RESUMEN
BACKGROUND: Thorn injuries are common in the desert Southwest; however, the frequency and microbiology of thorn-associated infections have not been systematically described. Most information comes from case reports describing infections from atypical or environmental microorganisms. Our aim was to summarize the spectrum of thorn-associated infections. METHODS: We conducted a retrospective review of electronic health records for patients presenting to our institution from January 1, 2005 to December 31, 2014 for treatment of thorn-associated injuries and then focused on the patients with cultures. RESULTS: Of 2758 records reviewed, 1327 patients had thorn-associated injuries; however, only 58 (4.4%) had cultures. Of these patients, 37 (64%) had positive findings; 5 had polymicrobial infection. The most commonly identified organisms were Staphylococcus aureus (n = 22, 59.0%) and coagulase-negative Staphylococcus species (n = 8, 21.6%). Other pathogens included Nocardia species (n = 3, 8.1%), Streptococcus species (n = 2, 5.4%), Gram-negative bacteria (n = 2, 5.4%), Aspergillus species (n = 2, 5.4%), Paecilomyces lilacinus (n = 1, 2.7%), and Candida species (n = 1, 2.7%). There were no infections caused by Pantoea agglomerans, Sporothrix schenckii, or Coccidioides spp. CONCLUSIONS: In contrast to most published case reports, we found that typical cutaneous microorganisms, such as Staphylococcus species, caused the majority of culture-positive, thorn-related infections.
RESUMEN
Continuous versus bolus dosing of furosemide has been a longstanding debate for clinicians treating patients with acute decompensated heart failure. This article discusses the efficacy and safety of both options, and reviews several meta-analyses examining this topic.
Asunto(s)
Diuréticos/administración & dosificación , Furosemida/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Enfermedad Aguda , Insuficiencia Cardíaca/fisiopatología , HumanosRESUMEN
Severe adverse events associated with varicella-zoster virus (VZV) vaccination are rare. The authors describe a 53-year-old woman with no known immunodeficiency who presented with diffuse pruritic rash 17 days after receiving the varicella virus vaccine live. She had a low level of white blood cells and received a diagnosis of thrombocytopenia with elevated aminotransferase levels. Punch biopsy demonstrated positive VZV immunostaining and viral culture positive for VZV. After treatment with acyclovir, her rash improved and her white blood cell and platelet counts returned to normal. Mild reactions to vaccines including localized rash are well recognized. Disseminated infections have been reported in patients with congenital and acquired immunodeficiency, but systemic postvaccination infections are rare in immunocompetent adults. This case highlights the importance of recognizing adverse events associated with vaccination.
Asunto(s)
Vacuna contra la Varicela/efectos adversos , Exantema/etiología , Herpes Zóster/etiología , Herpesvirus Humano 3/aislamiento & purificación , Femenino , Herpes Zóster/prevención & control , Humanos , Persona de Mediana Edad , Vacunas Atenuadas/efectos adversosRESUMEN
BACKGROUND: Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published. PURPOSE: A systematic review of the literature on burnout in inpatient-based and outpatient-based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians. DATA SOURCES: Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects. STUDY SELECTION: Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians. DATA EXTRACTION: Fifty-four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty-eight studies used the same burnout measure and therefore were amenable to statistical analysis. DATA SYNTHESIS: Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies. CONCLUSIONS: The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed.
Asunto(s)
Atención Ambulatoria/psicología , Agotamiento Profesional/psicología , Médicos Hospitalarios/psicología , Médicos/psicología , Agotamiento Profesional/epidemiología , Comparación Transcultural , Bases de Datos Bibliográficas , Médicos Hospitalarios/estadística & datos numéricos , Humanos , Médicos/clasificación , Médicos/estadística & datos numéricosAsunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Enfermedades Cardiovasculares/prevención & control , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Operativos , Ensayos Clínicos como Asunto , Medicina Basada en la Evidencia , Humanos , Factores de RiesgoRESUMEN
Many hospitalist groups are hiring physician assistants (PAs) to augment their physician services. Finding PAs with hospitalist experience is difficult. Employers often have to recruit PAs from other specialties or hire new graduates who have limited hospital experience. Furthermore, entry-level PA training focuses on primary care, with more clinical rotations centered in the outpatient setting. In light of these challenges, our institution created a 12-month postgraduate training program in Hospital Medicine for 1 PA per year. It is the first reported postgraduate PA hospitalist fellowship to offer a certificate of completion. The program's curriculum is based on the Society of Hospital Medicine (SHM) "Core Competencies," and is comprised of 12 one-month rotations in different aspects of hospital medicine supplemented by formal didactic instruction. In addition, the PA fellow completes "teaching modules" on various topics not directly covered in their rotations. Furthermore, this postgraduate physician assistant training program represents a model that can be utilized at almost any institution, academic or community-based. As the need for hospitalists increases, so will the need for trained physician assistants in hospital medicine.
Asunto(s)
Educación de Postgrado en Medicina , Médicos Hospitalarios/educación , Asistentes Médicos/educación , Arizona , Competencia Clínica , Curriculum , Becas , Humanos , Desarrollo de ProgramaRESUMEN
We describe a 79-year-old male with recurrent high-grade liposarcoma who developed postoperative chest pain, dyspnea, and hypoxia suspicious for acute pulmonary embolism (PE). However, electrocardiogram (ECG) was suggestive of an acute ST-elevation myocardial infarction (MI). Heparin was initiated and emergent coronary angiography was performed, which demonstrated a "cutoff sign" in the distal left anterior descending artery (LAD) consistent with coronary embolism. A patent foramen ovale (PFO) and bilateral pulmonary emboli were subsequently identified. It was concluded that the patient had suffered an acute PE, with a portion of clot traversing the PFO and entering the LAD, resulting in a simultaneous acute ST-elevation MI. While the case described is rare, the underlying anatomical variant is common and may have practical significance. We discuss the literature regarding PFO with acute PE and paradoxical emboli.
Asunto(s)
Foramen Oval Permeable/complicaciones , Infarto del Miocardio/etiología , Embolia Pulmonar/etiología , Enfermedad Aguda , Anciano , Comorbilidad , Humanos , Masculino , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/cirugíaAsunto(s)
Trastornos Inducidos por Alcohol/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Hospitalización , Psicosis Inducidas por Sustancias/prevención & control , Síndrome de Abstinencia a Sustancias/prevención & control , Trastornos Inducidos por Alcohol/diagnóstico , Trastornos Inducidos por Alcohol/fisiopatología , Ansiolíticos/uso terapéutico , Benzodiazepinas/administración & dosificación , Diazepam/uso terapéutico , Humanos , Lorazepam/uso terapéutico , Psicosis Inducidas por Sustancias/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Síndrome de Abstinencia a Sustancias/tratamiento farmacológicoAsunto(s)
Dolor en el Pecho/etiología , Cuerpos Extraños/complicaciones , Cuerpos Extraños/terapia , Remoción de Dispositivos , Técnicas de Diagnóstico del Sistema Digestivo/instrumentación , Diseño de Equipo , Esofagoscopía , Femenino , Humanos , Concentración de Iones de Hidrógeno , Persona de Mediana Edad , Índice de Severidad de la EnfermedadAsunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Cuidados Preoperatorios , Enfermedad Pulmonar Obstructiva Crónica , Fenómenos Fisiológicos Respiratorios/efectos de los fármacos , Antagonistas Adrenérgicos beta/farmacología , Anciano , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/cirugíaRESUMEN
Psychosocial factors, such as stress, abuse history, psychiatric disturbance, coping style, and learned illness behaviors, play an important role in functional GI disorders in terms of symptom experience and clinical outcome. These psychosocial factors are influenced by and influence GI symptoms in a bidirectional manner as mediated through the brain-gut axis (CNS and ENS pathways). Entering the patient encounter using a biopsychosocial approach and a care (versus cure) style can help avoid excessive diagnostic testing, and elicit crucial information about potential abuse history or psychiatric symptoms that can help guide therapy. Finally, for patients with severe, refractory symptoms, multicomponent treatment involving psychologic therapy, such as CBT, relaxation, or hypnotherapy, can be beneficial.
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Enfermedades Gastrointestinales/psicología , Actitud Frente a la Salud , Violencia Doméstica/psicología , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/fisiopatología , Enfermedades Gastrointestinales/terapia , Humanos , Trastornos Mentales/complicaciones , Personalidad , Relaciones Médico-Paciente , Calidad de Vida , Estrés PsicológicoRESUMEN
Graves disease is an autoimmune thyroid condition characterized by the production of autoantibodies against the thyrotropin receptor. The autoantibodies mimic the effect of the hormone on thyroid cells, which stimulates autonomous production of thyroxine and triiodothyronine. It has been hypothesized that cross-reactivity of autoantibodies may result in Graves ophthalmopathy and dermopathy. A seldom-recognized feature of Graves disease is thymic hyperplasia. We report 2 patients with Graves disease and incidentally discovered anterior mediastinal masses presumed to be thymic hyperplasia. In both cases, these masses regressed spontaneously after treatment of hyperthyroidism.