Journal of Brown hospital medicine最新文献

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare, treatable inflammatory variant of cerebral amyloid angiopathy that often presents with acute or subacute cognitive or behavioral decline. We describe a 76-year-old man with frontotemporal dementia who was admitted for an episode of unresponsiveness following several weeks of worsening agitation. MRI demonstrated bifrontal vasogenic edema, cortical superficial siderosis, and microhemorrhages, consistent with CAA-RI. The patient was treated with high-dose intravenous corticosteroids, followed by a prolonged taper, with clinical improvement to his baseline mental status prior to discharge. This case underscores the importance of considering CAA-RI in older adults with preexisting cognitive impairment who develop acute mental status changes.

A 52-year-old man with no personal or family history of bleeding presented with extensive hematomas and skin bruising following prolonged antibiotic use. Initial laboratory evaluation revealed coagulopathy, with an elevated activated partial thromboplastin time and mild anemia. Mixing studies and factor assays confirmed the diagnosis of acquired hemophilia A, characterized by low factor VIII levels and high-titer factor VIII inhibitors. The patient was initiated on corticosteroids and cyclophosphamide, leading to gradual improvement in both bleeding symptoms and coagulation parameters. Comprehensive evaluations excluded autoimmune diseases and malignancies, supporting the conclusion that the condition was linked to prolonged antibiotic use. The patient continues to be in clinical remission after targeted therapy.

Bullous pemphigoid is a common autoimmune blistering disorder that predominantly affects older adults aged 65 and older. While most cases present with a tense blistering eruption, characteristic of the disease, there is a lesser-known pre-bullous phase of the condition that can present insidiously with urticaria and intense pruritus, which can last for several weeks or months. Failure to consider this entity in patients with treatment-refractory, persistent urticaria or itch may lead to delayed diagnosis and poor quality of life. We describe a case of a 79-year-old gentleman who presented with a 3-week history of generalized urticaria on a background of intense pruritus for 4 months. His diagnosis was eventually clinched when he developed blistering lesions on an urticated base, with serum indirect immunofluorescence demonstrating anti-basement membrane zone IgG antibodies. He was commenced on immunomodulatory treatment with moderate doses of oral corticosteroids and doxycycline, with good clinical recovery thereafter. This case vignette highlights several learning points pertaining to the recognition and management of patients with urticarial manifestations in the pre-bullous phase of this common autoimmune blistering disease.

Patient experience has become a central dimension of healthcare quality, influencing safety, trust, adherence, and long-term engagement. It spans the patient journey across critical touchpoints-admission, hospitalization, environment, and discharge-highlighting opportunities to improve care delivery. First impressions during admission shape trust, as respectful interactions and clear orientation correlate with higher satisfaction and likelihood-to-recommend scores. Communication throughout hospitalization remains the most influential factor; empathy, active listening, and structured bedside reporting consistently enhance perceptions of clinician competence and compassion. The hospital environment-including cleanliness, reduced noise, and access to natural light-affects patients' sense of safety, dignity, and recovery. Discharge represents a pivotal transition in which structured education, culturally tailored planning, and follow-up calls reduce readmissions and strengthen preparedness for self-care. Importantly, patient experience varies across populations, with disparities by race, language, and socioeconomic status. Addressing these differences requires cross-cultural communication, interpreter services, and shared decision-making that respect patient values and beliefs. Measurement approaches also warrant reconsideration. While the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provides essential benchmarks, its delayed recall and fixed-response design may limit insights into trust, communication, and emotional safety. Patient experience should be recognized not merely as a compliance requirement but as an ethical and strategic imperative. Sustainable improvement depends on investment in staff training, inclusive design, and systems that embed empathy and cultural responsiveness as core elements of high-quality, patient-centered care.

While it is known that glucocorticoids can affect the immune system and increase white blood cell count, there is limited evidence suggesting that they directly lead to the presence of immature neutrophils (bandemia) in the bloodstream. To our knowledge, studies specifically looking at bandemia after corticosteroid use, in humans, have not been done. Our case highlights that a single high dose of dexamethasone may cause bandemia in otherwise healthy patients without signs of infection, or inflammation.

This article examines the management of VTE in patients with high-risk membranous nephropathy and the care of hepatitis B core antibody-positive patients preparing to start immunosuppressive therapy.

Background: Discharge summaries serve as comprehensive documentation of a patient's hospitalization and are essential for communicating with subsequent care providers. Despite their importance, discharge summaries often vary in both content and timing, leading to potential communication gaps that can adversely affect patient outcomes. # MethodsWe conducted a structured literature review using PubMed and Google Scholar, focusing on peer-reviewed articles published between 2010 and 2025. Articles were included if they addressed the relationship between discharge summary completion time, quality, and patient outcomes.

Results: Timely and high-quality discharge summaries are critical for effective communication between hospital-based and outpatient clinicians. Delayed or incomplete summaries are associated with increased readmission rates. Studies emphasize that the quality of the summary is equally, if not more, important than timeliness in ensuring continuity of care.

Conclusion: Discharge summary timeliness and content quality both significantly impact continuity of care and readmission risk. Standardization efforts and future innovations, including AI-assisted documentation, present promising opportunities for improvement.

Functional/dissociative seizures (FDS) are one of the most common manifestations of functional neurological disorder (FND) in both adult and pediatric populations. FND and FDS result in significant healthcare utilization and costs, often due to excessive medical interventions and workup. Previously regarded as a diagnosis of exclusion that required extensive testing to identify, FND and FDS are now more accurately understood as "rule-in" diagnoses, based on the presence of characteristic positive clinical findings. Early identification and evidence-based therapies can facilitate patient recovery. However, patient outcomes continue to be negatively affected by clinicians' limited familiarity and comfort with this diagnosis. We describe the case of an adolescent with FDS who was intubated and admitted to the intensive care unit for presumed convulsive status epilepticus, and who has since had resolution of FDS after treatment by an interdisciplinary team. Our goal is to highlight the need for increased training of healthcare personnel in the recognition and management of this important clinical entity to facilitate early diagnosis, improve clinical outcomes, and potentially decrease healthcare utilization.

An 86-year-old man presented with severe, debilitating, dual antibody positive rheumatoid arthritis associated joint deformities of his upper and lower extremities. These developed over twenty years but were progressive and debilitating. They began in the forefoot and eventually progressed to mid and hindfoot bilaterally. Examination of his lower extremities revealed severe bilateral hallux valgus deformities, traumatic pes planus deformity, right foot metatarsal head subluxation, and bilateral claw and hammer toes. Relentless progression of his lower extremity pain, joint destruction and significant gait limitation was due to a constellation of factors including ongoing tobacco use, dual antibody positivity and intolerance based on side effects to multiple targeted biologic disease-modifying antirheumatic (DMARD) medications including infliximab, etanercept, golimumab and tofacitinib.