Cureus最新文献

{"title":"Right Heart Clot in Transit: A Case Report of Acute Submassive Pulmonary Embolism.","authors":"Kubiat E Udoh, Kuseme E Udoh, Joy Efik, Andikan E Udoh","doi":"10.7759/cureus.84909","DOIUrl":"10.7759/cureus.84909","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is classified into massive, submassive, and low-risk categories, with severity often assessed using tools such as the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) to determine inpatient versus outpatient management. This report discusses an 84-year-old male with a history of prostate cancer (not on chemotherapy), hypertension, type 2 diabetes mellitus, and hyperlipidemia, who developed bilateral PE and a right heart thrombus in transit after a syncopal episode during hospitalization for a viral illness. A right heart thrombus in transit is a mobile clot within the right heart chambers or vena cava, posing a high risk for further embolization. These thrombi are often visualized on echocardiography and are considered a medical emergency. Although the patient remained hemodynamically stable, evidence of right ventricular dysfunction confirmed by laboratory markers (e.g., elevated troponin and BNP levels) and imaging studies was consistent with the diagnosis of submassive PE. Management of right heart thrombi in transit remains controversial due to the lack of randomized controlled trials. Treatment options include systemic anticoagulation, systemic or catheter-directed thrombolysis, catheter-based embolectomy, and surgical thrombectomy. In elderly patients with multiple comorbidities, selecting the optimal approach requires multidisciplinary input. This case highlights the critical need for multidisciplinary evaluation and the complexity of managing right heart thrombi and the importance of individualized treatment strategies in high-risk patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84909"},"PeriodicalIF":1.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12111494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164390","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":"Discharging Patients With Pending Microbiology Cultures: A Narrative Review of Safety and Best Practices.","authors":"George Bechir, Angelina Bechir","doi":"10.7759/cureus.84905","DOIUrl":"10.7759/cureus.84905","url":null,"abstract":"<p><p>Discharging patients with pending microbiology culture results from the hospital has become a common practice aimed at improving hospital throughput and reducing length of stay. One of the main contributors to prolonged hospitalization is the delay in receiving finalized culture results, especially when patients are clinically stable and ready for discharge. Consequently, many hospitals have explored strategies to safely discharge patients before culture results are finalized. While this approach may help alleviate bed shortages and reduce healthcare costs, it raises important patient safety concerns. Finalized culture results may reveal pathogens or resistance patterns that necessitate changes in antimicrobial therapy. Without timely review and action, these findings can lead to missed diagnoses, suboptimal treatment, or avoidable readmissions. This narrative review synthesizes the current evidence on the safety, clinical impact, and system-level strategies associated with discharging patients with pending culture results. Studies show that 2%-11% of pending cultures in hospitalized patients require a change in clinical management, yet documentation of these pending results is often missing from discharge summaries, and follow-up responsibility is frequently unclear. Vulnerable populations, such as older adults and those discharged to subacute care facilities, are particularly at risk due to fragmented transitions and limited outpatient monitoring. Adverse outcomes in these groups include delayed therapy adjustments, inappropriate antimicrobial use, and increased healthcare utilization. To address these risks, several interventions have shown promise. These include electronic health record (EHR)-based alerts, pharmacist-led stewardship programs, and auto-populated discharge summary tools. When integrated into standardized discharge workflows and supported by institutional policy, these interventions improve follow-up rates and reduce harm. Systematic reviews of hospital discharge practices emphasize that multidisciplinary approaches, combining clinical teams, pharmacists, and care transition services, are most effective in ensuring timely review and response to finalized results. In conclusion, discharging patients with pending microbiology cultures can be safe when supported by structured systems that ensure results are reviewed and acted upon after discharge. Hospitals should implement protocols that clearly document pending tests, assign follow-up responsibility, and utilize EHR tools to facilitate communication. These strategies enhance both patient safety and operational efficiency during the vulnerable transition from inpatient to outpatient care.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84905"},"PeriodicalIF":1.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164432","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":"When Two Lives Are at Stake: Sinonasal Adenoid Cystic Carcinoma During Pregnancy.","authors":"Sandra Marie Joe, Deepa Karmali, Vishal V Bhende","doi":"10.7759/cureus.84927","DOIUrl":"10.7759/cureus.84927","url":null,"abstract":"<p><p>Sinonasal malignancies during pregnancy present unique diagnostic and therapeutic challenges due to their rarity and nonspecific clinical presentation. This case describes a 28-year-old primigravida patient at 32 weeks of gestation, who presented with left-sided nasal obstruction, epistaxis, and facial swelling. Clinical evaluation, imaging, and histopathology confirmed adenoid cystic carcinoma of the left maxillary sinus. Given the advanced disease stage, a multidisciplinary team opted for conservative management until fetal viability was ensured. At 35 weeks and 3 days of gestation, the patient underwent an emergency cesarean section, delivering a healthy neonate. Postpartum, she underwent left total maxillectomy, followed by adjuvant radiotherapy and five cycles of intravenous cisplatin chemotherapy. Long-term follow-up demonstrated stable disease, with minor speech difficulties and adequate oral intake. This case highlights the importance of early recognition, individualized treatment strategies, and multidisciplinary collaboration in managing malignancies during pregnancy, while balancing maternal prognosis and fetal safety. Further research is needed to establish standardized treatment guidelines for rare malignancies in pregnancy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84927"},"PeriodicalIF":1.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175602","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":"Patients' Preferences and the Time to Finish Gonadotropin-Releasing Hormone (GnRH) Agonist and Antagonist Injections in Japanese Prostate Cancer Patients.","authors":"Takashi Kawahara, Akihito Hasizume, Yasuhide Miyoshi, Daiki Ueno, Masanobu Yamazaki, Jun-Ichi Teranishi, Kazuhide Makiyama, Hiroji Uemura","doi":"10.7759/cureus.84881","DOIUrl":"10.7759/cureus.84881","url":null,"abstract":"<p><p>Introduction Currently, androgen deprivation therapy (ADT) plays a key role in treating advanced prostate cancer, particularly in elderly patients. With the advent of gonadotropin-releasing hormone (GnRH) medications, ADT has shifted from surgical to medical castration. While GnRH agonists and antagonists remain mainstream treatments for prostate cancer, there has been no research comparing the burden each drug places on patients. Methods A study conducted at Yokohama City University Medical Center analyzed 851 hormonal injections administered between August 2018 and February 2019. The study evaluated the time from prescription to completion of injection, as well as the perceived physical and mental burden on patients. Results showed that injections of degarelix took significantly longer time to injection than other treatments. Leuprorelin 22.5 mg most effectively reduced outpatients' hospital visits, primarily due to its six-month dosing interval and convenient kit formulation. Degarelix required a longer process, including drug dilution and cooling of the injection site to prevent potential skin reactions, contributing to its extended administration time. Results In terms of patient burden, leuprorelin 22.5 mg was associated with the least discomfort, showing minimal difference from the oral formulation. One limitation of this study is that the method of leuprorelin administration in Japan (subcutaneous injection) differs from that in other countries (intramuscular injection). Conclusion In summary, the six-month leuprorelin 22.5 mg regimen reduces hospital time. Patient burden was also considered a factor in the selection of GnRH preparations.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84881"},"PeriodicalIF":1.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164460","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 Incidental Discovery of the Tibiocalcaneus Internus Muscle of Testut: An Exceedingly Rare Variation of the Soleus Muscle.","authors":"Mary Walker, Hosne Ara, Adegbenro O Fakoya","doi":"10.7759/cureus.84925","DOIUrl":"10.7759/cureus.84925","url":null,"abstract":"<p><p>This report describes an incredibly rare variant of the soleus, the tibiocalcaneus internus muscle of Testut, observed during routine cadaveric dissection. In our cadaveric dissection, we observed this tibiocalcaneus internus muscle of Testut as an accessory muscle in the posterior compartment of the leg, which originates at the soleal line of the tibia and travels deep to the flexor retinaculum, ending in a tendinous insertion on the medial surface of the calcaneus, medial to the tendon of Achilles. Due to the few existing reports of this anomalous finding, any occurrence warrants reporting to expand the knowledge in clinical practice. Although it remains asymptomatic during the lifetime, this variant muscle may have clinical relevance, particularly in diagnostic imaging and in cases of unexplained medial ankle pain. By understanding this rare anatomical variation, clinicians, surgeons, and radiologists could avoid misdiagnosis and unnecessary interventions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84925"},"PeriodicalIF":1.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182707","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":"Developing the Next Generation of Physician Changemakers: \"You Have to Love the People, and Love the Process\".","authors":"Andrea L Austin, Anne Wildermuth, Joshua Hartzell, Jerusalem Merkebu","doi":"10.7759/cureus.84861","DOIUrl":"10.7759/cureus.84861","url":null,"abstract":"<p><strong>Introduction: </strong>There is a growing consensus among patients, physicians, and policymakers that healthcare must undergo a massive transformation to promote healthcare worker well-being. The Institute for Health developed the Triple Aim framework for high-performing health organizations, which focused on reducing costs, improving individual patient experience, and population health. The move from the Triple to Quadruple Aim added a focus on the well-being of healthcare professionals, acknowledging growing literature and a movement that healthcare professionals' well-being is crucial to the quality of healthcare patients receive.  Objectives: This study sought to investigate the individual transformation and the organizational contributors that promote effective change. More specifically, how do attending physicians from various specialties construct their understanding and make sense of the individual and organizational factors that contribute to their development as changemakers? Given the exploratory nature of this topic and the limited existing literature, we employed a semi-structured interview format and an inductive analytic approach to allow unanticipated insights to emerge to determine the individual and organizational factors that support and enhance changemaking in attending physicians.</p><p><strong>Methods: </strong>Qualitative semi-structured interviews were conducted with 15 physician changemakers who have successfully implemented transformative healthcare initiatives. Data were analyzed using Braun and Clark's reflexive thematic analysis (RTA) to identify key themes and develop a comprehensive understanding of their experiences.</p><p><strong>Results: </strong>Analysis at the individual and organizational level illuminated a constellation of interconnected themes propelling these physician changemakers: Participants' insatiable appetite for learning, coupled with sustained inspiration and the capacity for embracing ambiguity and emotional regulation, drives changemakers' courage and resilience. Notably, while challenging, participants did not perceive changemaking as unduly burdensome. At the organizational level, changemakers perspicaciously report leveraging the system, engage in job crafting through protected time, and authentically take accountability and own the change.  Conclusions: With an increased focus on addressing the systems issues that impact quality healthcare, this study provides a roadmap for individual and organizational actions to expand and accelerate the number of physician changemakers.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84861"},"PeriodicalIF":1.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201151","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":"Abolish Psychiatry, Abolish Neurology: Toward a Unified Discipline of Brain Medicine.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84817","DOIUrl":"10.7759/cureus.84817","url":null,"abstract":"<p><p>The longstanding division between psychiatry and neurology is a historical artifact, not a scientific necessity. Despite addressing the same organ, these fields operate as separate disciplines, fragmenting education, care, research, regulation, and reimbursement. This editorial argues for the abolition of that divide and the creation of a unified discipline of brain medicine. Drawing on advances in systems neuroscience, artificial intelligence, and neuromodulation, I present a comprehensive critique of the dual-specialty model and propose an integrated alternative. The editorial synthesizes data from brain network research, the lived inefficiencies of medical training and healthcare delivery, and the constraints placed on innovation by legacy frameworks. I highlight how computational psychiatry, neurobiology, and regulatory reform can converge to enable a model that is mechanistically grounded and clinically effective. Through two conceptual tables, I demonstrate the shared circuitry across traditionally labeled psychiatric and neurological conditions, and the system-wide efficiencies gained through integration. The future of brain care lies not in silos, but in circuits, and it is time our institutions, educators, payers, and innovators catch up with science. This is a call to unify how we understand, teach, regulate, and treat the brain not only for administrative elegance but also for clinical reality, therapeutic progress, and human dignity.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84817"},"PeriodicalIF":1.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153089","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":"Keys to an Early Diagnosis of Miller Fisher Syndrome: A Case of Miller Fisher Syndrome Masquerading as Myasthenia Gravis.","authors":"Chamine Robince, Kinnari Modi, Peter Park, Tara Norris","doi":"10.7759/cureus.84834","DOIUrl":"10.7759/cureus.84834","url":null,"abstract":"<p><p>Miller Fisher syndrome (MFS) and myasthenia gravis can present with similar symptoms. However, some key differences can help differentiate between these two disorders. Early identification is extremely important for MFS so treatment can be initiated in a timely manner. Here, we present the case of a 33-year-old female who was initially diagnosed with myasthenia gravis and was later found to have MFS. The goal of this case report is to provide information to aid in the early diagnosis and identification of MFS.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84834"},"PeriodicalIF":1.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153090","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":"Messenger Ribonucleic Acid (mRNA)-Based Universal Vaccines: Engineering Broad-Spectrum Immunity Against Future Pandemics.","authors":"Joan C Muodiaju, Chidinma S Madu","doi":"10.7759/cureus.84821","DOIUrl":"10.7759/cureus.84821","url":null,"abstract":"<p><p>The rapid emergence and evolution of infectious pathogens, including the COVID-19 pandemic and recurring influenza outbreaks, underscore the need for universal vaccines capable of providing broad-spectrum immunity. Messenger ribonucleic acid (mRNA) vaccine technology has emerged as a transformative platform due to its rapid development, high immunogenicity, and adaptability to new variants. Unlike conventional vaccines, which rely on weakened or inactivated pathogens, mRNA vaccines instruct host cells to produce antigens that elicit robust immune responses. This paper explores the design principles, mechanisms of action, and advancements in mRNA-based universal vaccines, emphasizing their potential against influenza, coronaviruses, and antimicrobial-resistant pathogens. We discuss innovations such as self-amplifying mRNA (saRNA), nanoparticle-based delivery systems, and artificial intelligence (AI)-driven antigen selection. Additionally, challenges such as antigenic variability, immune evasion, stability issues, and global distribution barriers are addressed. With continued research and development, mRNA-based universal vaccines could play a critical role in pandemic preparedness and global health security.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84821"},"PeriodicalIF":1.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153091","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 Role of Nurse Leadership in the Implementation of Evidence-Based Practices in Oncology Care: A Focus on Spain.","authors":"Chidinma S Madu, Victoria M Ajibade","doi":"10.7759/cureus.84858","DOIUrl":"10.7759/cureus.84858","url":null,"abstract":"<p><p>Oncology nursing is a dynamic and evolving field that requires high-quality, research-informed care to meet the complex needs of cancer patients. The integration of evidence-based practices (EBPs) is crucial for improving clinical outcomes, enhancing symptom management, and promoting patient-centered care. Nurse leaders play a pivotal role in advancing EBP adoption by demonstrating transformational leadership, providing mentorship, and advocating for supportive organizational structures. Professional nursing also demands active engagement in research, both as contributors to the evidence base and as informed consumers of research findings. Despite this, barriers such as resistance to change, limited time, and insufficient institutional support often hinder the effective implementation of EBPs. Overcoming these challenges through increased research funding, interdisciplinary collaboration, and the use of innovative technologies is key to cultivating a culture of evidence-based oncology nursing. Strong nurse leadership remains essential in bridging the gap between research and clinical practice, ultimately ensuring the delivery of high-quality oncology care.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84858"},"PeriodicalIF":1.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163297","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}