HCA healthcare journal of medicine最新文献

{"title":"Nursing and Supply Chain as Critical Partners in Enterprise-Level Efforts to Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study.","authors":"Dana L Blayney, Julia Moody, James Pittman, Noah Zanville, Missy Pennington, Sarah A Fraker, E Jackie Blanchard","doi":"10.36518/2689-0216.2022","DOIUrl":"https://doi.org/10.36518/2689-0216.2022","url":null,"abstract":"<p><strong>Background: </strong>Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. The purpose of this study is to discuss the implementation and lessons learned from a successful collaboration between supply chain and nursing standardization of the supply of CHG-impregnated HD-CVC end caps in more than 140 United States-based hospitals.</p><p><strong>Methods: </strong>The 3-year, enterprise-wide initiative to standardize supply and end cap practice as well as reduce HD CLABSIs involved 3 phases: (Phase I) piloting the change in 5 inpatient facilities; (Phase II) implementing and scaling the change across 140 hospitals; and (Phase III) stabilizing supply and hard-wiring practices.</p><p><strong>Results: </strong>Following the pilot, access to CHG-impregnated HD-CVC end caps increased more than 100-fold over the next 4 quarters, with more than 50 000 CHG HD-CVC end caps being available for use by the end of 2022. Throughout the process, review and real-time audit of HD-CVC end cap application and removal were used to standardize the practice. The review of CLABSI data over the course of the program showed a nearly 16% reduction in HD-CLABSI events per 1000 catheter days following standardization of HD-CVC end cap supply.</p><p><strong>Conclusion: </strong>Overall, our results suggest that standardizing the supply of HD-CVC end caps (which are a critical link in the infection prevention chain) was associated with a reduction in CLABSIs among patients undergoing HD. In addition, the close collaboration between supply chain and nursing was instrumental to the success of our endeavor and may serve as a model for other health systems wanting to pursue similar efforts.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 5","pages":"587-595"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634178","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":"Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach.","authors":"Nicki Roderman, Shandlie Wilcox, Andrew Beal","doi":"10.36518/2689-0216.1922","DOIUrl":"https://doi.org/10.36518/2689-0216.1922","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national HAPI rate of 3.5% of observed patients. In rapid response, a multidisciplinary team was formed to address and improve the HAPI rate via a quality improvement project.</p><p><strong>Methods: </strong>To achieve the goal of decreased pressure injuries or ulcers, a team of nurses, patient care technicians, nutritionists, infectious disease specialists, radiologists, surgeons, vascular technicians, supply chain administrators, case management and social workers, hyperbaric medicine specialists, and wound care experts was created. The team completed a gap analysis and discovered inconsistencies in documentation and care practices that led to HAPI rates above the national average. The team then standardized a policy, standardized documentation of wounds, and provided staff education. Measures were implemented to proactively prevent pressure injuries.</p><p><strong>Results: </strong>There was a 4.2 percentage point decrease in HAPIs from the beginning of the project (5.76%) to the last survey (1.59%). However, this difference was not statistically significant (<i>P</i> = .07). Overall, there were 6 fewer patients (8 vs 2 patients) with hospital-onset observed injury. Additionally, the length of stay decreased by 46%. Documentation of skin assessments within 24 hours of admission improved to 100%.</p><p><strong>Conclusion: </strong>We implemented a quality improvement program across 10 service lines, monitoring pressure injuries, HAPI incidence, and length of stay in 480 patients over 2 years. Although the reduction in HAPI was not statistically significant (<i>P</i> = .07), our program positively impacted the hospital's response to pressure injuries and warrants further replication.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 5","pages":"577-586"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634152","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 Future of Nurse-Led Research: The Road Ahead.","authors":"Sammie Mosier","doi":"10.36518/2689-0216.2033","DOIUrl":"https://doi.org/10.36518/2689-0216.2033","url":null,"abstract":"<p><p>Description Nursing as a profession is full of innovation. From nurse-led research and new technology to emerging models of care, nurses continue to blaze trails and take steps to improve patient care. As one of the largest employers of nurses in the United States, HCA Healthcare has an obligation to produce research and evidence-based practices to pave the way for the future of nursing practice and potentially change how care is delivered. In this editorial, HCA Healthcare's chief nurse officer describes her vision for the future of nurse-led research and examines how education, partnerships, and technology facilitate the road ahead for nurses.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 5","pages":"497-500"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634210","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":"Nursing Informatics: The Vital Nursing Link Between Technology And Patient Care.","authors":"Sherri Hess, Caryn Alper","doi":"10.36518/2689-0216.2003","DOIUrl":"https://doi.org/10.36518/2689-0216.2003","url":null,"abstract":"<p><p>Description Advances in technology offer additional health care tools to improve the health of patients and efficiencies for our clinicians in innovative ways. These technologies cover a huge variety of therapeutics, ranging from wearable devices, such as insulin pumps, to robotic-assisted surgeries. Nursing informatics is firmly embedded in the use of technology to improve nursing care and science. One of the most recent developments in nursing is the exploration of virtual nursing. This paper will present the past, current, and future projections for this unique blend of nursing art and science with cutting-edge technology.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 5","pages":"513-516"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Acknowledgement to the <i>HCA Healthcare Journal of Medicine</i>'s Reviewers and Editors for the First Half of 2024.","authors":"Bruce Deighton, Graig Donini","doi":"10.36518/2689-0216.2041","DOIUrl":"https://doi.org/10.36518/2689-0216.2041","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":"5 4","pages":"389-391"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302575","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":"Unveiling the Complexity of Nocardia Septic Arthritis in an Immunocompromised Patient: A Case Report.","authors":"Steven A Kessler, Meghan R Mansour, Ali Khreisat, Mamon Tahhan","doi":"10.36518/2689-0216.1694","DOIUrl":"https://doi.org/10.36518/2689-0216.1694","url":null,"abstract":"<p><strong>Background: </strong>Nocardiosis is the systemic manifestation of <i>Nocardia</i> infection, often found in immunocompromised individuals. <i>Nocardia</i> are transmitted via inhalation or skin wounds, disseminating hematogenously to organs and rarely, joints. We present a patient with immunosuppression who developed gout of the knee with superimposed Nocardial septic arthritis and a possible subsequent systemic infection.</p><p><strong>Case presentation: </strong>A 74-year-old man presented with left lower extremity swelling and pain. He was taking immunosuppressive medication for antineutrophilic cytoplasmic antibody-positive vasculitis. A week prior, an arthrocentesis test was positive for gout. He received prednisone without improvement. A repeat arthrocentesis was positive for <i>Nocardia farcinica</i> septic arthritis. Chest imaging showed subpleural nodules. After failed antibiotics, a susceptibilities test yielded results that favored linezolid. The patient exhibited acute anemia from hematomas intramuscularly above the infection, which resolved with transfusions. Immunosuppression was stopped, and the patient recovered appropriately after the correct antibiotics were administered.</p><p><strong>Conclusion: </strong>This case involves septic arthritis with possible pulmonary nodule involvement, showcasing the complexity of infections in immunocompromised individuals. Clinicians should maintain adequate suspicion for an infectious cause of arthritis in patients with immunosuppression. In our case, the hematomas are a curious finding, without known etiology. The question of when and how to reintroduce immunosuppressive agents while preventing the recurrence of nocardiosis remains a complex consideration.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"473-477"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302588","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":"Thrower's Fracture With Subsequent Compartment Syndrome Requiring Emergent 2 Compartment Upper Extremity Fasciotomy.","authors":"Andrew Wise, Darwin Ang","doi":"10.36518/2689-0216.1727","DOIUrl":"https://doi.org/10.36518/2689-0216.1727","url":null,"abstract":"<p><strong>Introduction: </strong>A thrower's fracture is a mid-to-distal third humerus fracture that commonly presents as an audible pop with severe arm pain sustained during the throwing motion. Although thrower's fracture has been described previously in the literature, this report is the first to demonstrate compartment syndrome as its potential sequel.</p><p><strong>Case presentation: </strong>A 25-year-old semi-professional pitcher presented to the emergency department with severe right arm pain following a pitch. He described hearing an audible pop with subsequent severe pain. He was found to have elevated compartment pressures in his upper arm and was rushed to the operating room for a 2 compartment fasciotomy. The thrower's fracture classically presents as an audible pop with subsequent arm pain in male patients aged 20-30 years during the acceleration phase of throwing. A potential well-known sequel is radial nerve palsy, which occurs in roughly 5-11% of patients. A sequel which has not been previously described is the subsequent development of compartment syndrome.</p><p><strong>Conclusion: </strong>Compartment syndrome should be monitored in patients with thrower's fractures, as it is a limb-threatening condition that can subsequently develop.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"479-482"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302587","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 of Patients Hospitalized to Community Hospitals With Malignant Brain Tumors and Factors Associated With Discharge Destination.","authors":"Se Won Lee, Thanapath D Thantacheva, Denny Mack","doi":"10.36518/2689-0216.1698","DOIUrl":"https://doi.org/10.36518/2689-0216.1698","url":null,"abstract":"<p><strong>Background: </strong>Our main objective was to compare the characteristics and hospital outcomes of patients with primary and metastatic brain malignancies and to investigate the associated factors related to hospital outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective, cross-sectional study of 1628 patients with brain malignancies from 8 community hospitals between 2017 and 2022 who were identified using International Classification of Disease codes. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge.</p><p><strong>Results: </strong>The median age was 65 years old, with 72.5% of patients having metastatic brain malignancies. After 7.2 days of hospital stay, 49.2% were discharged home, and 102 patients expired during hospitalization. Increased age, medical coverage by Medicare, hemiplegia or paraplegia, lower initial hemoglobin level, increased length of stay, and the use of electrolyte replacement, antibiotics, laxatives, heparin, and anticonvulsants were associated with a decreased likelihood of discharge to home. No medical insurance, Medicaid insurance coverage, comorbidities of cerebrovascular disorder, the need to stay in the intensive care unit, patient safety indicator events, and the use of antibiotics, oral analgesics, and ipratropium-albuterol were associated with increased odds of in-hospital mortality.</p><p><strong>Conclusion: </strong>We identified several predictor variables that delineate differences between both mortality risk and home discharge in patients with primary and metastatic brain tumors. Understanding these predictor variables can be helpful in improving the acute and post-acute care of this population.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"435-443"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302577","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":"Atypical Hemolytic Uremic Syndrome Following Influenza B: A Case Report.","authors":"Kathryn E McGraw, Amanda P Porter, Alyssa M Moffitt, Marina E M Golden, Heather Stewart","doi":"10.36518/2689-0216.1669","DOIUrl":"https://doi.org/10.36518/2689-0216.1669","url":null,"abstract":"<p><strong>Background: </strong>Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy that presents with a triad of hemolytic anemia, thrombocytopenia, and acute kidney impairment. It can be attributed to mutations in an array of different complement proteins leading to the overactivation of the complement system, the most impacted being the alternative pathway. Though rare, influenza B has been documented as a potential trigger to the development of aHUS.</p><p><strong>Case presentation: </strong>We discuss a 10-year-old girl with a history of aHUS who was found to have a repeat episode of aHUS following an influenza B infection. There have only been a few reports of aHUS triggered by influenza B, making this a unique case. Given the recurrence and atypical features present in this case, a genetic workup was obtained, which showed a heterozygous mutation of complement protein CD46. The presence of mutations in CD46 is a known predisposing factor to aHUS, but influenza B infection is rarely implicated as a trigger to aHUS. The prognosis of aHUS varies and is dependent on the complement mutation specific to the individual.</p><p><strong>Conclusion: </strong>Patients with CD46 mutations have been shown to have high rates of relapse but less long-term kidney damage, as seen in this case. Clinicians should be aware of the association between influenza B and aHUS to improve patient outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"459-464"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302576","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":"Management Targeted Genetic Evaluation of an Idiopathic Neuropathy Cohort Through ATTRv Amyloidosis Screening.","authors":"Kristy A Fisher, Santiago Diaz, Jeffrey Gelblum, Charles Brock, Niraja Suresh, Meghan Towne","doi":"10.36518/2689-0216.1557","DOIUrl":"https://doi.org/10.36518/2689-0216.1557","url":null,"abstract":"<p><strong>Background: </strong>While the reported prevalence of polyneuropathies is 1%-3%, the incidence of hereditary transthyretin amyloidosis in the United States is estimated to be 1 in 100 000 individuals. Polyneuropathies are known to be difficult to treat and lead to significant morbidity. The aim of pain management is symptomatic treatment, with varying approaches to progression prevention being based on the causative pathophysiology.We assessed the prevalence of hereditary amyloid transthyretin variant (ATTRv) amyloidosis, a progressive autosomal dominant multisystem disease caused by the abnormal formation and extracellular deposition of transthyretin protein fibrils in various tissues, in an idiopathic polyneuropathy population by using genetic analysis.</p><p><strong>Methods: </strong>Individuals aged 18 and over with an established diagnosis of polyneuropathy, via electromyography testing that was deemed to be idiopathic, at a large, urban neurology clinic consented to an institutional review board-approved protocol for genetic testing. No further exclusions were made regarding age of onset, family history, axonal neuropathy subtype, comorbidities suggestive of ATTRv amyloidosis, etc. Clinical genetic testing was performed on 134 participants via an 81-gene panel associated with inherited neuromuscular disorders or targeted <i>TTR</i> gene sequencing with deletion and duplication analysis.</p><p><strong>Results: </strong>Within our cohort, 38.06% had at least one reportable finding in one of 38 distinct genes, for a total of 76 reported alterations. Four individuals were identified as having a single pathogenic alteration in an autosomal recessive gene, consistent with carrier status for the 4 following disorders: congenital insensitivity to pain with anhidrosis (NTRK1), Charcot-Marie-Tooth disease type IIP (LRSAM1), Brown-Vialetto-Van Laere syndrome type II (SLC52A2), hereditary sensory and autonomic neuropathy type III (IKBKAP). One individual was found to have a variant of uncertain significance (VUS) (p.G103D) in the <i>TTR</i> gene.</p><p><strong>Conclusion: </strong>Precision medicine on the molecular level with genetic testing in the identification of specific neuropathies may provide clinicians with more detailed information for developing a more direct therapeutic and treatment modality for better-targeted management. Further investigation is needed to expand on the knowledge and understanding of the clinical relevance surrounding the alterations found in the genetic evaluation of idiopathic neuropathy.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 4","pages":"405-413"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302581","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}