HCA healthcare journal of medicine最新文献

Background: Tiburón is a small fishing village in Haiti with a clinic overseen by the Oblate missionaries and the Ministry of Public Health and Population (MSPP). This village was hugely impacted by Hurricane Matthew in 2016, leading to increased health care demands. The clinic was inaccessible from the furthest parts of the village and lacked basic medication supplies and adequate manpower. We aimed to reinforce the infrastructure and update the clinic using a multifaceted approach.

Methods: We developed a quality improvement project to strengthen the clinic's infrastructure and modernize its facilities with a comprehensive approach focused on enhancing health care for the people of Tiburón. We analyzed the data collected by MSPP statisticians, encompassing records of over 2000 patients visiting the clinic between 2017 and 2019. This analysis included all patients aged 1 to 80 years, with no exclusion criteria. We examined both pre- (before 2018) and post- (after 2018) intervention variables, including the number of patients, their gender, various visit types, and trends in encountered pathologies. In 2018, we implemented several interventions in collaboration with the MSPP, such as increasing staffing, expanding health care outreach efforts, providing financial support for medications, adopting a targeted approach to prevent common pathologies, educating and raising awareness about communicable and vaccine-preventable diseases, and placing greater emphasis on maternal health.

Results: We assessed the effects of our interventions by comparing data from previous years using the quality metrics established by the MSPP. Significant changes were observed pre- and post-intervention, including an increase in the number of patients, a rise in all visit types, expanded health care outreach, a reduction in communicable and vaccine-preventable diseases, and improved maternal health.

Conclusion: This was a promising quality improvement project, highlighting the improvement of studied variables after adding sustainable and efficient interventions. With our continued effort, we aim to facilitate future interventions based on the success of the current study to further update the clinic and to cater to the increasing health care needs of the population of Tiburón and other such underserved communities.

Background: Mucormycosis, commonly known as the "black fungus," is a severe infection affecting multiple organ systems, including the skin, brain, lungs, and gastrointestinal tract. This case report is focused on pulmonary mucormycosis, which is frequently observed in organ transplant recipients. Diagnostic challenges arise from nonspecific symptoms.

Case presentation: Our case involved a 61-year-old male with a history of renal transplantation. The patient initially presented with a persistent cough and bloody sputum and was treated unsuccessfully for a presumed fungal infection. A lung biopsy confirmed pulmonary mucormycosis, emphasizing the heightened vulnerability of immunocompromised individuals.

Conclusion: This case highlights the intricate nature of mucormycosis diagnosis and management, particularly in post-organ transplantation patients. It underscores the importance of awareness and collaboration among medical specialists, including infectious disease experts, pulmonologists, and transplant teams, to optimize outcomes in the face of this life-threatening infection.

Description This article discusses how monthly extended-release buprenorphine can be used to improve the treatment of opioid use disorder (OUD). In particular, the use of monthly extended-release buprenorphine holds promise for patients who have recently been released from jail or prison and are battling OUD, those who are unstable and continue to use opioids illicitly, patients who are experiencing homelessness while also struggling with OUD, and those who are stable and want to be weaned off buprenorphine.

Description Computed tomography (CT) imaging has become a cornerstone of modern medical diagnostics, thanks to the groundbreaking work of Sir Godfrey Hounsfield. However, the significant role played by his employer, Electric and Musical Industries (EMI), in providing financial support for his research is often overlooked. In this paper, we explore the connection between EMI's success in the music industry, particularly its signing of the Beatles, and Hounsfield's pioneering work on CT imaging. EMI's success in the music industry provided the financial stability for Hounsfield's research endeavors. In 1971, he developed the first CT scanner, which revolutionized diagnostic medicine. His collaboration with radiologist James Ambrose led to the first clinical CT scan the very same year, marking a significant milestone in medical imaging history. Hounsfield's contributions to the field of medical imaging were honored with the Nobel Prize in Physiology and Medicine in 1979. This award showcased the interdisciplinary nature of medical innovation, thereby bridging the gap between theoretical insight and practical application. The intertwined narratives of music and medicine and the unlikely partnership between the Beatles, EMI, and Sir Godfrey Hounsfield led to the birth of CT imaging.

Background: Supraventricular tachycardia (SVT) is one of the most common tachyarrhythmias found in young women, and SVT can be exacerbated by pregnancy. The symptoms associated with SVT frequently overlap with physiologic changes and symptoms of pregnancy which can lead to delayed or missed diagnosis.

Case presentation: We describe the presentation and the acute management of a patient who had sustained SVT that developed during the active phase of labor. We then detail the varying management approaches of SVT in pregnancy and labor as well as refractory management options. Maternal monitoring will also be discussed as this case shows how an SVT diagnosis could have been overlooked with varying maternal monitoring practices between or within facilities.When the patient went into SVT, the labor and delivery team was able to stabilize her, and she progressed to labor without further complications. Throughout the patient's remaining hospital admission, there was an additional episode of SVT, but this incident was also stabilized. The patient was stable for discharge on postpartum day 2 with follow-up recommended with cardiology.

Conclusion: Supraventricular tachycardias are often overlooked in young women and can present during labor. A lack of consensus amongst experts and medical organizations regarding management needs for further investigation.

Description In the intersection of medicine and art lies a profound synergy that nurtures both professional and personal well-being. This piece embodies this connection through a detailed and abstract representation of the human body and its complexities. At the center of the piece, the gross anatomical depiction of the head and neck serves as a nod to the foundational knowledge in medicine. Surrounding this central figure is an intricate conglomeration of medical elements, including the inner ear canal, a fetus, a hand, an eye, the brain, nerves, chemical elements, microbiology, and excerpts from the Hippocratic Oath, tying together aspects from basic sciences to clinical practice. This work symbolizes the vast and interconnected nature of medical knowledge while also reflecting the multifaceted experiences of a health care professional. The abstract elements convey the unpredictability and intricacy of the human body and the practice of medicine. Creating this piece was a means of exploring these connections and a strategy for maintaining wellness amidst the demands of a medical career. Much like medicine, art requires precision, attention to detail, and an understanding of complex systems. Moreover, the act of creating art provides a therapeutic escape, offering a space for reflection and emotional expression, which are essential for mental health and resilience in the medical field. In this way, my artwork serves as a visual narrative of my journey in medicine, illustrating how the practice of art enhances my ability to navigate the challenges of the profession and maintain a holistic sense of well-being.

Background: Airway management in emergency situations poses significant challenges, particularly in patients with difficult airway anatomy or comorbid conditions. Blind nasal intubation has been explored as a rescue technique when conventional methods fail. Masseter muscle rigidity (MMR), characterized by significant jaw muscle stiffness, is a recognized complication following succinylcholine administration that can complicate traditional approaches to securing an airway.

Case presentation: A 75-year-old man with multiple comorbidities, including hypertension, prior stroke with paralysis, dementia, and a seizure disorder, presented with acute hypercapnic hypoxemic respiratory failure requiring emergent intubation. Orotracheal intubation failed due to trismus despite etomidate, succinylcholine, and rocuronium. Nasal fiberoptic intubation was unsuccessful, leading to blind nasal intubation as a rescue technique using oxymetazoline and surgical lubricant, successfully guided by breath sounds. Oxygen saturation remained stable, but post-intubation imaging revealed a right-sided tension pneumothorax which was subsequently managed via percutaneous decompression.

Conclusion: This case underlines the efficacy of blind nasal intubation as a rescue strategy in challenging airway management scenarios, particularly when conventional methods fail. While not the gold standard, blind nasal intubation offers a feasible alternative, especially in cases of limited mouth opening or compromised airway anatomy. This approach is also less invasive and requires fewer logistical resources than surgical cricothyrotomy, which typically necessitates an operating room and an ear, nose, and throat specialist.

Background: Early palliative care practice implementation in the intensive care unit (ICU) improves advance care planning, promotes patient and family satisfaction, and decreases health care costs. The consensus for protocolized palliative care delivery is unknown. We assessed the impact of a qualitive improvement educational intervention that promotes the identification of critically ill patients who will benefit from early expert palliative care interventions.

Methods: In this observational study, we examined the impact of an educational intervention that promoted (1) early detection of palliative care triggers (PCT) during ICU multidisciplinary rounds (MDRs), (2) admission and 48-hour pain assessment, and (3) family meetings within the first 72 hours of ICU admission among critically-ill patients in a mixed adult community ICU. The primary outcome was the monthly number of hospital-wide palliative care consultations pre- and post-intervention. Secondary outcomes included trends in the rate of PCT detection by the MDR team, pain assessment, and family meetings within 72 hours in ICU patients after the implementation of the education intervention.

Results: The median monthly palliative care consultations progressively increased after the ICU-PAL implementation (preceding year: median 49 [45.5-54], first year: 70 [57.25-78.5], second year: 90 [79-105.25], P < .05 for all comparisons). Family meeting documentation within 72 hours among critically ill patients progressively became more frequent after implementation without changes in PCT detection in MDRs nor pain assessment frequency.

Conclusion: Implementing the ICU-PAL qualitive improvement initiative was associated with a consistent increase in the median average hospital-wide palliative care consultations over several years and a progressively increased rate of early family meetings in critically ill patients after its deployment.

Description "Words Unspoken" is a poem depicting the emotional hardships encountered as an emergency medicine physician.

Description Dr Juan A Sanchez, the new editor-in-chief of the HCA Healthcare Journal of Medicine, shares his vision for elevating the journal's influence by publishing high-quality, impactful research. Moving forward, the journal will introduce new initiatives, including more special issues and invited editorial commentaries, to foster a dynamic academic environment. Dr Sanchez invites the medical community to contribute and engage with the journal to advance medical knowledge and improve health care outcomes.