Ohio Valley Medical Center

IntroductionImmunoglobulin A vasculitis (IgA vasculitis), formerly Henoch-Schonlein purpura, is the most common vasculitis in children.Case ReportA 6-year-old female presented with low back pain and swelling, difficulty ambulating, and rash two weeks after a respiratory infection. She was approached with a broad differential and ultimately diagnosed with IgA vasculitis.DiscussionCutaneous manifestations, arthralgias, renal and gastrointestinal involvement are the most common presenting signs of IgA vasculitis. Only two cases of IgA vasculitis associated with lumbar pain and swelling were identified in the literature.ConclusionWhile rash and joint pain are common presenting signs of IgA vasculitis, practitioners should be aware it can present atypically.

While the prevalence of burnout in practicing emergency physicians has been studied, little is known of the prevalence and risk factors in emergency medicine (EM) residents. The aim of this study was to assess the prevalence of burnout among EM residents and the individual-level factors associated with burnout. Eight EM residency programs were surveyed using the Maslach Burnout Inventory (MBI). Demographic data and data on job satisfaction and tolerance of uncertainty in clinical decision-making were collected using validated instruments. Of 289 eligible residents, 218 completed the MBI (response rate= 75%). A total of 142 residents (65%) met the criteria for burnout. Complete data sets of the other instruments were obtained from 193 (response rate= 67%), and this group comprised our study population. Subjects having a significant other or spouse had a higher prevalence of burnout compared to single residents (60% vs. 40%, p=0.002). Poor global job satisfaction (p<0.0001), lack of administrative autonomy (p=0.021), and lack of clinical autonomy (p=0.031) correlated with burnout, as did intolerance of uncertainty (p=0.015). Burnout is highly prevalent in EM residents. Interventions should be targeted at 1) improving resident autonomy in the emergency department where possible, 2) supervision and instruction on medical decision-making that may affect or teach individuals to cope with risk tolerance, and 3) social supports to reduce work-home conflicts during training.

To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. Epidemiologic investigation of the outbreak with a case-control study. A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

Home health nurses face many challenges in the course of their jobs. One such challenge is that of wound care. In today's environment it is difficult to choose the appropriate therapy as we are being bombarded with new information and treatments almost daily. It is imperative for home health nurses to base their plan of care on scientific principle.

Coarctation of the abdominal aorta is uncommon, occurring in only 0.5-2% of aortic coarctations. This disease is usually manifest by upper body hypertension. A case report of a thirty-three-year-old female who had the unusual manifestation of peripheral emboli to both lower extremities secondary to fibrin emboli from her infrarenal segmental aortic coarctation was presented. This is the only case we know of to be manifest in this manner. No others could be found in an English-language literature search.

A case is described of tuberculosis of the cecum mimicking carcinoma so closely that a conventional cancer operation was carried out. Ileocecal tuberculosis, reported in the literature, is briefly reviewed with special attention to its incidence, clinical manifestations, clinical investigation, and treatment.

Dynamic exercise stress testing had become a widely accepted technique in the diagnosis of cardiac patients. The results of standardized exercise testing may be used to evaluate a patient's functional capacity and to derive an exercise prescription to assist him in improving his state of cardiovascular fitness. Because the physical therapist has special training and skill in exercise-related techniques, a stress testing laboratory and an exercise-based cardiac rehabilitation program may be appropriately established in a hospital's physical therapy department. Results are presented of a diagnostic exercise testing and an exercise-based cardiac rehabilitation program organized and supervised by physical therapists in a 300-bed private hospital.