Abstract:The Healthcare Matrix is a tool developed at Vanderbilt University Medical Center which assesses the care of patients using the Accreditation Council for Graduate Medical Education (ACGME) competencies and the Institute of Medicine (IOM) Aims for Improvement. House staff have been using this tool since 2004 as a means of…
Abstract:Injuries resulting from blunt cervical spine trauma are common problems seen in emergency departments and treated by trauma care specialists. Timely and appropriate imaging studies are essential to the cervical spine evaluation in the trauma patient. Despite advances in imaging techniques, cervical injuries may still be missed. Several specialty bodies…
Abstract:Adult onset Still disease is an unusual multisystem inflammatory disorder of unknown etiology and pathogenesis. Among its protean manifestations is pericarditis which occurs in approximately 30–40% of patients. Cardiac tamponade is a rare complication of pericarditis occurring in the context of Still disease. We conducted a review of the English…
Abstract:Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage laryngeal carcinoma around the world. The loss of natural voice is very often traumatic for the total laryngectomy patient, presenting lifelong challenges for communication in a world that relies heavily on verbal…
Abstract:Chilaiditi sign is a radiological finding which describes the interposition of a part of the bowel between the diaphragm and the liver, a finding that can be misinterpreted as pneumoperitonium. Chilaiditi syndrome refers to a clinically symptomatic patient in the presence of the classical radiographic findings. It is a very…
Abstract:Hepatopulmonary syndrome (HSP) is characterized by the triad of advanced liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. Most cases of HSP are associated with cirrhotic portal hypertension; however, it has also been reported in acute liver failure patients. An estimated prevalence of HPS in patients with chronic liver disease…
Abstract:Tuberculosis of the clavicular bone is a very rare clinical entity, with limited cases reported in the United States. Furthermore, sparing of the sternoclavicular joint is exceedingly unusual. A literature review of the prevalence of clavicular tuberculosis identified fewer than 80 cases reported since the discovery of the tubercular bacillus,…
The marriage of Medicaid to the managed care model was supposed to bring about benefits for enrollees that provided a medical home which coordinated and improved medical care. As of 2005, 63% of the Medicaid population were enrolled in a managed care program of some type.1 This was to be…
Abstract:A 60-year-old man was diagnosed with retroperitoneal fibrosis. Curiously, his back pain became intense immediately after the performance of a colonoscopy. The fibrotic mass was seen on computed tomography (CT) of the abdomen. The patient developed obstructive nephropathy secondary to bilateral encasing of the ureters. Early diagnosis and combined therapy…
Abstract:Simvastatin is a cholesterol-lowering medication heavily prescribed to treat and prevent vascular disease. Despite widespread use, cases of simvastatin-induced rhabdomyolysis are rare. Little information is available regarding the recovery period for a patient who has experienced drug-induced rhabdomyolysis. We present a case involving a patient with multiple risk factors (advanced…
Abstract:Extraskeletal dedifferentiated chondrosarcomas (DC) are uncommon tumors that predominantly occur in the head and neck. Herein, we describe a case of pulmonary DC detected in a patient with systemic sclerosis and presenting with a symptomatic large pleural effusion and a pulmonary lobar consolidation on chest imaging. To the best of…
Abstract:Splenic metastases from solid tumors are uncommon. They may be observed in a context of multivisceral dissemination or as a solitary lesion. We report the case of an 80-year-old woman with a history of two metachronous gastric cancers treated with distal gastrectomy and resection of the gastric remnant within a…
To the Editor:Twiddler's syndrome is an uncommon condition in which a patient's subconscious, inadvertent, or deliberate external manipulation of their cardiac pacemaker/implantable cardioverter defibrillator (ICD) results in the movement of the transducer wires along its longitudinal axis. First introduced in 1968, this syndrome causes a wide array of symptoms, most…
To the Editor:An 84-year-old man was admitted to our hospital due to several syncopal episodes occurring at nighttime for a few weeks prior. The patient also complained of mild chest discomfort during walking. His past medical history was significant for chronic obstructive pulmonary disease, and he was receiving inhaled corticosteroids…
Chilaiditi sign is a condition in which the colon or, less frequently, the small intestine is interposed temporarily or permanently between the liver and the diaphragm. It is also known by other names such as interpositio hepatodiaphragmatica, subphrenic displacement of the colon, and subphrenic interposition syndrome. It is usually asymptomatic…
Background:Medicaid health plan enrollment changes may be a barrier to optimal care and may increase costs.Methods:Data represented 45,768 infants enrolled in Medicaid in South Carolina, 2000–2002. We examined associations between health plan changes and preventive health care, sick infant doctor visits, emergency department (ED) visits, and hospitalizations.Results:In adjusted results, compared…
Objective:To assert the importance of the use of the healthcare matrix formulation for competency assessment in psychiatry residency training.Methods:We present a case from our inpatient psychiatric facility and format it in the form of the healthcare matrix, which was developed at Vanderbilt University incorporating the Institute of Medicine ‘aims' and…
Background:Transition of patient care from an inpatient to outpatient setting is a critical aspect of patient care. The objectives of this study were to describe the content and evaluation of the discharge planning curricula (DPC) in internal medicine (IM) residency programs and identify program directors' perceptions of discharge planning education.Method:A…
Background:The objective of this investigation was to examine depression in, and the lifestyles of, 260 college students of a nursing school in nonclinical settings.Methods:The principal measure of depressive symptoms was the 9-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current stress levels and sleeping,…
Background:Lack of health insurance can adversely affect access to medical care which leads to poor disease outcome. Few studies examine the effects of no insurance on the development of diabetes complications. The objective of this study was to determine if there is an association between health insurance status and the…
Abstract:A case of neurobrucellosis complicated by optic, abducens and vestibulocochlear nerve palsies is reported. Brucella melitensis was isolated in the cerebrospinal fluid, and the patient was diagnosed with retrobulbar neuritis. Despite medical treatment, the patient developed optic atrophy. Multiple cranial nerve involvement should be kept in mind in patients presenting…
Abstract:Isopropyl alcohol is a relatively common source of clinical intoxication. It is usually suspected when a patient presents with high serum or urine ketones and a high osmolar gap without acidosis. Acute renal failure due to isopropyl alcohol ingestion is rare. We describe a patient with isopropyl alcohol ingestion who…
Abstract:The high number of uninsured or underinsured Americans and the spiraling cost of healthcare in the United States has spurred growth in patients traveling abroad for affordable healthcare, which has become known as medical tourism. It is projected to become a $21 billion a year industry by 2011. Overseas prices…
Abstract:Each year about 1.5 million people suffer from a traumatic brain injury. Many of these are seen in primary care settings and most recover completely. Traumatic brain injury can show many signs and symptoms, some of which are readily identified and treated. Often the neurobehavioral sequelae appear months to years…
The victim of a blunt injury that may involve the cervical spine presents a number of management problems for the emergency room physician and trauma surgeon: During resuscitation, what constitutes an adequate initial evaluation? How is the spine protected until it has been determined that there is no possibility of…
To the Editor:I would like to thank the authors for discussing the subject of the provision of pharmaceuticals to indigent patients.1 Our clinic serves only patients without any type of medical insurance, whether private or governmental, who have family incomes that are twice below the federal poverty guideline. Since we…
To the Editor:A 51-year-old white male presented with a 6-month history of nasal congestion, nasal discharge, and left-sided nasal swelling along with persistent throat pain and odynophagia. During the same 6-month period, he was treated repeatedly for infectious and allergic causes of sinusitis and pharyngitis. His symptoms continued to worsen,…
To the Editor:The case report by Tabibian and Gutierrez1 of a 23-year-old woman with doxycycline-induced pseudotumor cerebri (benign intracranial hypertension) may provide further insight concerning the still-ignored role of aspartame products in the causation of this disorder. The patient developed the typical features two months after being placed on doxycycline…
To the Editor:The mainstay of treatment for primary hypothyroidism is lifelong replacement therapy with the oral administration of synthetic thyroxine. Although this therapeutic approach seems simple, some patients with concurrent diseases cannot achieve euthyroidism despite taking high doses of thyroxine. Furthermore, several reports have been shown that subclinical hypothyroidism is…
Medicine Healthguides http://healthguides.mapofmedicine.com/choices/map/index.html promises that your patients will “see what the doctor sees.” The flowcharts that they use to do that have been formulated by “NHS Choices,” a publication from the National Health Service, United Kingdom. They say that this “Map of Medicine Healthguides is a web-based visual representation of…
Using the Healthcare Matrix with Interns as a Tool to Effect Change1. The strength of the Matrix is its ability to:A. Define the problems.B. Identify the issues after a systematic assessment.C. Be used by any and all clinicians.D. All of the above.2. What is the endorsed hand-off format by the…
A Cross-Sectional Study of HIV and Tuberculosis Coinfection Cases in Mainland China: ErratumIt was recently discovered that the article that appeared on page 914 of the September 2008 issue of the SMJ had been previously published in the Chinese Journal of Internal Medicine. The SMJ article lists Jiang Xueyan as…
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