HCA healthcare journal of medicine最新文献

{"title":"Structured Textbook Review and Individualized Learning Plans Successfully Remediate Underperforming Residents and Improve General Surgery Program Performance on the ABSITE.","authors":"Aaron Pinnola, Christoph Kaufmann","doi":"10.36518/2689-0216.1616","DOIUrl":"10.36518/2689-0216.1616","url":null,"abstract":"<p><strong>Background: </strong>We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance.</p><p><strong>Methods: </strong>This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE.</p><p><strong>Results: </strong>Curriculum implementation resulted in a statistically significant reduction in the number of residents scoring below the 35th percentile, from 50% to 30.8% (<i>P</i> = .023). One hundred percent of residents initially scoring below the 35th percentile were successfully remediated over the study period. Average overall program ABSITE percentile scores increased from 38.5% to 51.4% over a 2-year period.</p><p><strong>Conclusion: </strong>Structured textbook review and testing combined with a question-writing assignment and a SCORE-focused ILP successfully remediated residents scoring below the 35th percentile and improved general surgery residency ABSITE performance.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337891","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":"Quiet.","authors":"Thashali Anthony","doi":"10.36518/2689-0216.1760","DOIUrl":"https://doi.org/10.36518/2689-0216.1760","url":null,"abstract":"<p><p>Description According to theatrical superstition, saying \"Macbeth\" in the theater when you aren't actively performing or rehearsing foreshadows impending doom. In a similar way, in the hospital, its own production of sorts where medical staff is under pressure to perform, it's the \"Q\" word. We all dread the \"Q\" word and are vexed with anyone who dares say it. Yet sometimes wandering the hospital during night float, I often feel a profound sense of \"Quiet.\" The word is typically associated with a lack of it, but I find there is a certain peace with being alone with one's thoughts. Residency can be an isolating endeavor, and this particular type of quiet reflection doesn't come around often in a busy hospital. When it does, I think about the other people in this shared space that we work in who may also be feeling the same way, which is bizarrely comforting. However, I probably wouldn't say so out loud, especially under a full moon.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337890","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":"Characteristics and Hospital Outcomes of 1403 Patients Hospitalized at Community Hospitals With Ankylosing Spondylitis.","authors":"Se Won Lee, Carol Elsakr, Jonathan Holt, Napatkamon Ayutyanont","doi":"10.36518/2689-0216.1600","DOIUrl":"10.36518/2689-0216.1600","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS).</p><p><strong>Methods: </strong>We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home discharge and readmission.</p><p><strong>Results: </strong>The mean age for all AS patients was 56.06 ± 17.01 years, which was younger in the favorable outcome group, and 82.47% of patients were discharged to home after the average length of stay of 3.72 ± 4.09 days, also shorter in the favorable outcome group. Of 1403 patients, 37.56% were readmitted within 3 months of discharge, at a lower rate in the group with home discharge. Opioids were the most commonly used medication during hospitalization (67.07%), prescribed at a lower rate in the favorable outcome group. Medical coverage by Medicare and Medicaid, fall at admission, hospital-acquired anemia, steroid, acetaminophen, muscle relaxant use, and an increased dose of morphine milligram equivalent at discharge were significantly associated with decreased odds of home discharge. Surgical procedures during admission, gastrointestinal complications, discharge to inpatient rehabilitation units, and use of benzodiazepine were associated with an increased risk of readmission within 3 months.</p><p><strong>Conclusion: </strong>Recognizing factors that put patients with AS at risk of unfavorable outcomes is useful information to improve patient care during hospitalization.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337865","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":"Primary Mucinous Carcinoma of the Thyroid: A Case Report, Literature Review, and Immunohistochemistry Summary.","authors":"Martin T Halicek, Caleb Scott, Terence Zimmermann, Brian Watson","doi":"10.36518/2689-0216.1570","DOIUrl":"10.36518/2689-0216.1570","url":null,"abstract":"<p><strong>Introduction: </strong>Primary mucinous carcinoma of the thyroid is an exceedingly rare malignancy that is histologically similar to mucinous carcinoma of other sites. Accurate diagnosis is a challenging yet crucial component of clinical management for both patients and our understanding of this rare disease.</p><p><strong>Case presentation: </strong>We report the case of a 69-year-old male patient with primary mucinous carcinoma of the thyroid. Microscopic examination of a biopsy specimen showed fibrous tissue, which was extensively and irregularly infiltrated by a cytologically malignant epithelial neoplasm showing glandular differentiation with mucin production. Immunohistochemistry demonstrated that tumor cells were positive for TTF1, thyroglobulin, CK7, and PAX8. Co-expression of TTF1 and PAX8 is most commonly seen in thyroid tumors. These findings support our diagnosis of mucinous carcinoma of thyroid origin, which is rare and highly aggressive.</p><p><strong>Conclusion: </strong>In this report, we present the only documented case of primary mucinous carcinoma of the thyroid reported in the United States in the last decade. The diagnosis of primary mucinous carcinoma of the thyroid can be challenging. Therefore, we discuss and detail the clinicopathologic tumor profile and provide more current, detailed histological criteria to assist in the diagnosis of this rare disease.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337889","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":"Bowel-Associated Dermatosis-Arthritis Syndrome: A Case Report.","authors":"Christian J Scheufele, Leisa Hodges, Aya Hasan, Ashleigh E Workman, Peter Malouf, Stephen E Weis","doi":"10.36518/2689-0216.1468","DOIUrl":"10.36518/2689-0216.1468","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric bypass surgery is an effective surgical intervention for morbid obesity. However, it is not without risk. Gastric bypass surgery may produce malabsorptive or surgical complications, which can result in nutritional deficiencies as well as syndromes related to bacterial overgrowth in the blind loops of the bowel.</p><p><strong>Case presentation: </strong>Severe nutritional deficiencies may occur due to patient noncompliance with the prescribed regimen, or arise secondary to malabsorptive or mechanical surgical complications. We describe a case of a 37-year-old female who underwent gastric bypass surgery and experienced a recalcitrant eczematous eruption with sporadic subcutaneous, purulent nodules which completely resolved after the reversal of her bariatric procedure.</p><p><strong>Conclusion: </strong>Since 2001, the number of morbidly obese patients who have undergone bariatric surgery has been increasing. As a result, clinicians can expect to more frequently encounter complications that can result from these procedures.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337864","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":"Variation in Transcript Reports Among Residency Applicants: An Anesthesia Program's Perspective.","authors":"Alex M Hendon, Imani Thornton","doi":"10.36518/2689-0216.1598","DOIUrl":"10.36518/2689-0216.1598","url":null,"abstract":"<p><strong>Background: </strong>With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review.</p><p><strong>Methods: </strong>Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript information from 156 allopathic and osteopathic medical schools. Transcript data were separated into 9 different categories.</p><p><strong>Results: </strong>The most common grading system for allopathic medical schools was Pass/Fail. The most common grading system for osteopathic medical schools was Pass/Fail and Letter Grades. There were several medical schools that had unique grading systems and many of those did not provide a grading key for interpretation. Less than half of the allopathic and osteopathic schools offered Honors or High Pass in their grading systems, often with little information provided as to how these grades were earned.</p><p><strong>Conclusion: </strong>The information provided on medical school transcripts is extremely variable. Although many schools reported grades as Pass/Fail, there was no majority or consistent presentation among the transcripts. Much of the information provided on transcripts required interpretation by its reviewer and made the process of holistic applicant review more difficult.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337892","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 Microcystic Serous Cystadenoma in a 19-Year-Old Male Patient.","authors":"Jamie Lee Aldakkour, Alvin Boyd Newman-Caro, Ashley Henning","doi":"10.36518/2689-0216.1510","DOIUrl":"10.36518/2689-0216.1510","url":null,"abstract":"<p><strong>Introduction: </strong>Microcystic serous cystadenomas are uncommon, benign neoplasms rarely known to progress to malignancy. They are typically asymptomatic and inadvertently discovered during imaging for another unrelated condition. When discovered, they are commonly found in females over 60 years of age.</p><p><strong>Case presentation: </strong>In this case report, we examine a unique presentation of a serous cystadenoma discovered when a 19-year-old male presented with symptoms of abdominal pain, nausea, and vomiting.</p><p><strong>Conclusion: </strong>Previous studies on serous cystadenomas in a younger male demographic are rare. Therefore, this study will provide additional insight into the signs, symptoms, diagnosis, and management of cystadenomas in young patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337863","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":"Percutaneous Endoscopic Gastrostomy: A Possible Trigger for Dieulafoy's Lesion.","authors":"Ali Tariq Alvi, Elsa Tchouambou, Murali Shankar","doi":"10.36518/2689-0216.1587","DOIUrl":"10.36518/2689-0216.1587","url":null,"abstract":"<p><strong>Introduction: </strong>Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients can present with hematemesis, melena, or hematochezia in case of severe bleeding. The initial evaluation should involve assessing the hemodynamic status with adequate resuscitation followed by diagnostic tests to identify the source and potentially treat it. Dieulafoy's lesion, sometimes referred to as Dieulafoy's disease, is a rare cause of upper GI bleeding with no clear risk factors, which makes it a diagnostic conundrum. Here we describe an unusual case of Dieulafoy's lesion developing following percutaneous endoscopic gastrostomy (PEG) placement.</p><p><strong>Case presentation: </strong>We describe a case of a 70-year-old female patient with a past medical history of hyperlipidemia, well-controlled hypertension, and an ischemic cerebrovascular accident, which caused neurologic dysphagia and placement of a PEG tube 3 weeks prior. She presented to the emergency department due to melena, with hypotension of 90/50 mmHg, tachycardia of 126 beats/minute, and hemoglobin of 5.6 g/dl. An endoscopy revealed a Dieulafoy's lesion on the lesser curvature of the stomach just across the PEG tube, which was managed with epinephrine and hemoclips.</p><p><strong>Conclusion: </strong>This is a rare case of Dieulafoy's lesion on the lesser curvature of the stomach, potentially developing due to PEG placement.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337866","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":"Presentations of Cutaneous Disease in Various Skin Pigmentations: Acne Vulgaris - Comedonal Acne.","authors":"Christopher M Wong, Christina Guo, Christian J Scheufele, Daniel A Nguyen, Jean Elizze M Charles, Michael Carletti, Stephen E Weis","doi":"10.36518/2689-0216.1634","DOIUrl":"10.36518/2689-0216.1634","url":null,"abstract":"<p><p>Description Acne vulgaris is a common inflammatory skin condition of the pilosebaceous unit in adolescents and young adults and is primarily characterized by the presence of open and closed comedones. In patients of various skin pigmentations, skin-colored comedones may be difficult to appreciate and lead to incorrect or delayed diagnosis of acne. To aid in the identification of acne vulgaris in patients of various skin pigmentations, we present comedonal acne in different skin types and commonly encountered differential diagnoses. With its significant volume and burden of disease, acne vulgaris should be correctly identified in various skin pigmentations by primary care clinicians for the initiation of appropriate management.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337867","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 HCA Healthcare Journal of Medicine's Reviewers and Editors for the Second Half of 2023","authors":"Bruce Deighton, Hossein Akhondi, Barbara L Gracious, G. Donini","doi":"10.36518/2689-0216.1828","DOIUrl":"https://doi.org/10.36518/2689-0216.1828","url":null,"abstract":"","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140412634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}