HCA healthcare journal of medicine最新文献

Background: Prior practice in a 523-bed community hospital required automated dispensing cabinets (ADCs) to be replenished daily by early afternoon to ensure accurate drug ordering. Because of the tight time window, technicians frequently refilled ADCs during peak medication administration times. After a positive report from a smaller facility in the health system, the study facility implemented a quality improvement project to optimize the ADCs. This involved new processes of every-other-day ADC replenishment staggered via shift-specific workflows, and a dedicated technician was assigned to optimize ADC inventories.

Methods: Monthly reports of ADC refilling and dispensing transactions were compiled from inpatient, nonprocedural units. Data on stock-out transactions, when a nurse attempts to remove a medication from an empty ADC pocket, were obtained from facility reports from the same machines. Based on hospital policy for standard medication administration times, peak times were identified. For these time windows, an overlap ratio was calculated by dividing the relative frequencies of refill and dispense transactions. The average overlap ratios were calculated for the pre- and post-implementation periods. Stock-out transactions were tracked monthly, and a 95% confidence interval was constructed for all months before implementation.

Results: Post-implementation, monthly stock-out counts significantly decreased by 38% within 6 months. While there was no change in medication dispensing patterns, there was a major shift in refilling activity patterns. Overlap during morning peak times decreased, but overlap increased during the evening peak times due to the rearrangement of technician shift times and workflows.

Conclusion: After implementation of the new process and ADC inventory optimization, refill habits significantly changed, leading to reduced technician-nurse overlap during the morning medication pass, likely due to the spread out replenishment schedule. Dispensing habits did not change during the study period, and while there was a significant decrease in stock-outs post-implementation, there was insufficient data to assess effects of the new refilling processes.

Description Demodex blepharitis is a chronic eyelid inflammation caused by Demodex mites, which are ubiquitous skin parasites. Lotilaner, a newly United States Food and Drug Administration (FDA)-approved drug, is an antiparasitic agent that selectively inhibits parasite-specific γ-aminobutyric acid chloride channels, inducing spastic paralysis and death of Demodex mites. It is applied as an ophthalmic solution, 0.25%, twice a day for 6 weeks, and it has a long half-life and high lipophilicity, facilitating the penetration of the drug into the eyelash follicles and meibomian glands where the mites reside. This study systematically reviewed 6 clinical trials that compared lotilaner with placebo for Demodex blepharitis. The primary efficacy endpoint was complete collarette cure, defined as collarette grade 0 on the upper lid of the analysis eye. The secondary efficacy endpoint was decreased mite density with mite eradication, defined as 0 mites per lash on the analysis eye at day 42. The results showed that lotilaner treatment was significantly more effective than the control in achieving both endpoints, with a maximum reduction of 94.7% in mite density at day 43. The treatment effect persisted for at least 2 months after the end of treatment. Lotilaner was also safe and well tolerated, with no serious adverse events reported. For primary care providers, this study underscores the importance of recognizing collarettes as a key diagnostic marker for Demodex blepharitis during routine examinations. Lotilaner ophthalmic solution, 0.25%, offers a novel, effective therapy for this condition, enabling earlier intervention and improved outcomes for patients. Further investigation in larger trials is warranted to confirm these findings and refine their clinical application.

Introduction: COVID-19-induced rhabdomyolysis is a common complication in COVID-19 infection. However, only a handful of cases have been reported showing links between COVID-19 vaccine and rhabdomyolysis.

Case presentation: We present the case of a 53-year-old woman, who recently received COVID-19 vaccine and presented to the hospital with progressive extremity weakness. Common reasons for rhabdomyolysis were ruled out as possibility and the patient was found to have rhabdomyolysis induced from COVID-19 vaccine.

Conclusion: Even though COVID-19 vaccine-induced rhabdomyolysis is rare, it should be considered in the differential diagnosis with patients presenting with neuromuscular complaints and a recent COVID-19 vaccine.

Description This collage is made of hundreds of small pieces of paper cut from old magazines and junk mail. As I worked on it, I thought about how each tiny piece of paper alters the canvas in a nearly imperceptible way, but the shapes and colors could shift completely in the course of an hour. This concept of making small changes is something I think a lot about in my work as a psychiatric nurse as well. Even though it doesn't always feel like it, we become wiser each day. By looking for these small opportunities to evolve, we can build resilience and live happier, healthier lives.

Background: Health coaching is a field that is growing in popularity. Health coaching is not regulated and there is no standard for background, education, or training for those acting as health coaches. The purpose of this study was to investigate the burgeoning field of health coaching: who is performing it and common practices.

Methods: A total of 560 health coaching websites were reviewed to record educational backgrounds, recommendations for supplements, and the sale of supplements and/or other wellness products. Multivariable logistic regression was used to test associations between characteristics of health coaches and whether they recommend supplements, sell supplements, or sell other wellness products.

Results: The sample was mostly female without an applicable associate or bachelor's degree listed practicing without national board certification. Twenty-nine percent recommended supplements, approximately 17% sold supplements, and 17% sold other wellness products. Of those without national board certification, nearly a quarter sold supplements. Multivariable logistic regression was used to identify associations between characteristics and supplement recommendations or selling supplements or other wellness products.

Conclusion: As health coaching develops, it is important to understand who is practicing as a health coach and common health coaching practices in the field.

Description I painted this rooster during my first semester of graduate school while relaxing after a long day of research. It was my first time using oil paint and a palette knife. I kept it because it brings me joy and reminds me to try new things.

Background: Guillain-Barré Syndrome (GBS) is an acute autoimmune polyneuropathy. Cases of GBS have been reported following administration of the vaccines for swine influenza, seasonal influenza, hemagglutinin type 1 and neuraminidase type 1, and meningococcal disease. Despite these links, a causal relationship has not been confirmed.

Case presentation: We present a case of a 70-year-old woman who presented with progressive bilateral ascending weakness and numbness and reported receiving the first dose of the Moderna COVID-19 vaccine 2 weeks prior to presentation.

Conclusion: At the time of writing, this is the first reported case of GBS following the Moderna Spikevax COVID-19 vaccine. While a temporal link does not confirm causation, vigilance for GBS symptoms in recently vaccinated patients is crucial. Early recognition enables timely treatment, preventing severe complications like respiratory failure. However, the public health benefits of vaccination far outweigh the risks, as it remains the most effective tool in preventing severe disease.

Description Writing a research manuscript is a meticulous process necessary for effective communication of scientific findings. In this article, we cover the key concepts and steps involved in crafting a well-structured manuscript. Research manuscripts use a formal structure with discrete sections that facilitate data review and interpretation. The opening section is a structured abstract, which summarizes the entire manuscript in about 300 words and highlights the research problem, using the headings Background, Methods, Results, and Conclusion. The introduction provides context, states the research question and justifies its significance. The methods section details the study design, data collection, and analysis procedures. The results section presents findings objectively, using tables, figures, and text, while also emphasizing key results and trends. In the discussion section, the authors interpret their results and relate them to the research question and findings from similar studies-some of which should be covered in the introduction-consider implications, address limitations, and suggest future research directions. The conclusion provides a summary of the main findings and their significance. Lastly, the reference section presents citations of all sources used in the article, formatted according to the chosen journal's citation style.

Background: Pyomyoma is a rare, but potentially fatal, complication of uterine leiomyoma. Most cases occur in postpartum or postmenopausal patients with vascular disease and arise due to infarction and infection of existing fibroids. The proposed diagnostic triad for pyomyoma includes 1) sepsis or bacteremia; 2) uterine leiomyomata; and 3) no other apparent source of infection. We present a case of a postmenopausal patient who presented with the aforementioned triad and was found to have a pyomyoma, positive for Streptococcus agalactiae.

Case presentation: A 67-year-old woman with no known past medical history presented to the emergency department for altered mental status. Although afebrile, she was tachycardic and hypertensive, with severe hyperglycemia and leukocytosis on initial assessment. Multiple embolic cerebral infarcts were noted on imaging, but workup was negative for a cardiac or vascular source. Her infectious workup was ultimately notable for S agalactiae bacteremia and a fibroid uterus with a rim enhancing fluid collection seen on a computed tomography (CT) abdomen and pelvis scan. Broad spectrum antibiotics were initiated, and she underwent CT-guided drainage of the abscess, which was also positive for S agalactiae. Given continued fevers and elevated white blood cell counts, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic washout. Intraoperative findings were notable for a pedunculated, necrotic uterine fibroid with purulent material within, and no other apparent gastrointestinal source. The final pathology was benign, and the patient was ultimately discharged to an inpatient rehabilitation facility.

Conclusion: While rare, pyomyoma should be considered for any postpartum or postmenopausal patient with risk factors for, or known, vascular disease, presenting with the triad noted above. The high mortality rate associated with pyomyoma is often due to patients succumbing to overwhelming sepsis, likely related to delays in diagnosis. As such, pyomyoma should be considered in the appropriate context and warrants prompt diagnosis and treatment.

Description The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols may guide future adoption of portable CT technology in trauma settings.