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Receipt of Services for Transition From Pediatric to Adult Health Care Among Youth With Chronic Medical Conditions: A Cross-Sectional Analysis of the 2022 National Survey of Children’s Health
Get PDFNew Onset Dyspnea in a Patient with Pacemaker, What Does the ECG Tracing Show?
Get PDFDual chamber pacemakers are programmed to allow for AV synchrony. Whenever a patient with a dual chamber pacemaker with underlying sinus rhythm presents with AV dissociation, the lack of AV synchrony should be questioned. The authors present a case of new onset dyspnea diagnosed as pacemaker syndrome. The diagnosis was initially delayed due to underlying ventricular paced rhythm as misidentified as normal pacemaker behavior.
A 69-year-old female with a past medical history of 2:1 atrioventricular block status post dual-chamber pacemaker implant presented with complaints of new onset shortness of breath and dyspnea. The ECG showed a ventricular rate of 66 beats per minute. Pacing spikes were prior to each QRS complex indicating ventricular-paced rhythm with left bundle branch morphology. There were p waves from sinus origin which were completely dissociated from the ventricular paced rhythm. Overall, there was ventricular paced rhythm with underlying AV dissociation. This was initially suspected to be normal pacemaker behavior as there was appropriate ventricular pacing and ventricular capture. Review of the tracing noted AV dissociation, which would be unusual in a patient with underlying sinus rhythm and dual chamber device. Device interrogation noted that device was at end of life and atrial lead was powered down to allow for ventricular pacing. It is important to always question the lack of AV synchrony if patients have dual chamber pacemaker as lack of AV synchrony can cause pacemaker syndrome
Asplenia-Associated Babesiosis: A Quagmire Traversed by Exchange Transfusion.
No full textBabesiosis is a potentially life-threatening tick-borne parasitic infection. Severe disease in splenectomized individuals may require exchange transfusion. A 58-year-old male with a history of splenectomy presented with 2 weeks of subjective fever, weakness, and abdominal pain. He denied any rashes, tick bites, or recent travel. He had a motor vehicle accident a few years ago and had undergone an emergency splenectomy. On examination, the patient was febrile (39.3 °C), tachycardic (106/min), and jaundiced. Labs revealed anemia and thrombocytopenia. Computed tomography (CT) abdomen revealed asplenia. As it was summer, there was concern for a tick-borne illness. A peripheral smear showed schistocytes, and labs revealed hyperbilirubinemia, high lactate dehydrogenase (LDH), low haptoglobin, and reticulocytosis (13%), consistent with hemolysis. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Establishing a Health Equity Office: The Importance of Recentering Equity.
No full textOBJECTIVES: The Pediatric Health Equity Collaborative (PHEC) set out to describe the best practices for establishing a health equity-focused office within a clinical setting.
STUDY DESIGN: Survey and in-depth interviews of the members of the PHEC comprised pediatric care delivery systems in the United States and Canada.
METHODS: Human-centered design methods were utilized in an iterative fashion to develop and agree on survey and interview domains. The final seven domains were as follows: (1) history of the office, (2) general description of the office, (3) position of the office in the organization, (4) budget and finance, (5) stakeholders, (6) community engagement, and (7) measuring outcomes. Interviews were analyzed using an applied thematic approach to inductively identify themes until saturation was achieved.
RESULTS: PHEC participants articulated several key implementation factors in the development of a health equity office. First, the history of the office is important and has the potential to determine the office\u27s scope of work and sphere of influence. Second, a health equity office can provide crosscutting organizational direction, stability, and execution of equity efforts, reducing the effects of siloing. Third, high-level leadership buy-in provides time and financial resources. Finally, a health equity office should be centrally involved in the collection, analysis, and reporting of equity-focused metrics.
CONCLUSIONS: A health equity-focused office can play an integral and sustaining role in representing and focusing equity efforts across an organization, measuring processes and outcomes, and helping to develop the equity mission and vision
Risk Factors for Readmission of Patients with Amputation to Acute Care from Inpatient Rehabilitation: A Retrospective Cohort Study.
No full textINTRODUCTION: Amputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population.
OBJECTIVE: This study aimed to identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility.
DESIGN: Retrospective cohort study.
SETTING: An acute rehabilitation hospital associated with a community-based tertiary medical center.
PATIENTS: A retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022.
MAIN OUTCOME MEASURE: The study outcome measure was readmission to acute care from an acute rehabilitation unit.
RESULTS: Of the 156 independent admissions, the readmission rate was 19%(29/156). The most common cause of transfer was incision-site complications (9/29, 31%) including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be on dialysis(p \u3c 0.001), have a longer length of stay in acute care before admission to the rehabilitation facility(p = 0.039), and lower Section GG score on admission(p \u3c 0.001). Age, sex, ethnicity, amputation level and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ration[OR] 4.82, p = 0.006).
CONCLUSIONS: This study showed that incision-site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation that carry certain risk factors to reduce rehospitalization to the acute care unit. This article is protected by copyright. All rights reserved
Postoperative Altered Mental Status: A Case Report and Diagnostic Dilemma.
No full textPostoperative altered mental status (AMS) is a prevalent and complex issue that poses a significant diagnostic challenge in the clinical setting. Clinical presentation consists of cognitive disturbances that can range from mild confusion to coma. Given the complexity and variability of AMS, each patient requires a careful and thorough evaluation to identify the underlying cause. Thus, we present a case of a 57-year-old male with confirmed left knee septic arthritis, whose admission was complicated by AMS following several incision and drainage procedures. We highlight the importance of considering a broad differential diagnosis when evaluating postoperative AMS, including electrolyte disturbances and systemic conditions. The case also discusses the importance of early recognition, interdisciplinary collaboration, and a comprehensive diagnostic strategy. By adopting a comprehensive and collaborative approach, healthcare providers can optimize patient outcomes and minimize complications in postoperative AMS cases. The patient\u27s AMS was ultimately attributed to a combination of metabolic disturbances, drug-related factors, and systemic conditions. His severe psychiatric symptoms were successfully managed with targeted pharmacologic interventions
Association of Supranormal Left Ventricular Function With Major Adverse Cardiovascular Events: A Systematic Review of Literature.
No full textThis systematic review aims to assess the prognostic implications of supranormal left ventricular ejection fraction (snLVEF) in cardiovascular disease, particularly heart failure (HF), and explore its association with major adverse cardiovascular events (MACE). A comprehensive search of electronic databases was conducted to identify relevant studies examining the relationship between snLVEF and cardiovascular outcomes. Studies utilizing various imaging modalities, including echocardiography, cardiac positron emission tomography, computed tomography, and cardiac magnetic resonance imaging, were included. Data extraction and quality assessment were performed according to predefined criteria. The review identified several studies investigating the association between snLVEF and cardiovascular outcomes. Findings revealed an increased risk of MACE, including HF hospitalization and stroke, in patients with snLVEF, particularly in women. Coronary microvascular dysfunction and autonomic dysregulation were proposed mechanisms underlying these associations. However, conflicting results were observed when focusing exclusively on snLVEF, with some studies reporting similar outcomes between snLVEF and other HF subgroups. snLVEF (\u3e65%) appears to be associated with an elevated risk of MACE, particularly in women, suggesting a U-shaped mortality curve. However, the prognostic implications may vary among HF patients, necessitating further research to elucidate the specific contributions of HF phenotypes and comorbidities. These findings underscore the importance of tailored risk assessment and management strategies for patients with snLVEF, particularly in the context of HF
Gastric Ulcer From Prolonged Oral Iron Therapy: A Case Report and Literature Review.
No full textIron deficiency is a leading cause of anemia worldwide and is commonly treated with oral iron supplements, which are known for their GI side effects. We present a case of a 66-year-old woman with a history of GI bleeding and multiple comorbidities who developed a gastric ulcer after prolonged oral iron therapy. Although GI side effects are frequent with iron supplements, ulceration is rare, with only a few documented cases. Endoscopic and histopathological evaluations identified iron deposition in the ulcer bed, confirming the diagnosis. Discontinuing the oral iron led to the resolution of symptoms. This case underscores the importance of recognizing and managing iron-induced gastric ulcers to ensure safe and effective treatment of iron deficiency
Possible Link Between Tamoxifen and Suicidality: A Case Report Analysis of a 43-Year-Old Woman With Mood Disorder and Breast Cancer.
No full textTamoxifen, a selective estrogen receptor modulator (SERM), has long been a cornerstone in the treatment of hormone receptor-positive breast cancer. While its benefits in reducing the risk of recurrence and mortality in this patient population are well-established, emerging evidence suggests a potential association between tamoxifen use and adverse psychiatric effects, including suicidality. Despite extensive research on the clinical efficacy of tamoxifen, the exploration of its psychiatric side effects, including suicidality, remains relatively understudied. We present a case of a woman with a medical history of depression and invasive lobular carcinoma of the left breast who developed a severe episode of recurrent major depressive disorder (MDD) and attempted suicide with a benzodiazepine overdose upon initiating tamoxifen for her breast cancer. This case report aims to contribute to the growing body of literature on the relationship between tamoxifen and suicidality by presenting a detailed analysis of a patient who experienced suicidality while undergoing tamoxifen therapy
The Significance of Rhabdomyolysis Secondary to Hypothyroidism.
No full textRhabdomyolysis is a rare but serious complication of hypothyroidism, typically associated with precipitating factors such as medication interactions, strenuous exercise, and illicit drug use. We present a unique case of rhabdomyolysis in an 89-year-old female due to severe hypothyroidism without identifiable precipitating factors. Laboratory results revealed markedly elevated creatine kinase (CK) levels and acute kidney injury (AKI). The diagnosis was confirmed by critically elevated thyroid-stimulating hormone (TSH) and low free thyroxine (FT4) levels. Prompt initiation of levothyroxine supplementation and fluid resuscitation led to clinical improvement and downward trend in creatinine and CK levels. This case highlights the importance of considering hypothyroidism in the differential diagnosis of rhabdomyolysis and the need for timely T4 supplementation and supportive care to prevent severe complications