Medicine and Health Sciences Commons^™

The Challenges Of Diagnosis And Management Of Suspectedautoimmune Hepatitis In A 34-Year-Old Woman With Periodicparalysis And Graves’ Disease, Yeni Larasati, C. Singgih Wahono

Jurnal Penyakit Dalam Indonesia

Periodic paralysis hypokalemia is a muscle weakness that can be caused by hyperthyroidism due to Graves’ disease. The prevalence reaches 10% of patients with periodic paralysis hypokalemia with symptoms of thyrotoxicosis. Graves’ disease is an immune system disorder that can cause other organ dysfunction, such as autoimmune hepatitis. Currently, the diagnosis of autoimmune hepatitis is still a challenge for clinicians due to limited supporting examination facilities, such as SMA, AMA, anti-LKM-1. This article discusses a case of a 34-year-old woman with limb weakness for 3 months, losing 4 kg of weight in 1 month, often feeling hungry, restless, having trouble …

Management Of Chronic Kidney Disease-Mineral And Bone Disorder (Ckd-Mbd), Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Chronic kidney disease (CKD) is still a burden on worldwide health issues affecting about 11-13% of the general population. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in CKD, which occurs early in the disease, and progresses as kidney function deteriorates. With declining kidney function, mineral homeostasis becomes progressively dysregulated, including alterations in several parameters such as calcium, phosphate, intact parathyroid hormone (iPTH). Changes in these parameters are associated with bone disorders and vascular abnormalities, which are strongly correlated with increased cardiovascular (CV) morbidity and mortality, and overall mortality. Currently, CKD-MBD and its complication management have been …

Factors Associated With Length Of Stay Of Covid-19 Patients At Serui Regional General Hospital Papua Province: Cross-Sectional Study, Fahri Ahmad Baihaqi, Henny Rumaropen

Jurnal Penyakit Dalam Indonesia

Introduction. Coronavirus Disease 2019 (COVID-19) is a respiratory infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 has become a global health problem. The length of stay of the patient is related to the use of hospital resources. COVID-19 patients are at risk of increasing length of stay due to various factors and the increased length of stay can increase the burden of health services. The purpose of this study was to determine the factors that influence the length of stay of COVID-19 patients.Methods. An observational analytic study with a cross-sectional design was conducted at Serui Regional General …

Depresi Pada Populasi Lanjut Usia Yang Menjalani Hemodialisis, Edward Faisal

Jurnal Penyakit Dalam Indonesia

Menurut laporan tahunan European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), pasien yang menjalani transplantasi ginjal dari tahun 2014 sampai 2018 memiliki kesempatan hidup hanya setengah dari usia dengan sisa fungsi ginjal yang ditransplantasikan, sedangkan untuk pasien yang dilakukan hemodialisis (HD) adalah 70% lebih pendek.

The Effect Of Heparinoid As Systemic Prophylactic Anticoagulants On Covid-19 Patient Mortality And Its Safety Profiles: A Systematic Review And Meta-Analysis, Ariska Deffy Anggarany, Rani Sauriasari, Muhammad Alkaff, Famila Takhwifa, Hayatun Nufus, Diana Paramita

Pharmaceutical Sciences and Research

Coagulopathy is one of the complications of COVID-19 and is associated with a higher risk of mortality. However, evidence regarding the effectiveness and safety of anticoagulant therapy in various doses among COVID-19 patients is limited. This systematic review and meta-analysis aims to review and explore the effect of using heparinoids as a systemic anticoagulant at prophylactic doses on mortality in COVID-19 patients. Systematic searches were conducted of various databases (Pubmed, ScienceDirect, SpringerLink, Scopus, and ProQuest) covering the period 2019-2021. We assessed the quality of the articles using the STROBE checklist. Studies with a high risk of bias were excluded before …

The Difference In Nutrition Intake Adequacy Amonginstitutionalized Elderly Residents With And Without Sarcopeniaat Nursing Homes In Bandung, West Java, Delia Anastasia Tirtadjaja, Muhamad Apandi, Lazuardhi Dwipa

Jurnal Penyakit Dalam Indonesia

Introduction. The changes in the elderly’s daily routine including dietary intake and nutritional pattern may cause them to be more susceptible to malnutrition. The changes also increase the risk of sarcopenia that may lead to poor health outcomes such as fall injury, fracture, hospitalization, disability, or even death. Sarcopenia is more likely to occur in a nursing home compared to community settings. This study aimed to determine the difference in nutrition intake adequacy between institutionalized elderly subjects with and without sarcopenia in Bandung, West Java. Methods. A cross-sectional study was held in Ciparay and Budi Istri Nursing Home, Bandung, West …

Comparison Of Lipid Profiles In Patients With Type 2 Diabetes Mellitus With Good Glycemic Control And Poor Glycemic Control In Rsud Dr. Saiful Anwar Malang, Nyoman Satvika Dharma Yudha, Putu Moda Arsana, Rulli Rosandi

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia due to insulin resistance, deficiency of insulin action, or both with a prevalence of 8.5% in Indonesia. Evidence regarding the relationship between HbA1c and lipid profile in type 2 DM is currently contradictory, therefore a study was conducted to examine the relationship between glycemic control and lipid profile for DM patients.Methods. This survey research was conducted at the outpatient endocrine clinic Dr. Saiful Anwar Malang Hospital in 2014-2019 with a total of 1,308 patients. Patients were then classified into type 2 DM patients with good (HbA1c < 7%, n = 291) and poor glycemic control (HbA1c > 7%, …

Depressive Symptoms As A Predictor Factor Of All-Cause Mortality Within Six Months In Elderly Hemodialysis Patients, Langgeng Perdhana, Shofa Chasan, Yudo Murti Mupangati, Siti Nuraini

Jurnal Penyakit Dalam Indonesia

Introduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency …

The Relationship Of Subjective Global Assessment (Sga) With Energy Intake, Protein, Hand Grip Strength And Body Mass Index In Chronic Kidney Disease (Ckd) Patients With Continuous Ambulatory Peritoneal Dialysis (Capd), Yudhi Adrianto, Ni Made Hustrini, Triyani Kresnawan, Annisa Eka Amelia, Fitri Hudayani

Jurnal Penyakit Dalam Indonesia

Introduction. Energy and protein intake in chronic kidney disease (CKD) with continuous ambulatory peritoneal dialysis (CAPD) therapy plays an important role in balancing hypercatabolic conditions. Unbalanced intake will result in energy and protein deficits which are increasing the risk of muscle catabolism, decreasing body mass index (BMI), and malnutrition. Subjective global assessment (SGA) as the gold standard in nutritional assessment is needed in assessing nutritional status and determining malnutrition, therefore nutritional intervention can be delivered and improve CAPD patients’ quality of life. This study was conducted to determine the relationship between SGA with energy and protein intake, hand grip strength, …

Correlation Between Polypharmacy And Length Of Stay Geriatric Patient In Mohammad Hoesin Palembang Hospital, Iswadi Tanzil, Nur Riviati, Irsan Saleh

Jurnal Penyakit Dalam Indonesia

Introduction. Geriatric patients have multipathological characteristics, low physiologic reserves, atypical clinical signs and symptoms, decreased functional status, and nutritional disturbances. This situation is a risk factor for polypharmacy. Polypharmacy is closely related to drug side effects, drug interactions, and patient compliance. Polypharmacy is thought to have a relationship with the length of stay in geriatric patients. The purpose of this study was to determine the correlation between polypharmacy and length of stay in geriatric patients at Moehammad Hoesin Hospital Palembang. Methods. This was a cross-sectional study with a correlation test design conducted at Dr. Mohammad Hoesin Hospital (RSMH) Palembang from …

An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.

Objective

To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.

Methods

This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …

Preventing Bleeding Complications Of Paracentesis Using Point-Of-Care Ultrasound: An N-Of-1 Case Study, Adam Karevoll, Willie Talbert, Christopher J. Smith

Graduate Medical Education Research Journal

Abdominal paracentesis is a common bedside procedure, and the advent of point-of-care ultrasound has provided an opportunity to reduce the associated risks. Multiple society guidelines now recommend both site and vascular marking to avoid potential complications. This case illustrates the importance of vascular marking specifically to avoid damage to adjacent blood vessels.

Consultation/Liaison Psychiatry During Covid-19, Robert Frierson, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

Consultation/liaison psychiatrists care for people with co-existing medical and psychologic difficulties. The coronavirus pandemic is stressful for patients and their psychiatric caregivers. Patients have lost support systems and harbor fears about exposing family to the virus. COVID-19 sometimes exacerbates previous psychiatric conditions, while diminishing intimacy with physicians. Everyone is oversaturated with COVID-19-related news focusing on rising concerns about the illness and about jobs, school, and housing insecurities.

The psychiatrist maintains a hospital presence despite fear of contracting the disease. Challenges include addressing staff morale, evidencing empathy despite telecommunication devices, and treating anxiety, depression, sleep phobias, post intubation flashbacks, COVID-19-induced cognitive …

Feasibility Of A “Network Of Champions” In Implementing A Program To Address Physician Well-Being, Kerri Palamara, Sara Poplau, Cheryl Rusten, Maria L. Walter, Cynthia D. Smith, Clare Sipler, Susan Hingle, Mark Linzer

Journal of Wellness

Introduction: Healthcare leaders have been challenged to mitigate burnout and foster well-being among physicians. Professional societies are beginning to address this in a systematic manner.

Methods: In 2014, the American College of Physicians (ACP) endeavored to improve well-being for its 160,000 members of internists and trainees through a Well-being Champion (WBC) program based in the majority of its 85 national and international chapters. The program was supported by an evidence-based curriculum, chapter volunteers who served as champions, and in-person and virtual trainings. Training included a 1-2 day program in 2018 and 2019, focused on educating champions on causes …

Improving Value (Low Cost, Optimal Clinical Outcome, Patient Satisfaction) In A Skilled Nursing Facility: A Quality Improvement (Qi) Project, Nirajan Adhikari, Joseph Mwesige, Lester Kirchner

Advances in Clinical Medical Research and Healthcare Delivery

Improving the value of care with reduced cost without compromising the quality is utmost important in the modern era of medical practice. An attempt was made in the nursing facility to observe an outcome with a plan to implement in much larger scale in the larger facility in future. In the 7-month period of this ambi- directional study, the focus was on minimizing unnecessary daily laboratory orders and to observe the reduction in the cost without adverse effect on length of stay in the nursing facility and hospitalization from the nursing facility.

The Role Of Coronary Artery Disease In Demand Mediated Myocardial Infarction: A Retrospective Study From A Community Hospital, Amr Salama, Nikhil Mehta, Abdullah Abdullah, Ruth Kouides, Jeremiah Depta, Ryan Hoefen, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in …

An Integrated Multispecialty Curriculum For Point-Of-Care Ultrasound, Carina M. Brown, Karl Fields, Duncan Vincent, Alison Rumball, Joshua Zavitz, Shane Hudnall, Caroline Iskander, Alexander Raines

Advances in Clinical Medical Research and Healthcare Delivery

Point-of-care ultrasound is increasingly recognized as a valuable tool for physicians practicing in a variety of specialties. Currently there is no standard curricula or assessment model for training primary care specialty residents in the use of ultrasound. This article presents a multispecialty experience in developing a list of 11 core Pediatric, 13 core Family Medicine and 22 core Internal Medicine ultrasound scans based on best available evidence for their clinical use.

Using Design-Thinking To Investigate And Improve Patient Experience, Jennifer Smiechowski, Megan Mercia, Kyle Kemp, Elizabeth Oddone Paolucci, Maria Santana, Rahim Kachra

Patient Experience Journal

Understanding and enhancing the patient experience can lead to improved healthcare outcomes. The purpose of this study was to capture a comprehensive and nuanced understanding of the patient experience on an inpatient medical teaching unit in order to identify key deficiencies and unmet needs. We then aim to implement a design-thinking methodology to find innovative ways to solve these deficiencies. Here we present the first two phases of this four-phased study. We retrospectively and prospectively collected quantitative data about patient experience with the Canadian Patient Experiences Survey-Inpatient Care. We then used this data to guide patient interviews. We identified several …

A Rare Presentation Of An Acute Type A Aortic Dissection Obscured Due To The Simultaneous Presence Of Acute Pancreatitis, Amrin M. Kharawala, Nirav Brahmbhatt, Huzefa Bhopalwala, Nakeya Dewaswala, Adnan Bhopalwala, Waqas Ghumman, Robert Dean Chait

HCA Healthcare Journal of Medicine

Introduction

Acute pancreatitis (AP) and acute aortic dissection (AAD) are medical emergencies that must be promptly recognized to avoid the development of life-threatening complications. Both of these diseases can present with chest or epigastric pain which can radiate to the back, thus, early suspicion based on clinical presentation and risk factors is essential. We present the case of a 56-year-old patient initially diagnosed with AP who was later found to have an AAD.

Clinical Findings

A 56-year-old man with a history of alcohol abuse presented with 1 day of diffuse abdominal pain, nausea and vomiting. His lipase was 3,909 U/L …

A Research Framework For Evaluating Next Generation Sequencing In Community-Acquired Pneumonia, Ashley M. Wilde, Elena Swingler, Sarah E. Moore Pharmd, Brian C. Bohn Pharmd, Matthew Song Pharmd, Bcidp, Ruth Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

The Compounding Effect Of Rurality On Health Disparities Among Black Patients With Covid-19, Jessica E. Johnson, Ruchi Bhandari, Allison Lastinger, Rebecca Reece

Journal of Appalachian Health

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines.

Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians.

Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state’s largest health system (West Virginia University Health System) between March …

Improving Cancer Screening Rates In Primary Care Via Practice Facilitation And Academic Detailing: A Multi-Pbrn Quality Improvement Project, Christopher P. Morley, Laura A. Schad, Laurene M. Tumiel-Berhalter, Laura A. Brady, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger

Journal of Patient-Centered Research and Reviews

Purpose: In the United States, cancer screening rates are often below national targets. This project implemented practice facilitation and academic detailing aimed at increasing breast, cervical, and colorectal cancer screening rates in safety-net primary care practices.

Methods: Three practice-based research networks across western and central New York State partnered to provide quality improvement strategies on breast, cervical, and colorectal cancer screening. Pre/postintervention screening rates for all participating practices were collected annually, as were means across all practices over 7 years. Simple ordinary least squares linear regression was used to calculate the trend for each cancer type and test for statistical …

Increasing Breast, Cervical, And Colorectal Cancer Screenings: A Qualitative Assessment Of Barriers And Promoters In Safety-Net Practices, Laura A. Brady, Laurene M. Tumiel-Berhalter, Laura A. Schad, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger, Christopher P. Morley

Journal of Patient-Centered Research and Reviews

Purpose: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters.

Methods: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each …

Patient And Clinician Characteristics That Predict Breast Cancer Screening Behavior In 40–49-Year-Old Women, Sarina Schrager, Claudia Evaristo, Terry Little, Lori Dubenske, Elizabeth S. Burnside

Journal of Patient-Centered Research and Reviews

Guidelines recommend that clinicians practice shared decision-making (SDM) with women in their 40s to discuss breast cancer screening. Traditionally, SDM includes discussion of values and preferences to help determine a decision that is congruent with what the patient desires. We analyzed 54 women’s breast cancer screening decisions after a SDM conversation with their clinician. We looked at both patient and clinician characteristics that predicted whether or not a woman would get a screening mammogram. Women with a family history of breast cancer or who had a previous abnormal mammogram had higher rates of screening. Screening rates also varied widely between …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Neuroimaging Referral For Reassurance In Evaluation Of Headache With Low-Risk Features, Omar E. Fernandez

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry. 2005;76(11):1558-1564. https://doi.org/10.1136/jnnp.2004.057851

for a patient with daily headache.

Peritoneal Dialysis Vs. Hemodialysis: The Choice Of Modality Of Dialysis May Drastically Affect The Quality Of Life Of Patients Initiating Dialysis, Deepa Daryani

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Jung HY, Jeon Y, Park Y, et al. Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation. Sci Rep. Jul 16 2019;9(1):10266. https://doi.org/10.1038/s41598-019-46744-1

for a young patient initiating dialysis.

Using A Single Tablet Regimen Of Darunavir, Cobicistat, Emcitrabine, And Tenofovir Alafenamide In Virally Suppressed Hiv-1 Patients Is An Adequate Treatment Option For Controlling Hiv, Priya Kathuria

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Orkin C, Molina JM, Negredo E, et al. Efficacy and safety of switching from boosted protease inhibitors plus emtricitabine and tenofovir disoproxil fumarate regimens to single-tablet darunavir, cobicistat, emtricitabine, and tenofovir alafenamide at 48 weeks in adults with virologically suppressed HIV-1 (EMERALD): a phase 3, randomised, non-inferiority trial. Lancet HIV. 2018;5(1):e23-e34. https://doi.org/10.1016/S2352-3018(17)30179-0

for a patient with viriologically suppressed HIV-1.

Remdesivir Has Questionable Efficacy In Patients With Severe Covid-19 Receiving High-Flow Oxygen, Gabriel Burdick

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Final Report. N Engl J Med. 2020;383:1813-1826. https://doi.org/10.1056/NEJMoa2007764

for a patient with severe COVID-19.

University Of Louisville International Travel Clinic: Pivoting During The Covid-19 Pandemic, Dawn Balcom, Subathra Marimuthu, Leslie A Wolf, Luanne Didelot, Sarah Tan, Daniel Hall, Ruth Carrico

The University of Louisville Journal of Respiratory Infections

No abstract provided.