HCA healthcare journal of medicine最新文献

{"title":"How Did That Get There? A Case Series of Adolescent Foreign Bodies.","authors":"Justin Ian Hanson,&nbsp;Paul Bomar,&nbsp;Sarah Kleist,&nbsp;Denver Rogalla,&nbsp;Lori Crihfield,&nbsp;Scott Gutovitz","doi":"10.36518/2689-0216.1470","DOIUrl":"10.36518/2689-0216.1470","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric foreign bodies (FBs) come in many shapes and sizes, and the method by which they enter the body can greatly impact the level of acuity at presentation. Most FBs in children are found in those younger than 5 years old, but the following 3 cases were found in adolescent patients.</p><p><strong>Case presentation: </strong>We report on 3 adolescent patients who presented to a single community-based emergency department with the chief complaint of abdominal pain and were found to have complications of abdominal FBs. If undiagnosed, the initial indolent courses of FBs can lead to serious complications, as shown in these examples.</p><p><strong>Conclusion: </strong>These cases emphasize the need for physicians to maintain a high level of suspicion, to perform detailed histories, and to consider advanced imaging despite reassuring vital signs or physical examination.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519637/pdf/26890216_vol4_iss4_303.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164233","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":"Video Documentation as a Measure of Written Documentation Accuracy in Emergency Medical Service Field Intubations.","authors":"Christopher S Keller,&nbsp;Christopher Dilger,&nbsp;Shih-Chin Chou,&nbsp;Rasheed Lawal,&nbsp;Shane Jenks","doi":"10.36518/2689-0216.1183","DOIUrl":"https://doi.org/10.36518/2689-0216.1183","url":null,"abstract":"<p><strong>Introduction: </strong>Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI.</p><p><strong>Methods: </strong>We used a systematic retrospective chart review to compare written with video documentation in 100 consecutive prehospital RSI encounters in a single EMS agency.</p><p><strong>Results: </strong>Of the patient care records (PCRs), only 6% matched the video record for all quality measures tracked. The largest reason for the discrepancy was in the time required to intubate (58%) whether LEMON was evaluated (42%), total number of intubation attempts (36%), first attempt success (24%), BVM used (18%), and whether an airway introducer device was used (12%).</p><p><strong>Conclusion: </strong>Written documentation is inaccurate compared to video documentation when used as a quality improvement process for EMS prehospital RSI encounters.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519629/pdf/26890216_vol4_iss4_279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164723","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":"COVID-19 Disease Characterization and Outcomes Comparison in Pediatrics.","authors":"Rachel Rowland,&nbsp;Abigail Schauble,&nbsp;Brendon Cornett","doi":"10.36518/2689-0216.1522","DOIUrl":"https://doi.org/10.36518/2689-0216.1522","url":null,"abstract":"<p><strong>Background: </strong>It has been reported that children experience less severe COVID-19 symptoms than adults; however, the literature that supports this idea is evolving. The purpose of this study was to retrospectively characterize hospitalized COVID-19-positive pediatric patients with a focus on the assessment of risk factors for poorer outcomes, mortality, and evaluation of interventions utilized and associated clinical outcomes.</p><p><strong>Methods: </strong>We conducted a multi-center retrospective chart review of patients 18 years old or younger who were COVID-19 positive and admitted to any US HCA Healthcare Pediatric service line between January 1, 2020, and November 30, 2020. We identified 6081 children across 4 states and included them in our data analysis. Negative Binomial Regression was used to measure the associations between characteristics abstracted from medical records and length of hospital stay.</p><p><strong>Results: </strong>Of the total cohort, 2.7% had at least one comorbidity. The majority of patients were discharged shortly after admission with 93.6% of patients spending less than 48 hours as an inpatient. The mortality rate during the study period was 0.1%. Factors found to be significantly associated with an increased length of stay were time in the intensive care unit (ICU), surgeries, developmental disorders, diabetes, post-traumatic stress disorder (PTSD), suicidal ideation, and type of admission.</p><p><strong>Conclusion: </strong>The results of this cohort show there was a low disease burden at baseline and during hospitalization in pediatric patients positive for COVID-19. However, as the pandemic continues, future studies that further describe COVID-19 in children will be crucial to fully understand the disease course.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519631/pdf/26890216_vol4_iss4_283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174882","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":"Eruptive Sebaceous Hyperplasia: A Case Report and Review of the Literature.","authors":"Carsten Z Steinmetz,&nbsp;Amanda Getz,&nbsp;Andras Schaffer,&nbsp;Stephen K Richardson","doi":"10.36518/2689-0216.1524","DOIUrl":"https://doi.org/10.36518/2689-0216.1524","url":null,"abstract":"<p><strong>Introduction: </strong>Eruptive sebaceous hyperplasia (ESH) is a benign process characterized by the acute onset and rapid proliferation of sebaceous glands, typically on the face. Although historically attributed to cyclosporine therapy, the preponderance of reports over the past 2 decades suggests a more complex etiology. There is increasing thought a combination of multiple medications as well as a genetic component contribute to ESH's clinical presentation. Despite these theories, the exact cause of ESH in immunosuppressive therapy is poorly understood.</p><p><strong>Case presentation: </strong>To our knowledge, we report the third case of ESH arising in multimodality immunosuppressive therapy, consisting of tacrolimus, mycophenolate mofetil, and prednisone, affecting a renal transplant patient. Our patient began cyclosporine monotherapy at an early age but did not see eruption of lesions until years later after following a multimodal therapy.</p><p><strong>Conclusion: </strong>We discuss the association of ESH with other medical conditions and treatments. We hope this case sheds light on a possible complication of multimodal immunosuppressive therapy in renal transplant patients. This will allow patients and providers to be better informed of the pros and cons of different treatment options for immunosuppressive therapy in renal transplant patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519630/pdf/26890216_vol4_iss4_315.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175291","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 2023.","authors":"Bruce Deighton,&nbsp;Hossein Akhondi,&nbsp;Barbara L Gracious,&nbsp;David Scott Lind,&nbsp;Graig Donini","doi":"10.36518/2689-0216.1686","DOIUrl":"10.36518/2689-0216.1686","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. We also announce our inclusion in PubMed Central.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519636/pdf/26890216_vol4_iss4_263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156428","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":"Acute Esophageal Necrosis and Duodenal Disease in the Setting of Recently Initiated Chemotherapy.","authors":"Kulveer Dabb,&nbsp;Ryan Jansen van Rensburg,&nbsp;Heba Yusuf,&nbsp;Daniel Klein,&nbsp;Alexander D Lake,&nbsp;Mohamed Kaif","doi":"10.36518/2689-0216.1517","DOIUrl":"10.36518/2689-0216.1517","url":null,"abstract":"<p><strong>Introduction: </strong>Acute esophageal necrosis (AEN), commonly referred to as \"black esophagus\" or Gurvits syndrome, is a rare condition characterized by diffuse black mucosa in the distal esophagus. Most often, the patient is an older male with multiple comorbidities, presenting with upper gastrointestinal bleeding. The exact pathogenesis is unclear, but it is often thought to be secondary to acute vascular hypo-perfusion or ischemia of the esophageal mucosa in critically ill patients with certain secondary comorbid conditions such as renal insufficiency, diabetes mellitus, dyslipidemia, coronary artery disease, malnourishment, alcohol abuse, or association with an underlying malignancy.</p><p><strong>Case presentation: </strong>We present a case of AEN in a 78-year-old female following the recent start of a chemotherapy regimen with carboplatin and paclitaxel two weeks prior. The patient underwent EGD and was found to have AEN throughout the entirety of her esophagus with necrosis and eschars seen up to the second part of the duodenum. The patient initially improved after receiving blood transfusions, being made nil-per-os, and starting proton pump inhibitor (PPI) therapy, but she ultimately died given the severity of her clear cell uterine cancer and other comorbidities.</p><p><strong>Conclusion: </strong>Although it is rare that initiation of chemotherapy leads to AEN, it should be considered as a potential etiology.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519627/pdf/26890216_vol4_iss4_309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171708","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":"Fascial Defect Closure During Ventral Hernia Repair: A Systematic Review of Randomized Controlled Trials.","authors":"Shin Jeong,&nbsp;Tunmi A Anwoju,&nbsp;Oscar A Olavarria,&nbsp;Natalia Cavagnaro,&nbsp;Naila H Dhanani,&nbsp;Nicole B Lyons,&nbsp;Zuhair Ali,&nbsp;Mike K Liang","doi":"10.36518/2689-0216.1469","DOIUrl":"https://doi.org/10.36518/2689-0216.1469","url":null,"abstract":"<p><strong>Background: </strong>During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of life (QOL). Pooled risk ratios with 95% confidence intervals were obtained through random effect meta-analyses.</p><p><strong>Results: </strong>Of 579 screened articles, 6 publications of 5 RCTs were included. No significant difference in major complications (10.6% vs 10.4%, RR=1.05, 95% CI=0.51-2.14, <i>P</i>=.90) or recurrences (9.0% vs 10.6%, RR=0.92, 95% CI=0.32-2.61, <i>P</i>=.87) were found between groups. Fascial defect closure decreased the risk of seromas (22.9% vs 34.2%, RR=0.60, 95% CI=0.37-0.97, <i>P</i>=.04) and may decrease the risk of eventrations (6.7% vs 9.0%, RR=0.74, 95% CI=0.37-1.50, <i>P</i>=.41) at the expense of potentially increasing the risk of SSI (3.2% vs 1.4%, RR=1.89, 95% CI=0.60-5.93; <i>P</i>=.28). Reporting of pain and QOL scores was inconsistent.</p><p><strong>Conclusion: </strong>While most individual RCTs demonstrated benefit with fascial defect closure during minimally invasive VHR, our meta-analysis of fascial defect closure demonstrated only a statistically significant difference in seromas compared to bridged repair. Large, multi-center RCTs are needed.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519634/pdf/26890216_vol4_iss4_267.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175958","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 Infective Endocarditis.","authors":"Ethan J Peterson,&nbsp;Jordan Jackson,&nbsp;Syed M Zaidi,&nbsp;Jorge Perez","doi":"10.36518/2689-0216.1455","DOIUrl":"https://doi.org/10.36518/2689-0216.1455","url":null,"abstract":"<p><strong>Introduction: </strong>Leukocytoclastic vasculitis is the inflammation of small blood vessels due to leukocyte migration that comprises a wide range of differentials. It can be caused by autoimmune disorders, infections, neoplasms, or certain medications and warrants prompt recognition and therapy for optimal patient outcomes.</p><p><strong>Case presentation: </strong>Here we present a case of a 37-year-old male who presented with a painful, petechial rash on his torso and extremities. Skin biopsy revealed leukocytoclastic vasculitis, thereby prompting a comprehensive investigation into the underlying etiology leading to the diagnosis of <i>Pseudomonas aeruginosa</i> infective endocarditis.</p><p><strong>Conclusion: </strong><i>Pseudomonas aeruginosa</i> is a rare cause of infective endocarditis with a high mortality and morbidity rate. This case highlights the importance of taking a thorough history and physical along with a complete workup of vasculitis as the underlying cause can be life-threatening.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519628/pdf/26890216_vol4_iss4_297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177633","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":"Who Left the Hospital Against Medical Advice During the Early COVID-19 Pandemic?","authors":"Bryan Werner,&nbsp;Se Won Lee","doi":"10.36518/2689-0216.1530","DOIUrl":"10.36518/2689-0216.1530","url":null,"abstract":"<p><strong>Background: </strong>Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.</p><p><strong>Methods: </strong>This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with subsequent AMA discharge.</p><p><strong>Results: </strong>These patient characteristics included being younger than 50; identifying as male sex; having non-white ethnicity, including both Black and Hispanic; having either Medicaid or no health insurance; and the presence of specific medical comorbidities. The identified medical comorbidities were substance abuse, renal failure, deep vein thrombosis, hypertension with heart failure, hypertension with chronic kidney disease stage 5, rheumatoid arthritis or collagen vascular diseases, alcohol abuse, chronic pulmonary disease, hypertensive encephalopathy, and solid tumor.</p><p><strong>Conclusion: </strong>This study confirms some of the findings in previous studies looking at AMA discharges and has some interesting findings as it relates specifically to the COVID-19-infected patient population. An additional understanding of the factors leading to AMA discharges can help providers and administrators prevent suboptimal discharge outcomes in the future.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519635/pdf/26890216_vol4_iss4_291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171813","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":"COVID: The Sound of Silence.","authors":"Saptarshi Biswas","doi":"10.36518/2689-0216.1681","DOIUrl":"https://doi.org/10.36518/2689-0216.1681","url":null,"abstract":"<p><p>Description COVID brought its toll of deaths. Something the human race has not experienced in recent times. Something almost unimaginable in the modern world! But having joined a new hospital and moved to a sleepy old town, COVID gave me a sense of solitude I have not experienced for eons. There are times you wonder at the endless ocean in front of you and communicate with your inner soul.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519632/pdf/26890216_vol4_iss4_327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180639","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}