cyst. The diagnosis of ovarian torsion is a medical emergency, but symptoms typically resolve with prompt surgical intervention. Hematomas occurring within or around the inguinal region have been reported to occur primarily after procedures such as ablations or inguinal hernia repairs. These hematomas commonly present post-operatively and are not typical features in the setting of adnexal torsion.</p><p><strong>Case presentation: </strong>We report the case of a 36-year-old woman who presented with severe, acute-onset pelvic pain and prominent bruising on her left groin area following intercourse. A transvaginal ultrasound revealed the presence of a left ovarian cyst and lack of arterial blood flow to the left ovary, indicating the possibility of a left ovarian torsion. The patient underwent diagnostic laparoscopy with left oophorectomy. However, during the procedure an aberrant vessel was identified that branched from the left IP ligament, running through the inguinal canal, and terminated at the anterior abdominal wall. The vessel was ligated intraoperatively, and the patient ultimately recovered without complications. At the time of post-operative evaluation, the patient was without any recurring symptoms. This case report identifies an unusual presentation of symptoms mimicking ovarian torsion with accompanying ipsilateral subcutaneous inguinal hematoma secondary to aberrant pelvic vasculature.</p><p><strong>Conclusion: </strong>Our patient had an unusual presentation of pelvic pain mimicking ovarian torsion with accompanying ipsilateral subcutaneous inguinal hematoma secondary to aberrant pelvic vasculature. According to our recent literature searches, there is no available clinical information regarding this combination presentation. The goal of this report is to provide insight into diagnosis and treatment for patients with this atypical presentation.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607462","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":"Terlipressin-Induced Hyponatremic Seizures in a Patient With Congenital Hepatic Fibrosis.","authors":"Luca Gauci, Jorge Gafa, Suzanne Cauchi, Jurgen Gerada","doi":"10.36518/2689-0216.1806","DOIUrl":"10.36518/2689-0216.1806","url":null,"abstract":"<p><strong>Introduction: </strong>Acute variceal bleeding from portal hypertension is one of the most serious complications with a mortality rate of 15% to 25%. Terlipressin is a vasopressor that controls variceal bleeding by lowering the portal pressure and reducing blood flow to the varices.</p><p><strong>Case presentation: </strong>We report a case of a patient with acute variceal bleeding, treated endoscopically and with terlipressin, who developed severe hyponatremia and seizures requiring admission to intensive care. Clinical and biochemical improvements were noticeable upon the cessation of terlipressin, with an eventual discharge from the hospital.</p><p><strong>Conclusion: </strong>Prompt management of acute variceal bleeding with both endoscopic and medical interventions is required. Regular biochemical monitoring is necessary while a patient is on terlipressin treatment. The duration of treatment with terlipressin should not be prolonged unnecessarily.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607189","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":"Updating a Rural Clinic in Tiburón, Haiti.","authors":"Akankcha Alok, Mohamed Bakhit, Djene Helne, Philipe Milord, Marcelles Socrate, Camil Clermont, Marie A Kima","doi":"10.36518/2689-0216.1803","DOIUrl":"10.36518/2689-0216.1803","url":null,"abstract":"<p><strong>Background: </strong>Tiburón is a small fishing village in Haiti with a clinic overseen by the Oblate missionaries and the Ministry of Public Health and Population (MSPP). This village was hugely impacted by Hurricane Matthew in 2016, leading to increased health care demands. The clinic was inaccessible from the furthest parts of the village and lacked basic medication supplies and adequate manpower. We aimed to reinforce the infrastructure and update the clinic using a multifaceted approach.</p><p><strong>Methods: </strong>We developed a quality improvement project to strengthen the clinic's infrastructure and modernize its facilities with a comprehensive approach focused on enhancing health care for the people of Tiburón. We analyzed the data collected by MSPP statisticians, encompassing records of over 2000 patients visiting the clinic between 2017 and 2019. This analysis included all patients aged 1 to 80 years, with no exclusion criteria. We examined both pre- (before 2018) and post- (after 2018) intervention variables, including the number of patients, their gender, various visit types, and trends in encountered pathologies. In 2018, we implemented several interventions in collaboration with the MSPP, such as increasing staffing, expanding health care outreach efforts, providing financial support for medications, adopting a targeted approach to prevent common pathologies, educating and raising awareness about communicable and vaccine-preventable diseases, and placing greater emphasis on maternal health.</p><p><strong>Results: </strong>We assessed the effects of our interventions by comparing data from previous years using the quality metrics established by the MSPP. Significant changes were observed pre- and post-intervention, including an increase in the number of patients, a rise in all visit types, expanded health care outreach, a reduction in communicable and vaccine-preventable diseases, and improved maternal health.</p><p><strong>Conclusion: </strong>This was a promising quality improvement project, highlighting the improvement of studied variables after adding sustainable and efficient interventions. With our continued effort, we aim to facilitate future interventions based on the success of the current study to further update the clinic and to cater to the increasing health care needs of the population of Tiburón and other such underserved communities.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"51-56"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607329","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":"Extended-Release Buprenorphine Could Overcome Barriers to Medical Treatment of Opioid Use Disorder in At-Risk Populations.","authors":"Scott A Davis, Genevieve Verrastro, E Blake Fagan","doi":"10.36518/2689-0216.1680","DOIUrl":"10.36518/2689-0216.1680","url":null,"abstract":"<p><p>Description This article discusses how monthly extended-release buprenorphine can be used to improve the treatment of opioid use disorder (OUD). In particular, the use of monthly extended-release buprenorphine holds promise for patients who have recently been released from jail or prison and are battling OUD, those who are unstable and continue to use opioids illicitly, patients who are experiencing homelessness while also struggling with OUD, and those who are stable and want to be weaned off buprenorphine.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606737","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 Black Fungus: A Rare Case of Pulmonary Mucormycosis.","authors":"Stephanie Wong, Elsa Lesley Tchouambou Pougoue, Joanna Polanco, Betty Kirimi, Choudhry Poonam","doi":"10.36518/2689-0216.1827","DOIUrl":"10.36518/2689-0216.1827","url":null,"abstract":"<p><strong>Background: </strong>Mucormycosis, commonly known as the \"black fungus,\" is a severe infection affecting multiple organ systems, including the skin, brain, lungs, and gastrointestinal tract. This case report is focused on pulmonary mucormycosis, which is frequently observed in organ transplant recipients. Diagnostic challenges arise from nonspecific symptoms.</p><p><strong>Case presentation: </strong>Our case involved a 61-year-old male with a history of renal transplantation. The patient initially presented with a persistent cough and bloody sputum and was treated unsuccessfully for a presumed fungal infection. A lung biopsy confirmed pulmonary mucormycosis, emphasizing the heightened vulnerability of immunocompromised individuals.</p><p><strong>Conclusion: </strong>This case highlights the intricate nature of mucormycosis diagnosis and management, particularly in post-organ transplantation patients. It underscores the importance of awareness and collaboration among medical specialists, including infectious disease experts, pulmonologists, and transplant teams, to optimize outcomes in the face of this life-threatening infection.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"95-98"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607325","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":"Harmonizing Innovation: The Beatles, EMI, and the Birth of Computed Tomography Imaging.","authors":"Matthew A Daniel, Alexander Holland, Saptarshi Biswas","doi":"10.36518/2689-0216.1887","DOIUrl":"10.36518/2689-0216.1887","url":null,"abstract":"<p><p>Description Computed tomography (CT) imaging has become a cornerstone of modern medical diagnostics, thanks to the groundbreaking work of Sir Godfrey Hounsfield. However, the significant role played by his employer, Electric and Musical Industries (EMI), in providing financial support for his research is often overlooked. In this paper, we explore the connection between EMI's success in the music industry, particularly its signing of the Beatles, and Hounsfield's pioneering work on CT imaging. EMI's success in the music industry provided the financial stability for Hounsfield's research endeavors. In 1971, he developed the first CT scanner, which revolutionized diagnostic medicine. His collaboration with radiologist James Ambrose led to the first clinical CT scan the very same year, marking a significant milestone in medical imaging history. Hounsfield's contributions to the field of medical imaging were honored with the Nobel Prize in Physiology and Medicine in 1979. This award showcased the interdisciplinary nature of medical innovation, thereby bridging the gap between theoretical insight and practical application. The intertwined narratives of music and medicine and the unlikely partnership between the Beatles, EMI, and Sir Godfrey Hounsfield led to the birth of CT imaging.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 1","pages":"105-107"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607010","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}