Medicine and Health Sciences Commons^™

Pancreatic Cancer; From Effective Prevention And Early Diagnosis To Personalized Therapy, Adrian Silaghi, Dragos Serban, Bogdan Gaspar, Valentin Verlas, Dragos Epistatu, Cristian Paius, Roxana Sfetea, Liliana Andronache, Ioana Paunica, Irina Ruxandra Strambu, Daniela Gabriela Bălan, Alexandru Florin Motofei, Vlad Denis Constantin

Journal of Mind and Medical Sciences

Despite substantial improvements in survival rates for most cancers, pancreatic cancer still remains a leading cause of death from malignancy. The disease has no symptoms in the initial stages, it can early invade the surrounding organs, and treatment methods have poor long-term prognosis. In addition, this neoplasia is starting to be diagnosed more and more frequently in young people. High incidences have been found in developed regions such as Europe, North America, Australia, but recent data show that this condition is increasing in other regions as well. Pancreatic cancer involves multiple factors such as cigarette smoking, obesity, diabetes, alcohol consumption, …

Pathophysiological Mechanisms Of Type 2 Diabetes Mellitus Involved In Acute Mesenteric Ischemia, Andreea Pușcașu, Florin Bobîrcă, Alexandra Bolocan, Ion Daniel, Octavian Andronic, Dan Nicolae Paduraru

Journal of Mind and Medical Sciences

Type 2 diabetes mellitus is a complex condition with high prevalence in the global population, implying multiple complications for the entire organism. It is essential to understand its implications in the development and evolution of other pathologies in order to manage efficiently their complications thus decreasing overall mortality. A surgical pathology potentially associated with type 2 diabetes is acute mesenteric ischemia. Although it has a decreased prevalence in the global population, mesenteric infarction is related to an extremely high mortality rate due to its elusive clinical presentation and rapid progression. The difficult diagnosis emphasizes the need to make associations between …

Memory Impairment In Post-Covid-19 Syndrome; What Is The Evidence?, Luciano Luiz Alt, Amanda Delai Bortolini, Bruna Santin Andreis, Caroline Arais Schmidt, Giovana Rugeri, Maria Clara Tonini Pagliarin, Maria Eduarda Dupond Kindel, Maria Fernanda Almeida Costa, Nathália Lorenzoni Costa, Pedro Henrique Sarmento Dariz, Vinícius Grasselli Omizzolo

Journal of Mind and Medical Sciences

Objectives. Although COVID-19 mainly affects the respiratory system, it can also cause neurological complications like memory impairment, which may be part of post-COVID-19 Syndrome. Identifying these impairments is challenging due to the lack of approaches and limited follow-up. This systematic review aimed to identify the effects of COVID-19 on memory. Methods. Analyzing articles from PubMed, SciELO, and VHL databases, focusing on the relationship between COVID-19 infection and memory impairment. Results. COVID-19 infection was linked to significant declines in memory function. The severity of infection correlated with the intensity of neurological sequelae, particularly memory impairment, with cognitive and executive functions most …

Artificial Intelligence In Ovarian Cancers- From Diagnosis To Treatment; A Literature Review, Cristina Bucur, Irina Balescu, Sorin Petrea, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Marilena Stoian, Cristian Balalau, Nicolae Bacalbasa

Journal of Mind and Medical Sciences

Ovarian cancer remains the most lethal gynecological malignancy due to challenges in early detection stemming from a lack of reliable biomarkers. Despite this, various laboratory tests are commonly employed in clinical practice, some showing diagnostic and prognostic promise for ovarian cancer. This review aims to synthesize current literature to delineate the role of artificial intelligence (AI) in both the diagnosis—from laboratory tests to imaging—and treatment of ovarian cancers. Thus, the epidemiology, risk factors, pathology, screening methods, as well as the integration of AI in the diagnosis of ovarian cancer (AI based on both blood biomarkers and imaging-based ovarian cancer detection) …

Borderline Personality Disorder: A Narrative Review On Effective Psychotherapies, Marina Neri, Antonino Reitano, Lavinia Rinnone, Antonio Bruno, Fabrizio Turiaco, Felicia Matilde Ferreri, Carmela Mento, Maria Rosaria Anna Muscatello, Fiammetta Iannuzzo

Journal of Mind and Medical Sciences

Borderline personality disorder (BPD) is a severe mental disorder characterized by pervasive patterns of relational instability, chronic feelings of emptiness, sense of abandonment, self-injurious and anticonservative attempts. Pharmacological treatment has been found useful only for the management of severe symptoms and management of comorbidities, while psychotherapy is the main treatment for BPD. Although the disorder has long been considered resistant to any treatment, in recent years research has not only shown that BPD can be treated but also provided several manualized and empirically validated psychotherapeutic treatments. This paper set out to examine the most effective current psychotherapies for the treatment …

Thank You To Our 2023/2024 Reviewers, Paul Freeman, William Miller

Optometric Clinical Practice

Reviewers

Applying Multimodal Imaging In The Evaluation Of A Rare Complication Of Retinal Cavernous Hemangioma, Mariana Ferraz Od, Julie Rodman Od, Msc, Jose Diaz Md

Optometric Clinical Practice

Abstract

Background: Retinal cavernous hemangiomas are rare, benign vascular tumors usually encountered incidentally on routine examination. Although usually asymptomatic, complications have been reported and can result in vision loss. Ancillary imaging modalities such as fundus photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography provide valuable information about the lesion and possible associated findings. Case Report: A 66-year-old Caucasian female presented to the clinic for a comprehensive exam with mild blurry vision in both eyes with current spectacles. Her ocular history was remarkable for a retinal cavernous hemangioma along the superior-temporal arcade of the left eye. Dilated fundus …

Herpes Zoster Ophthalmicus Associated With Ipsilateral Bell's Palsy, Patricia Salazar Od

Optometric Clinical Practice

Abstract

Background: Herpes zoster is caused by reactivation of the varicella zoster virus with spread along the dorsal root ganglion and sensory nerve to a dermatome. In herpes zoster ophthalmicus (HZO), involvement of the ophthalmic (V₁) branch of the trigeminal nerve results in ocular sequelae and often presents with a characteristic pseudodendrite. Reactivation within cranial nerve VII can lead to the neurologic complication of facial nerve palsy on the affected side. Case Report: This case report describes a patient diagnosed with HZO and subsequent same-sided facial nerve palsy (Bell’s palsy) and discusses the potential link between the two …

Acute Syphilitic Posterior Placoid Chorioretinopathy: A Case Report, Kendra R. Null Od, Danielle E. Toms Od, Elizabeth M. Phillips Od, Candice A. Law Od, Ms

Optometric Clinical Practice

Abstract

Background: Acute syphilitic posterior placoid chorioretinopathy is a rare manifestation of ocular syphilis that can significantly impact the patient’s vision. However, it has been shown to have a good prognosis with the appropriate diagnosis and treatment of the underlying systemic syphilis infection. In addition to discussing the details of the case, this report also highlights the systemic staging, diagnosis, and treatment of syphilis. Case Report: This case features a 60-year-old Caucasian male diagnosed and treated for acute syphilitic posterior placoid chorioretinopathy after a recent diagnosis of syphilis. Conclusion: With the incidence rates of syphilis infections increasing, it is imperative …

Ocular Myasthenia Gravis; A Case Report, Amy Garbo Maxey Od, Kristin Wilson Od

Optometric Clinical Practice

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disease disorder that affects the skeletal muscles causing increased fatigability and weakness. When it affects the ocular muscles only, it is known as ocular myasthenia gravis (OMG). Patients with OMG will often have symptoms of diplopia and ptosis, which will be worse towards the end of the day. This case report will discuss the common symptoms of OMG as well as the appropriate treatment and management. It will also review the diagnostic tests used to aid in the diagnosis of OMG and discuss the prognosis of OMG. Case Report: A 67-year-old male …

A Most Difficult Conversation, Paul Freeman Od

Optometric Clinical Practice

Editorial

Micro Life, David Burton

HCA Healthcare Journal of Medicine

Painting is what I do to slow my brain and relax my body after a busy day at the hospital. Nothing puts me directly into a flow state like slowly moving acrylic paint across a canvas. This piece titled “Micro Life” depicts the diversity of life constantly surrounding us at the microbiological level everywhere we go. As a strong believer in nutrition and a healthy lifestyle, I know how important our microbiome is to healthy digestion and a properly functioning immune system. On the other side, I have witnessed the devastating effects dangerous microorganisms can have on our already compromised …

Minding The Details: The Importance Of Assessment Accuracy And Consistency In Managing Nursing-Sensitive Indicator Interventions, Elizabeth Card, Noah Zanville

HCA Healthcare Journal of Medicine

Evidence-based practice holds the potential to streamline health care, reduce costs, and improve patient outcomes. A good share of the data collected to create the evidence comes from electronic health records and other digital sources. Nurse-sensitive indicators, such as patient falls, pressure injuries, and hospital-acquired infections, are examples of data used to reflect the quality of nursing care. Other data may come from routine assessments nurses perform. It is crucial that nurses use valid and reliable instruments to create this data and that the use of the instruments is consistent across nurses in units, different shifts, and even different facilities. …

Measures Of Success: Making The Case For Advanced Practice-Sensitive Quality Indicators, Ruth Kleinpell, April Kapu, Cynthia Borum

HCA Healthcare Journal of Medicine

Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that …

Development Of A Facility-Level Second Victim Syndrome Peer-Mentor Program: Program Design And Future Directions, Jacqueline Trammell, Noah Zanville, Caryn Alper

HCA Healthcare Journal of Medicine

Background

Despite efforts to prevent errors, studies show that iatrogenic, or health care-related, errors continue to occur. Understandably, these errors, which can range in severity from near-misses to serious harm, can be devastating for the health care professionals involved, creating a potential second set of victims, in addition to the patient(s) that were harmed directly. Studies show that individuals struggling with second-victim syndrome (SVS) can be at increased risk for depression, burnout, and poor work performance. However, programs designed to develop peer mentors to support individuals struggling with SVS are poorly described.

Methods

Following a review of the literature, our …

Nursing And Supply Chain As Critical Partners In Enterprise-Level Efforts To Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study, Dana L. Blayney, Julia Moody, James Pittman, Noah Zanville, Missy Pennington, Sarah A. Fraker, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Background

Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Improving Maintenance Of Central Line Dressing To Reduce Risk Of Central Line-Associated Bloodstream Infections In An Acute-Care Setting, Kristi Gaskill, Kerry Wilder, Emily Sneed, Astrid J. Pujals, Kim Newman

HCA Healthcare Journal of Medicine

Background

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.

The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. …

Enhancing Patient Safety: The Role Of Interdisciplinary Teams In Reducing Blood Culture Contamination, Austin Patrick Eisenberg, Fady M. Awad, Brian Watson, Mohammed Faris

HCA Healthcare Journal of Medicine

Background

Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods

To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting …

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

A Randomized Controlled Trial Of 2% Chlorhexidine Gluconate Skin Preparation Cloths For The Prevention Of Surgical Site Infections In Adults Undergoing Spine Surgeries: Residual Reduction In Skin Bacterial Load For 4 Days, Elizabeth Card, Yaping Shi, Wuraola Adesinasi, Matt Shotwell, Nancy Wells, Elizabeth Hall, Joseph Cheng, Edward Sherwood

HCA Healthcare Journal of Medicine

Background

Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population.

Methods

Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Nursing Informatics: The Vital Nursing Link Between Technology And Patient Care, Sherri L. Hess, Caryn Alper

HCA Healthcare Journal of Medicine

Advances in technology offer additional health care tools to improve the health of patients and efficiencies for our clinicians in innovative ways. These technologies cover a huge variety of therapeutics, ranging from wearable devices, such as insulin pumps, to robotic-assisted surgeries. Nursing informatics is firmly embedded in the use of technology to improve nursing care and science. One of the most recent developments in nursing is the exploration of virtual nursing. This paper will present the past, current, and future projections for this unique blend of nursing art and science with cutting-edge technology.

Revitalizing Emergency Rooms Nationally: Strategies And Insights, Jeffin Dejanovich, Noah Zanville

HCA Healthcare Journal of Medicine

Throughout the United States, the post-COVID-19 pandemic period has been marked by profound disruption to health care operations, coordination, and care capacity. These disruptions have been especially serious in the emergency room (ER) setting. While intensely challenging, the post-pandemic period has also presented opportunities for health care systems to approach classic challenges facing the ER with fresh eyes. In this editorial, the authors discuss key strategies being used to help revitalize ERs nationally and reflect on future challenges and directions.

Infection Prevention: The Small But Mighty Teams In Health Care, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

The Future Of Nurse-Led Research: The Road Ahead, Sammie Mosier

HCA Healthcare Journal of Medicine

Nursing as a profession is full of innovation. From nurse-led research and new technology to emerging models of care, nurses continue to blaze trails and take steps to improve patient care. As one of the largest employers of nurses in the United States, HCA Healthcare has an obligation to produce research and evidence-based practices to pave the way for the future of nursing practice and potentially change how care is delivered. In this editorial, HCA Healthcare’s chief nurse officer describes her vision for the future of nurse-led research and examines how education, partnerships, and technology facilitate the road ahead for …

A Historical View Of Nursing Research At Hca Healthcare, Jane D. Englebright

HCA Healthcare Journal of Medicine

HCA Healthcare has been a pioneer in evidence-based practice (EBP) in nursing for over 20 years. Nursing leaders overcame 2 major challenges, generating useful data to inform practice and disseminating EBP across their vast network. These challenges were overcome by using data outside the electronic health record (EHR) while advancing the standardization of data within the EHR. Standardizing data had a significant impact on nurse-led research, leading to improvements in patient outcomes and changes in practice including medication dispensing, patient fall reporting, and scheduling guidelines. This retrospective shares some of these important innovations in nursing practice.

Inspiring And Supporting Nurses’ Scholarly Works Through A Special Issue Highlighting Nursing-Sensitive Indicators, Sammie Mosier, Elizabeth Card, Caryn Alper

HCA Healthcare Journal of Medicine

Nursing represents the largest discipline in health care, with just over 5 million nurses in the United States, and the discipline is under increasing pressure to make evidence-based decisions in the delivery of patient care. This special issue of the HCA Healthcare Journal of Medicine can inspire and support nurses’ scholarly work with an eye to dissemination in peer-reviewed medical journals. This issue highlights nursing’s contributions to improving patient outcomes through nurse-sensitive indicators, with the hope of elevating the quality of tomorrow’s health care.

A Clinical Case Of A Right Eyelid Multilobulated Lesion: Invasive Sebaceous Carcinoma Masquerading As Chalazion, Tyler Van Auken, Erin Reese, Martin Nguyen, Reece Fletcher, Peyton Collias, David Webb

Marshall Journal of Medicine

Sebaceous carcinoma (SC) is a rare and aggressive malignancy of the sebaceous glands, most commonly arising from the eyelid. The general presentation of SC varies, resulting in delayed identification and frequent misdiagnosis. Clinicians should include SC in a differential diagnosis when a patient presents with an eyelid lesion. Undiagnosed and untreated SC can have detrimental outcomes; therefore, early diagnosis and treatment are imperative to decrease mortality and morbidity.

This is the case of a 71-year-old male referred by his primary care physician to the ophthalmologist for an inflamed, multilobulated lesion on his right upper eyelid. The patient was initially diagnosed …