Digital Commons Network^™

When Broken Hearts Clot: Takotsubo Cardiomyopathy With Left Ventricular Thrombus, Ramez Alyacoub, Andy Veras Victoria

Journal of Community Hospital Internal Medicine Perspectives

Background: Takotsubo Syndrome (TTS) is a transient, stress-induced cardiomyopathy that mimics acute myocardial infarction in the absence of obstructive coronary artery disease. Although often self-limiting, TTS may lead to serious complications, including left ventricular (LV) thrombus formation.

Case Summary: A 73-year-old woman with a complex medical history was referred to the emergency department for an abnormal electrocardiogram. She reported transient dyspnea and indigestion but denied chest pain. Laboratory evaluation demonstrated elevated high-sensitivity troponin I and B-type natriuretic peptide. Electrocardiography showed new diffuse T-wave inversions. Coronary angiography revealed non-obstructive coronary artery disease. Transthoracic echocardiography demonstrated apical akinesis with a large LV …

Mpox Coinfection With Coxsackie B Virus In A Transgender Host With Well-Controlled Hiv, Ranel Thaker, Ayesha Khan, Tommy Ojukwu Perdomo, Leilah Tisheh,

Journal of Community Hospital Internal Medicine Perspectives

Background: Mpox (formerly monkeypox) is a double-stranded DNA virus with increasing global prevalence, particularly among men who have sex with men (MSM) and individuals living with HIV. Co-infections with other viruses such as HSV and Varicella have been reported, but no documented cases with Coxsackievirus exist to date.

Case: We report the first known case of co-infection with Mpox and Coxsackie B virus in a 30-year-old transgender female with well-controlled HIV. The patient presented with a diffuse painful rash, perianal lesions, rectal pain, and constitutional symptoms. Physical examination revealed characteristic vesiculopustular lesions of Mpox, and laboratory testing confirmed …

Recurrent Ischemic Colitis Associated With Chronic Low-Flow Physiology: Diagnostic And Therapeutic Implications, Mustafa Sadek, Alaa Almallouhi

Journal of Community Hospital Internal Medicine Perspectives

Ischemic colitis is the most common form of intestinal ischemia and is typically associated with acute hypoperfusion states such as shock or dehydration.¹ Chronic low-flow states related to persistently low baseline blood pressure may represent an underrecognized contributor to recurrent disease in the absence of classic acute triggers.² We present a case of a 54-year-old woman with recurrent, biopsy-proven ischemic colitis occurring in the setting of persistently low blood pressure documented across multiple clinical encounters. Unlike many patients with ischemic colitis, she lacked documented atherogenic, autoimmune, radiation-related, or vasospastic risk factors, and CT angiography showed patent mesenteric vasculature. …

Acute Liver Injury Likely Induced By Alpha Lipoic Acid Contained In Dietary Supplement, Simona Maksimyan, Jonathan V. Reyes, Kasim Kazbay, Farah K. Gazi

Journal of Community Hospital Internal Medicine Perspectives

The rise in use of herbal and dietary supplements, which are regulated as food rather than as drugs by the Food and Drug Association, poses the risk of unknown and potentially severe side effects. We describe the case of acute liver injury, characterized by significant elevation in AST and ALT, likely induced by the consumption of an over-the-counter supplement containing alpha lipoic acid (ALA). Our patient trusted in a “natural” alternative to Western medicine for management of neuropathy, which was ultimately detrimental to her liver. An immediate and sustained improvement in liver enzyme levels was noted with discontinuation of the …

Granulomatosis With Polyangiitis Presenting As Asymmetric Oligoarthritis: A Diagnostic Challenge, Hasan Obeidat, Heba Alalem, Marwan Ahmed, Mahyar Toofantabrizi

Journal of Community Hospital Internal Medicine Perspectives

Granulomatosis with polyangiitis (GPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis classically involving the respiratory tract and kidneys. Although musculoskeletal symptoms are common, they are rarely the initial or dominant presentation, which may lead to diagnostic delays. We present the case of a man in his 40s who initially presented with acute asymmetric oligoarthritis and constitutional symptoms. Initial evaluation for infectious and crystal-related etiologies was unrevealing. During hospitalization, he developed cutaneous vasculitic lesions, including punctate digital lesions and subungual hemorrhages, prompting further investigation. Imaging revealed bilateral pulmonary nodules, and serologic testing demonstrated markedly elevated PR3-ANCA levels. Lung and skin biopsies …

The High Cost Of Incomplete Physical Exams: Missed Diagnosis Of Cushing Syndrome In A Patient With Recurrent Hospital Admissions, Tarah M Burton, Miranda K Hunter, Mihail Zilbermint

Journal of Community Hospital Internal Medicine Perspectives

Cushing syndrome is a rare but life-threatening endocrine disorder associated with a classic constellation of physical exam findings (e.g. “moon facies”, abdominal striae, etc.). However, thorough biochemical testing is needed to confirm this diagnosis. We present the case of a 35-year-old male with multiple hospitalizations across a variety of healthcare institutions for heart failure, cellulitis, uncontrolled hypertension, and diabetes.  While an adrenal mass was eventually identified on imaging, classic signs of Cushing syndrome – including violaceous striae, truncal obesity, and facial plethora – were missed during prior admissions.  This case illustrates the diagnostic delay that can result from incomplete physical …

Mpo-Anca–Positive Eosinophilic Granulomatosis With Polyangiitis Presenting As Acute Reversible Cardiomyopathy: A Case Report, Stephanie Ammari, Nawras Ibrahim, Bahaeddin Shabaneh

Journal of Community Hospital Internal Medicine Perspectives

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare ANCA-associated vasculitis characterized by asthma, eosinophilia, and small-vessel vasculitis. Cardiac involvement occurs in up to 62% of cases but is more commonly associated with ANCA-negative disease; MPO-ANCA positivity typically correlates with vasculitic manifestations such as neuropathy and glomerulonephritis rather than isolated cardiomyopathy. We present a 65-year-old man with adult-onset asthma who developed acute dyspnea, markedly elevated high-sensitivity troponin (peak 1980 ng/L), peripheral eosinophilia (peak 1550/mm³), and new left ventricular systolic dysfunction (LVEF 30–34%) with normal coronary angiography. He improved rapidly after intravenous corticosteroids, with LVEF normalization to 55–60% within six weeks. MPO-ANCA …

Adenosquamous Carcinoma Of The Gallbladder: A Case Report, Sameeha Sajid, Aishwarya Hanspal, Muhammad Daud Abdullah, Haweda Aljarray, Rakahn Haddadin, Swatam Jain

Journal of Community Hospital Internal Medicine Perspectives

Background/Purpose: Adenosquamous carcinoma of the gallbladder is a relatively rare histological subtype, accounting for approximately 1-5% cases of gallbladder carcinomas. The scarcity of this tumor and its poor prognosis contribute to the clinical challenges associated with its diagnosis and management.

Case: We present a case of a 65-year-old female with a past medical history particularly significant for cholelithiasis, choledocholithiasis, and gallstone pancreatitis who presented to the emergency room with complaints of severe right upper quadrant pain of one-day duration. Initial evaluation was remarkable for an abdominal ultrasound with cholelithiasis with a positive sonographic Murphy sign, biliary scan demonstrating persistent non-visualization …

Fatal Early-Onset Cirrhosis Secondary To Masld In A Young Adult: A Case Report And Historical Overview, Brittani Paige Kongala, Khursana Duty, Hussam Ammar

Journal of Community Hospital Internal Medicine Perspectives

Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent liver disease worldwide. Its natural history is typically characterized by slow progression over decades. We describe a rare case of rapidly progressive MASLD in a young woman that culminated in decompensated cirrhosis, multiorgan failure, and death within one year of diagnosis—an unusually aggressive course that diverges from the typical trajectory of the disease. Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent liver disease worldwide and is generally characterized by slow progression over decades. Although progression to cirrhosis typically occurs over many years, rapidly progressive disease has …

When Steroid Injection Meets Rituximab: Disseminated Mssa, George Fawzy, Christlyn Blessing-Ujomor, Amna Anees

Journal of Community Hospital Internal Medicine Perspectives

Background: Septic arthritis is a rare but potentially fatal complication of intra-articular corticosteroid injection, commonly caused by Staphylococcus aureus. The risk is higher in older adults and those with diabetes, rheumatoid arthritis (RA), immunosuppression, or a history of recent joint procedures. Diagnostic delay is possible, as non-infectious arthritis can present with similar features. Although rituximab is generally considered safe, rituximab-associated hypogammaglobulinemia may increase susceptibility to severe infections. We report a case of methicillin-sensitive Staphylococcus aureus (MSSA) septic arthritis with hematogenous vertebral seeding following intra-articular corticosteroid injection in a patient receiving rituximab therapy.

Case: A 73-year-old man with seropositive RA, treated …

Cied-Related Infection Incidence And Clinical Outcomes In Adult Recipients Of Leadless Pacemakers, Abdullah Sahyouni, Esdras Panchame Pavon, Aylin Ma, Johny Alrahal, Matthew Guzie, Kirstenn Claire Calaguas, Steven H. Nguyen, Anjali Balla, Shruti Sreekanth, Bobby Malik, Robert Subbiondo, Yizhi Lin

Journal of Community Hospital Internal Medicine Perspectives

Infections of traditional pacemakers represent a serious complication as they are associated with significant morbidity and mortality. Unlike traditional pacemakers, which have a subcutaneous pocket and transvenous leads, leadless pacemakers have emerged as a promising alternative with a self-contained intracardiac design with significantly lower infection rates. The aim of this systematic review is to synthesize current research on device-related infections in leadless pacemaker recipients. A comprehensive review was performed through PubMed with the following key words, “leadless pacemaker,” “Micra,” “infection,” “PPM,” “conventional pacemaker,” yielding 291 articles. Then, articles were screened for relevance to infection rates among adult recipients of leadless …

The Hospitalist’S Toolbox: Inpatient Management Of Hidradenitis Suppurativa, Mahaa Ayub, Angela Zaladonis, Sherry Yang

Journal of Community Hospital Internal Medicine Perspectives

Hidradenitis suppurativa (HS) is a chronic dermatologic condition characterized by painful inflammatory nodules, abscesses, and draining sinus tracts, predominantly affecting intertriginous regions and significantly impairing patients' quality of life. These lesions are prone to relapsing, with many patients experiencing painful recurring flares. HS patients frequently visit emergency departments during flares and often end up requiring hospitalization. This may be due to limited access to outpatient dermatologic care. Therefore, hospitalists must possess the knowledge and skills to effectively manage HS flares in the inpatient setting. Optimal management of HS involves a multimodal approach, including wound care, topical and systemic medications, and …

Glp-1 Receptor Agonists Beyond Glycemic Control: Clinical Implications In Neurodegenerative Disease And Substance Use Disorders, Michelle Raja, Khush Patel, Pranav Krish, Chrissy Chow, Zaki Azam

Journal of Community Hospital Internal Medicine Perspectives

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have expanded beyond glycemic control to include cardiovascular and renal risk reduction, with recent approval for reducing major adverse cardiovascular events in individuals with obesity or overweight and established cardiovascular disease. Increasing attention has focused on their potential applications in neurodegenerative disorders and substance use disorders (SUDs), supported by mechanistic links to neuroinflammation, mitochondrial function, and central reward pathways. However, clinical evidence remains heterogeneous and disease-specific, with discordance between biological mechanisms, biomarker changes.

In Alzheimer disease, phase 3 trials of oral semaglutide (EVOKE and EVOKE+) did not demonstrate slowing of clinical progression despite biomarker effects. …

The Hospitalist Support Team: The Foundation For Supporting A Seven-Specialty Hospitalist Group, Michael S. Wang, Austin Tiesenga, Tho Nguyen, William Schreiner, Gwendolyn Brainard, Samantha Labay

Journal of Community Hospital Internal Medicine Perspectives

Hospitalist medicine has grown considerably over the last 30 years. What began as internal medicine physicians filling the role of primary care physicians for their hospitalized patients has expanded to other specialties. This growth has created a need for both administrative and clinical support for these hospitalist specialties. To meet the needs of the adult Internal medicine-based group, a small community hospital created an administrative structure in order to facilitate clinical and administrative needs. As the administrative group began providing support to other specialties, this led to integration within the group. The program has grown to seven specialties and 56 …

Thoracentesis-Related Complications: A Comparison Between Vacuum-Assisted And Manual Aspiration Methods, Nikith Rao, Muhammad S. Naseer, Farrin A. Manian, Woo J. Moon

Journal of Community Hospital Internal Medicine Perspectives

Thoracentesis is a commonly performed bedside procedure for diagnostic evaluation or symptomatic relief of pleural effusions. Although generally considered low risk, prior studies comparing complication rates between aspiration methods, particularly manual and vacuum-assisted aspiration, have reported mixed results. We therefore compared complication rates between these two methods among patients undergoing ultrasound-guided thoracentesis by a hospitalist-led procedure service at a community teaching hospital. Thoracentesis-related complications, including pneumothorax, hemothorax, procedure site bleeding, and re-expansion pulmonary edema were assessed. A total of 96 patients underwent manual aspiration and 97 underwent vacuum-assisted aspiration. Patient demographics and comorbidities were similar between groups with no statistically …

Cryptococcal Meningitis: A Retrospective Analysis Of Immunocompetent And Immunocompromised Cases, Daniel Kotas, Ho-Man Yeung

Journal of Community Hospital Internal Medicine Perspectives

Introduction. Cryptococcal meningitis (CM) primarily affects immunocompromised individuals, but up to 20% of cases occur in immunocompetent patients. However, there are limited clinical comparisons between immunocompromised and immunocompetent patients.

Methods. This is an IRB approved, single-centered retrospective chart review study. Patients aged >18 admitted between 2012 and 2022 with Cryptococcus neoformans meningitis were included. Demographic, associated conditions, clinical data, and clinical outcomes were obtained. Patients were categorized into immunocompromised and immunocompetent groups.

Results. 37 patients with CM were identified, with 32 (86.5%) immunocompromised patients and 5 (13.5%) immunocompetent patients. The median time to first lumbar puncture was …

Incidence And Risk Factors Of Pleural Effusion In Patients With Autoimmune Diseases: A Retrospective Cohort Study, Jacob Sutton, Marwah Muhammad, Muhammad Hashim Khan, Anastasia Slobodnick

Journal of Community Hospital Internal Medicine Perspectives

Background: Pleural effusion is a common manifestation of autoimmune and connective tissue disorders, but large-scale data on its incidence, risk factors, and outcomes are limited. This study aimed to assess the clinical characteristics, hospital course, and outcomes of patients with pleural effusion associated with autoimmune diseases compared to those without autoimmune conditions.

Methods: We conducted a single-center retrospective cohort study of adult patients admitted with pleural effusion. Patients were divided into two groups: those with autoimmune diseases (study group, n = 1,346) and those without autoimmune conditions (control group, n = 1,278). Data were extracted from electronic health records, and …

Atopic Comorbidity Burden And Inpatient Outcomes In Eosinophilic Esophagitis: A Nationwide Analysis Of Hospitalizations In The United States, 2016-2022, Cherechi Nwabueze, Charles Anugwom, Daniel Nyancho, Ihunanya Kanu, Yetunde Akande, Eunice Omeludike

Journal of Community Hospital Internal Medicine Perspectives

Background: Eosinophilic esophagitis (EoE) frequently coexists with atopic conditions, but the impact of atopy on inpatient outcomes and health care utilization remains unclear. This study evaluated national trends, hospitalization characteristics, endoscopic intervention rates, and the association between atopic comorbidities and clinical outcomes among adults hospitalized with EoE from 2016–2022.

Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (NIS) 2016 to 2022. Survey-weighted descriptive statistics, trend analyses, and multivariable survey logistic and linear regression models assessed associations between atopy and inpatient outcomes, including length of stay (LOS), total hospital charges, in-hospital mortality, and need for esophageal dilation. Subgroup …

Gender Differences In Presentation And Outcomes Of Spontaneous Coronary Artery Dissection (Scad): A Single Center Case Series Study, Abdul Nadeem Akhtar, Fnu Aisha, Aimen Binte Moazzam, Mohammad Omer Rehman Rana, Abida Perveen, Jahanzeb Malik

Journal of Community Hospital Internal Medicine Perspectives

Background: Spontaneous Coronary Artery Dissection (SCAD) is an important non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger females. Despite increasing recognition, data on gender-based differences in SCAD presentation and outcomes remain limited, particularly in South Asian populations.

Methods: This retrospective case series included 24 patients diagnosed with SCAD at Abbas Institute of Medical Sciences (AIMS) between January 2022 and March 2025. Patient demographics, clinical presentation, angiographic findings, management strategies, and outcomes were analyzed with a focus on gender-based differences.

Results: Of the 24 patients, 17 were female (70.8%) and 7 were male (29.2%). Females were younger and had …

Survival Outcome Of Gallbladder Cancer In The Us: An Updated Surveillance, Epidemiology, And End Results-Based Analysis Of Age And Gender Disparities, Ayrton Bangolo, Behzad Amoozgar, Budoor Alqinai, Ravleen Chowdhary, Rishabh Goyal

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Gallbladder cancer (GBC) is a rare but highly lethal malignancy with significant variability in mortality based on demographic and clinical factors. This study aims to analyze the impact of gender, age, tumor stage, and treatment modalities on mortality in GBC patients, providing a comprehensive overview of the factors influencing survival outcomes.

Methods: We conducted a retrospective analysis of 1,527 patients diagnosed with GBC between 2005 and 2021. Data were collected on demographic variables, tumor stage, treatment modalities (chemotherapy, surgery, radiation), and survival outcomes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall and cancer-related …

Clinical And Laboratory Predictors Of 30-Day Mortality In Hiv-Positive Adults With Pneumonia: A Prospective Observational Study From North India, Mandip Singh Bhatia, Ankita Kumari Bhargav, Saurabh Chandrabhan Sharda, Shankar Naidu, M. R Shivaprakash, Sunil Sethi, Vikas Gautam, Arnab Ghosh

Journal of Community Hospital Internal Medicine Perspectives

Background: Pneumonia remains a major cause of morbidity and mortality among people living with HIV (PLHIV), particularly in low- and middle-income countries. Despite the availability of antiretroviral therapy (ART), early mortality after hospitalization for pneumonia remains high. Indian data on short-term mortality predictors in HIV-associated pneumonia are limited.

Methods: We conducted a prospective observational study of HIV-positive adults admitted with pneumonia to a tertiary-care hospital in North India between April and December 2025. Clinical, laboratory, microbiological, and radiological parameters were recorded at admission. Patients were followed for 30 days. The primary outcome was all-cause 30-day mortality. Predictors of …

Can Peripheral Angiography Be Safely Performed In Patients With Chronic Renal Insufficiency Without Significant Risk Of Contrast-Associated Renal Injury In Outpatient Settings?, Mubashar Choudry, Artem Shmelev, 0. Pierce Sebastian, Noor-E-Fatima Khan, Aleezay Farhat, Donald Wilkerson

Journal of Community Hospital Internal Medicine Perspectives

Contrast-associated acute kidney injury (CA-AKI) is a known complication following

coronary angiographic procedures using iodinated contrast media (ICM). The risk of CA-AKI is

multifactorial, dependent largely on estimated glomerular filtration rates. The most important

and accepted hospital-based preventive strategy involves both a reduction of iodinated contrast

and multi-hour pre- and post-intervention normal saline hydration. Because of time constraints,

neither ambulatory surgical centers (ASC), nor outpatient-based laboratories (OBL)

can provide similar degrees of pre- and post-intervention hydration. The utilization of

carbon dioxide (CO₂) imaging, intravascular ultrasonography, and limited iso-osmolar

contrast agents may provide an alternative preventive strategy.

Multicentric Cross-Sectional Study On Determinants In Choosing Subspecialties In Internal Medicine And Job Satisfaction Among Internal Medicine Trainees And Specialists In The Usa, Indira Acharya, Onyekachi Ibe-Ejiogu, Mona Alkayyali, Ashik Pokharel, Nathan C Kilian, Mina M Al-Hamadani, Ashbina Pokharel, Jiling Chou, Christopher J Haas

Journal of Community Hospital Internal Medicine Perspectives

Background/ Purpose:

To analyze the sex distribution of physicians in a specific subspecialty, identify factors influencing subspecialty choice in internal medicine, assess job satisfaction, and evaluate burnout levels among Internal Medicine (IM) trainees and specialists.

Methods:

A questionnaire-based study was conducted using the Abridged Job Descriptive Index (AJDI) for job satisfaction and the Maslach Burnout Inventory (MBI) for burnout. Participants included IM residents, fellows, attendings, and hospitalists considering fellowship. Descriptive and statistical analyses, including Fisher's exact test, were performed using R to assess trends across subspecialties grouped by fellowship competitiveness.

Results:

A total of 162 IM physicians participated, with …

System And Method For Knowledge Reuse From Infrastructure Interaction Exhaust And Cross-Agent Behavioral Metadata Inference, Eric Zavesky

Defensive Publications Series

A system and method for cross-agent behavioral pattern learning and knowledge reuse from infrastructure interaction exhaust. The system passively captures interaction traces from multiple actors - including autonomous agents, semi-automated processes, and human users - as they interact with databases, APIs, and infrastructure endpoints through heterogeneous surfaces. A semantic inference layer analyzes captured traces to infer properties beyond raw telemetry, including organic field discovery, relevance weighting, prompt-level field alias mining, role frequency and sensitivity determination, and retry-aware intent detection. A pattern sanitization module strips individual actor identity and raw data values while preserving role-scoped organizational tokens, producing parameterized patterns with …

Context-Aware Semantic Method And System For Network-Connected Camera Notification Filtering, Josh Och, Andrew Axley

Defensive Publications Series

A system and method are provided for enhancing the operational intelligence of network-connected cameras through the establishment of camera-specific semantic context. A digital repository is associated with an individual monitoring device to store context metadata representing physical and logical relationships in the device's field of view. The context metadata can be defined via user input or automatically inferred using analytical models that identify historical activity patterns or process environmental feedback. When a monitoring event occurs, the associated context metadata is retrieved and integrated into an evaluation framework, such as an augmented prompt for a generative artificial intelligence model, to analyze …

Data Center Closed Loop Cooling And Water Generator, Daniel Schramm

Defensive Publications Series

Integrating closed-loop microchannel server cooling with an organic Rankine cycle (ORC) and an ambient atmospheric water harvesting (AWH) condensation stage creates a unified system. This architecture uses high-density server waste heat to drive thermodynamic cycles that simultaneously stabilize computing infrastructure and yield pure water as an environmental byproduct.

Honeycomb‑Insulated, Chemical‑Heated, Fail‑Safe Survival Tent (Hichest‑1.3), Michael Victor Caldwell Mr.

Defensive Publications Series

This invention describes a portable, non‑electric emergency survival tent that uses a gradient honeycomb air‑cell wall with an integrated aluminized inner face, structural heat‑pack pockets formed by the cells themselves, a continuous base heat channel, interlocking baffle redundancy, one‑way check valves, and a fail‑safe flexible dome frame. The tent maintains structural integrity and thermal protection even if the inflatable honeycomb walls deflate. It is optimized for short‑term emergency survival (1–3 nights) in sub‑zero conditions without electricity or fuel. All components use existing materials and manufacturing methods. This invention is released as open hardware for global use.

Cine Magnífico | Spanish Film Festival, National Hispanic Cultural Center

LAII Events

¡Cine Magnífico! celebrates Spanish and Latin American culture through presentation of some of the best of modern cinema in a weekend-long program, featuring work by first-time filmmakers and established masters alike.

The subject matter runs the gamut from comedies, action, romances and documentary films, to dramatic masterpieces. Some of the riskiest and most innovative films of recent years will be included.

¡Cine Magnífico! is organized by Instituto Cervantes, the National Hispanic Cultural Center and UNM Latin American & Iberian Institute so as to be at the forefront of the movement to increase cultural opportunities for the entire New Mexico community …

Childbirth Self-Efficacy And Factors Influencing Labor And Birth In The Dominican Republic, Lori Hubbard, Thomas P. Mccoy, Katherine Aquino, Franceska Charles, Julia Ricker, Gabrielle Carlson

International Nursing Research Congress (INRC)

At 58.1%, the cesarean birth rate in the Dominican Republic (DR) is the highest in the world (1). The World Health Organization cites the overuse of elective cesareans as a global health priority, but states reduction efforts should utilize educational interventions that incorporate local determinants of health (2,3). This descriptive, cross-sectional, convergent mixed methods study examined childbirth self-efficacy, demographics, and beliefs about labor and birth in expectant and newly postpartum parents from low resourced communities in the Dominican Republic. A demographic survey, researcher-designed items grounded in the theory of planned behavior, and the 62-item Spanish version (4) of the 4 …

Advance Care Planning In Practice: Hospital Nurses’ Experiences With Known And Unknown Goals Of Care, Ashley Hebert, Genevieve Thompson, Diana Mcmillan, Katarina Lee-Ameduri

International Nursing Research Congress (INRC)

Background: Hospital continues to be the place of death for the majority of Canadians, despite the common preference for a less aggressive comfort-focused plan of care at the end-of-life. Advance care planning (ACP) is recognized as a means to prevent unwanted care for patients. However, ACP is often not occurring in acute care settings before patients lose the capacity to participate. This means that a patient’s goals of care are frequently left unknown, which may not only lead to overtreatment and patient harm, but also to moral distress in nurses.

Purpose: The purpose of this thesis study is (1) to …