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BEHAVIORAL HEALTH PREFERENCES AMONG FOSTER AND BIOLOGICAL FAMILIES IN A PRIMARY CARE CLINIC FOR FAMILIES WITH SOCIAL COMPLEXITY
Get PDFRobotic Assisted Gastric Bypass Conversion to Single Anastomosis Duodenal Switch with Jejunal Interposition and Subtotal Gastrectomy, A Case Report
No full textMargaret Costa Reading PA1, Aaron Hechtman Wyomissing PA2, John Fam Wyomissing PA2Tower Health Reading Hospital1Tower Health2 This is a case of a 66 year old female with past medical history significant for morbid obesity, loop recorder placement for paroxysmal atrial fibrillation, anemia, hypertension, Roux-en-Y gastric bypass in 2007 who presented to the clinic with difficulty losing weight. Patient reported refractory weight gain despite appropriate lifestyle modifications several years postoperatively after previously having successful weight loss. She subsequently underwent gastric band placement in 2014 for weight gain which was later removed for difficulty tolerating food. She presented to the clinic to discuss surgical weight loss options, preoperative BMI at that time was 57.42 kg/m2. She underwent preoperative esophagogastroduodenoscopy which was notable for stomach, and she was cleared by cardiology for surgery given her history of paroxysmal atrial fibrillation and loop recorder placement. She underwent robotic assisted gastric bypass conversion to single anastomosis duodenal switch with jejunal interposition and subtotal gastrectomy, she tolerated procedure well without immediate complications. She was discharged home on postoperative day three. She progressed well postoperatively. One year after her gastric bypass conversion, most recent BMI was 41.7 kg/m2 and she recently underwent panniculectomy for symptomatic pannus
Navigating a Complex Case of
No full textINTRODUCTION: Blue rubber bleb nevus syndrome is a rare disorder of venous malformations, with around 200 cases reported. We present a case of
CASE DESCRIPTION: A 40-year-old female with blue rubber bleb nevus syndrome, asthma, and bronchiectasis came to the pulmonology clinic with shortness of breath and a cough. She was recently admitted for a bronchiectasis exacerbation but continued to have a worsening productive cough and fevers. The most recent CT scan of the chest showed interval stable right upper lobe fibrocavitary disease, demonstrating gradual progression over two years. She had occasional positive cultures for
CONCLUSION: Due to the high mortality of
LEARNING POINTS: The decision to initiate treatment for non-tuberculous mycobacterium infections is often challenging with prolonged treatment.Lifetime monitoring is required in patients with blue rubber bleb nevus syndrome, which can have pulmonary complications
Agranulocytosis Associated With Psychiatric Polypharmacy: Lessons Learned From a Clinical Case.
No full textPsychiatric polypharmacy involves the use of two or more psychotropic medications to manage a mental and emotional condition. The prevalence of psychotropic polypharmacy has been increasing since the 1990s and has been attributed to the rise in multiple psychiatric conditions presenting in one patient. However, as the prevalence of polypharmacy increases to maximize therapeutic advantages, so does the adverse effect profile of those drugs used in combination, leading to very life-threatening effects such as agranulocytosis. Thus, we report a case of agranulocytosis secondary to polypharmacy in a patient with a history of multiple complex psychiatric conditions. The patient is a 20-year-old female with a past medical history of major depressive disorder, borderline personality disorder, post-traumatic stress disorder, anxiety disorder, hypothyroidism, and ulcerative colitis. Her psychiatric conditions were managed with multiple medications including chlorpromazine, and clozapine was recently added a month prior to admission. Upon admission, the patient was hemodynamically stable and febrile, with complaints of generalized body aches and myalgia. Laboratory results showed profound leukopenia with a white blood cell count of 1.0x1
Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios.
No full textBACKGROUND AND OBJECTIVES: Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel Mentor-Trio implementation approach with multidisciplinary parent-nurse-physician teams coaching sites.
METHODS: Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents.
RESULTS: We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%-60.8% absolute increase by item), all P \u3c .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P \u3c .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P \u3c .05). Twelve of 12 measures of staff safety climate improved (eg, excellent / very good safety grade improved from 80.4% to 86.3% to 88.0%), all P \u3c .05. Patient/family experience and teaching were unchanged.
CONCLUSIONS: Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected
Once I take that one bite : the consideration of harm reduction as a strategy to support dietary change for patients with diabetes.
No full textBACKGROUND: Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals.
METHODS: This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a food node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach.
RESULTS: Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as an addict and describing food as their drug. Participants perceived their unhealthy food choices either as a sign of weakness or as cheating. They also identified food\u27s ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet.
CONCLUSION: Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes.
TRIAL REGISTRATION: Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016
The characteristics of CALR Mutations in Myeloproliferative Neoplasms: A Clinical Experience from a Tertiary Care Center in Qatar and a Literature Review
No full textBACKGROUND: Myeloproliferative neoplasms (MPNs) are hematological disorders characterized by abnormal production of myeloid cells due to genetic mutations. Since 2013, researchers have identified somatic mutations in the Calreticulin (CALR) gene, primarily insertions or deletions, in two Philadelphia chromosome-negative MPNs; essential thrombocytosis (ET) and primary myelofibrosis (PMF), and occasionally in chronic myelomonocytic leukemia (CMML). This study aims to identify the various types of CALR mutations and their impact on CALR-positive MPN patients\u27 clinical manifestations and outcomes.
METHODS: A single-center retrospective study was conducted. The data was collected from pre-existing records. The study was carried out on Philadelphia-negative MPN patients who were being followed up on at the NCCCR (National Center for Cancer Care and Research) to assess the clinical manifestation and outcome of disease treatment. All patients included, were followed in our center between January 1, 2008, and November 20, 2021.
RESULTS: A total of 50 patients with
CONCLUSION: The data shows a significant rise in CALR-positive MPN diagnoses in younger people, emphasizing the need for a better assessment tool to improve disease management and reduce complications