Baylor University Medical Center Proceedings最新文献

Background: Interprofessional collaboration is a critical component of high-quality, patient-centered care, particularly for high-risk Medicare patients. In response to the growing need for coordinated care, an interdisciplinary clinic was launched at Baylor Scott & White Health to provide integrated medical and social services.

Methods: A retrospective pre-post study design was used to evaluate outcomes in the pilot program. Eligible participants were referred to the interdisciplinary clinic based on the complexity of their needs and had completed at least one comprehensive clinic visit during the index period.

Results: A total of 586 patients were eligible. The mean change from baseline to follow-up in number of emergency department visits per patient decreased from 0.09 ± 0.41 to 0.08 ± 0.31 (P = 0.75), the number of hospitalizations per patient decreased from 0.17 ± 0.46 to 0.15 ± 0.49 (P = 0.38), and the 30-day readmission rate increased from 1.00% to 1.87% (P = 0.33). Secondary outcomes assessing blood pressure, lipids, and hemoglobin A1c levels demonstrated improvements.

Conclusions: While not statistically significant, the results of this study suggest that the interdisciplinary clinic demonstrates promise in closing healthcare gaps and improving outcomes for high-risk patients through interprofessional collaboration.

Histiocytoses encompass a group of rare mononuclear phagocytic cell proliferations with diverse presentations and overlapping features, making them at times difficult to classify. We present a unique case of one such histiocytic disorder, juvenile xanthogranuloma (JXG), in a 15-year-old patient who developed lesions shortly after initiation of chemotherapy for treatment of B-lymphoblastic leukemia/lymphoma and displayed genetic mutations not typically associated with JXG. Appropriate diagnosis and management of JXG requires an understanding of key features in clinical presentation and histopathology, associated conditions, and genetic mutations.

Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication of type 2 diabetes, traditionally linked to SGLT-2 inhibitors. We report a 59-year-old woman with type 2 diabetes and gastroparesis who discontinued SGLT-2 inhibitors 1 month earlier and developed EDKA shortly after initiating dulaglutide. She presented with nausea, vomiting, abdominal pain, and a modestly elevated glucose level. Laboratory findings confirmed EDKA, and she was successfully treated with intravenous insulin and fluids. Dulaglutide was discontinued, with no recurrence on follow-up. This case underscores the potential for GLP-1 receptor agonists to trigger EDKA in susceptible patients and the need for heightened clinical awareness.

Erythema nodosum (EN) is a septal panniculitis commonly triggered by infections, autoimmune conditions, and medications, with zoledronic acid (ZA) being a rarely reported cause despite its widespread use as an intravenous bisphosphonate for osteoporosis and metastatic bone disease. We present the case of a 68-year-old woman with osteoporosis who developed acute onset of painful bilateral lower-extremity subcutaneous nodules 10 days following ZA infusion. Physical examination revealed tender, ill-defined subcutaneous nodules with overlying erythema on both lower legs. Punch biopsy demonstrated septal panniculitis with thickened fibrous septa, granulomatous inflammation, and scattered calcifications, consistent with EN. Workup excluded other common causes. The patient was managed supportively with nonsteroidal anti-inflammatory drugs, rest, ice, and avoidance of future bisphosphonate infusions. This case represents only the second reported instance of EN associated with ZA administration in the literature. The relationship between infusion and symptom onset, combined with the absence of alternative triggers, suggests a temporal correlation. Given the increasing use of bisphosphonates in clinical practice, early recognition of this rare adverse reaction can ultimately reduce patient morbidity.

Background: Although advance care planning (ACP) has increased in recent years, there is still a discrepancy in the utilization of these resources among the Asian American, Native Hawaiian, and Pacific Islander populations. We present the first scoping review of ACP and hospice utilization among Japanese Americans.

Methods: This scoping review was created in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. A literature search was conducted using PubMed. The articles were screened, and the extracted articles then underwent thematic analysis.

Results: A total of 438 articles were found, and 7 articles remained for extraction. Japanese Americans had a high rate of completion for advance directives, comparable to that of White Americans. Japanese Americans had lower rates of hospice utilization after adjusting for demographic and clinical characteristics, suggesting cultural and systemic influences. Key factors included lack of procedural knowledge, acculturation, and preferences for shared decision models.

Discussion: Though Japanese Americans express interest in ACP, cultural and systemic barriers persist. Effective ACP must incorporate culturally sensitive education, family-inclusive approaches, and training in cross-cultural communication. Future research should disaggregate data, investigate socioeconomic influences, and develop strategies to improve ACP in this population.

Background: This study evaluated racial, geographic, and regional disparities in neonatal vaccination rates across the US from 2016 to 2021.

Methods: Data from the National Inpatient Survey, accessed via the Agency for Healthcare Research and Quality, were analyzed for hospitalized births between 2016 and 2021. Vaccination rates were stratified by race/ethnicity, US Census divisions, and urban versus rural residence. Trends were also compared before and after the COVID-19 pandemic.

Results: Significant disparities were observed. Hispanic and Asian/Pacific Islander infants had the highest vaccination rates, while White infants had the lowest. Urban areas had higher rates than rural counterparts. The West-South Central division showed the highest rates of neonatal vaccination, whereas the West-North Central and East-North Central had the lowest rates. The rate of increase in vaccination coverage slowed after the pandemic.

Conclusion: Notable disparities in birth vaccination rates exist across racial and geographic lines in the US. These findings emphasize the impact of structural and demographic factors on vaccine uptake and the urgent need for targeted public health interventions to promote equitable immunization.

Background: The opioid crisis continues to affect communities across the US, with significant sex- and race-based disparities in outcomes. Limited research has explored how these disparities influence hospitalization outcomes after opioid overdose.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample database. Opioid overdose codes specific to opioid poisoning were used. We analyzed in-hospital outcomes including mortality, complications, and healthcare utilization across sex and racial groups.

Results: Among 479,175 hospitalizations for opioid overdose, males accounted for 52% and had higher mortality than females (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI], 1.09-1.17; P < 0.001). Mortality declined over time for both sexes, with females showing greater reductions in severe outcomes like cardiac arrest (aOR, 0.86; 95% CI, 0.81-0.92; P < 0.001) and acute kidney injury requiring hemodialysis (aOR, 0.77; 95% CI, 0.71-0.84; P < 0.001). White patients had the highest mortality, which declined over time (τ = -0.733, P = 0.06), while Black patients had stable mortality but were more likely to need noninvasive ventilation (aOR, 1.27; 95% CI, 1.07-1.51; P = 0.006) and hemodialysis (aOR, 1.28; 95% CI, 1.16-1.41; P < 0.001).

Conclusion: Our study highlights persistent sex and racial disparities in inpatient opioid overdose outcomes, with males and White patients showing higher mortality.