Regional Medical Center

Antimicrobial Stewardship (AS) is crucial for delivering high-quality care to patients, minimizing adverse effects and outcomes, mitigating antimicrobial resistance, and generating cost savings for the healthcare system and patients. Successful AS programs are often multi-disciplinary, with infectious diseases and antimicrobial stewardship pharmacists (ID/ASP) playing a key role in the implementation and coordination of care. This study evaluated the documentation of stewardship interventions following the implementation of an ID/ASP-led stewardship program in a large Midwestern academic medical center. This quasi-experimental study evaluated the impact of hiring an ID/ASP with subsequent AS education and feedback and updated documentation methods. It was conducted from January 2023 to September 2023 (pre-intervention) and October 2023 to December 2024 (post-intervention), and compared the impact of an ID/ASP pharmacist on the documentation of key AS interventions by non-ID pharmacists. The number and type of interventions and drugs used in interventions were assessed for adult and pediatric patients before and after the ID/ASP pharmacist was hired. The primary outcome was the average number of interventions documented by non-ID pharmacists per month in the pre-intervention period compared to the post-intervention period. A p-value < 0.05 was considered statistically significant. A total of 5606 non-ID pharmacist interventions occurred throughout the study. There was a statistically significant increase in average monthly documented interventions by non-ID pharmacists after the intervention compared to before (283 ± 102 vs. 152 ± 49, respectively; p = 0.002). Furthermore, the ID/ASP pharmacist contributed an additional average of 104 interventions per month and was able to perform high-impact AS interventions. This study demonstrated a positive impact of an ID/ASP pharmacist-led AS program in a large academic medical center. The number of documented AS interventions significantly increased in the post-intervention period. These data underscore the importance of ID/ASP in advancing the shared goal of antimicrobial stewardship.

Abstract Human space flights in microgravity conditions lead to a spectrum of changes in the physiological and biomechanical properties of the central nervous system. These changes can pose challenges to the diagnosis, management, and recovery process for astronauts who sustain any neurotrauma. Understanding these interactions can be of particular importance to ensure the safety of astronauts and the development of space medicine, where valuable insight can be provided into neurotrauma care based on the experiences gained on Earth. The present narrative review discusses the neurophysiological effects of microgravity, its implications for neurotrauma, diagnostic challenges, and potential therapeutic interventions.

Tuberous breast is a congenital breast deformity that can have a significant impact. Most therapeutic algorithms involve glandular remodeling, with or without the addition of a breast implant. The increased use of fat grafting in breast surgery has introduced a new tool in the surgical arsenal. We conducted a retrospective study. The primary objective was to evaluate our surgical technique. The secondary objective was to assess patient satisfaction in a larger cohort than previously studied. This retrospective study included patients operated for unilateral or bilateral breast deformities. The fat grafting technique was offered to patients without any personal or familial history of breast cancer and with a mammogram performed within six months rated ACR 1 or 2. Patient satisfaction was retrospectively assessed at a minimum of 6 months post-op using the Breast-Q® augmentation module and an analog scale rated from 1 to 4. Statistical analysis was conducted on the 81 patients (103 breasts) included in the study. The median was two interventions. The only complication found was cystic fat necrosis cysts in 3% of breasts (n=3), with only one requiring surgical fragmentation. Patient evaluation was not correlated with the stage of the tuberous breast. According to our satisfaction scale, 90.9% of patients were satisfied or very satisfied with the overall appearance of their breasts. Fat grafting should not be considered merely as a volume augmentation but as a true reactivation of breast growth, akin to a localized pubertal restart of an underdeveloped breast. The quality of results obtained, the very high level of patient satisfaction, the very low complication rate, and the definitive nature of the reconstruction have made this technique our Gold Standard for managing tuberous breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: Diuretics are an essential component of decompensated heart failure management. Yet, some patients develop diuretic resistance. Defined as inadequate response to escalating dosage of diuretics. Management includes increasing diuretic dosage, combination diuretic therapy and ultrafiltration. A less recognized approach is Hyperdiuresis, where loop diuretics are combined with hypertonic saline to enhance natriuresis and overcome diuretic resistance. We present a case of diuretic resistant heart failure responding to Hyperdiuresis. Description: A 76-year-old male with a history of congestive heart failure presented with respiratory failure secondary to pneumonia and pulmonary congestion requiring intubation. Chest Xray showed pulmonary infiltrates and congestion. Despite completing antibiotics and receiving Bumex 2mg IV twice daily for congestion, patient failed weaning trials due to tachypnea and continued need for pressure support. Chest X-ray and CT showed persistent pulmonary congestion, BNP was 30,000 and urine output was ~1L with an intake of 2.7L. Bumex dose was increased to 2 mg three times daily, and metolazone 5 mg was added. Urine output improved to 2L. However, pulmonary congestion persisted. Considering serum sodium of 148 and Creatinine Clearance of 60 mL/min2, decision was made to pursue Hyperdiuresis. Patient received 40 mg IV Lasix and 150 ml of 3% saline. Urine output increased to 5L over 24 hours. Patient was then resumed on Bumex 2 mg IV twice daily with an output of 3 liters. Patient was liberated from mechanical ventilation 2 days after Hyperdiuresis. Discussion: Diuretic resistance poses a challenge in heart failure management. When increasing dosages of diuretics or combination therapy fail, interventions as ultrafiltration are often considered. Proposed pathophysiology of diuretic resistance includes renal hypoperfusion, neurohormonal activation and decreased sodium delivery to the distal nephron. The mechanism of Hyperdiuresis includes complementary effects on sodium reabsorption and renal blood flow, with hypertonic saline causing intravascular volume expansion, increasing sodium and chloride delivery to macula dense, inhibiting RAAS system and Lasix increasing renal blood flow, sodium and chloride delivery to macula dense, achieving both diuresis and natriuresis.

BackgroundTobacco plays a complex role in patients with inflammatory bowel disease (IBD). Its impact on inpatient outcomes of IBD needs additional study. We aimed to assess the impact of smoking on clinical outcomes in hospitalized patients with IBD.MethodsWe conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) spanning from 2016 to 2019. Patients with UC and CD were identified utilizing ICD-10 codes. Patients were stratified according to the smoking status in two groups. A propensity score matching was utilized to balance comorbidities between study groups. Study outcomes included rates of steroid use, surgeries, gastrointestinal (GI) bleeding, perianal abscess, and overall mortality. All outcomes were assessed during the index hospitalization. Statistical analysis was performed using Stata 17 software. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsA total of 413,208 patients were included in our study, 180,558 patients had UC, and 232,650 patients had CD. After propensity score matching, we had a total of 151,106 patients: 39,616 patients had UC, with a total of 19,808 in each group. The CD patients were 111,490, with a total of 55,745 patients in each group. For UC patients, smokers had lower odds of steroid use (aOR =0.69, 95% CI: 0.61–0.79, P=0.001), and all-cause mortality (aOR =0.54, 95% CI: 0.32–0.96, P=0.03). For CD patients, smokers had higher odds of steroid use (aOR =1.13, 95% CI: 1.03–1.25, P=0.009), perianal abscess (aOR =1.12, 95% CI: 1.10–1.36, P=0.02), and all-cause mortality (aOR =1.51, 95% CI: 1.27–1.84, P=0.04). All other outcomes were not significant between the study cohorts.ConclusionsTobacco use in hospitalized patients with UC was associated with lower steroid use, while in patients with CD, it correlated with higher steroid use and increased odds of perianal abscesses. These findings highlight the complex impact of tobacco use on IBD outcomes.

High-risk neighborhoods represent complex social environments where crime is shaped by intertwined socio-economic, institutional, and cultural factors. Traditional crime control strategies that rely predominantly on reactive law enforcement have proven insufficient in ensuring long-term public safety in such areas. This article explores mechanisms for improving crime prevention in high-risk neighborhoods through an integrated and preventive governance approach. Drawing on criminological theories and comparative analysis of preventive practices, the study examines the role of community-based policing, early social intervention, institutional coordination, and data-driven prevention tools. The findings indicate that effective crime prevention requires a shift from punitive models toward comprehensive frameworks that emphasize social inclusion, community participation, and inter-agency cooperation. Strengthening trust between residents and public institutions is identified as a critical condition for sustainable crime reduction. The study contributes to contemporary crime prevention discourse by highlighting the necessity of context-sensitive and multidisciplinary strategies in addressing criminal risks in high-risk neighborhoods.

PurposeTo present a case of type II oculocutaneous albinism (OCA2) diagnosed in infancy following the finding of nystagmus, and to review the diagnostic process and the management of this disorder.ObservationA 4‐month‐old female presented with subtle, roving eyes that were initially attributed to normal development. A subsequent evaluation by a pediatric ophthalmologist, prompted by a high index of suspicion, confirmed the findings of nystagmus, mild foveal hypoplasia, and astigmatism. Genetic testing confirmed the presence of pathological variants of the OCA2 gene, leading to a diagnosis of oculocutaneous albinism.Conclusion and ImportanceThis case highlights the importance of a meticulous ophthalmologic examination and a high index of suspicion in pediatric care. The early finding of nystagmus can be the key to a timely diagnosis of OCA2. This allows for early intervention to optimize visual development and allows for multidisciplinary management and genetic counseling for the family. This case underscores the need for ongoing education in enhancing the early detection of OCA.

In this study, patients infected with severe acute respiratory syndrome coronavirus 2/coronavirus 2019 (SARS-CoV-2/COVID-2019) had their diets, levels of physical activity, and smoking habits evaluated, along with the effects of these parameters on disease symptom duration. The study followed a cross-sectional design. Data were collected from a group of SARS-CoV-2-infected patients who were tested at the Regional Science and Technology Center from January to December 2021. The survey research included a cohort of 3,155 SARS-CoV-2 patients. Nasopharyngeal swab samples were tested using reverse transcription polymerase chain reaction (RT-PCR), confirming infection by detecting the presence of SARS-CoV-2 RNA. The data did not identify any potentially harmful effects of cigarette smoking on the duration of COVID-19 symptoms. It was confirmed that a high-calorie diet was associated with a reduction or absence of disease symptoms. The results confirmed that physical activity positively affected the duration of COVID-19 symptoms by shortening it (p ≤ 0.05). The data demonstrated a relationship between cigarette smoking, diet, physical activity, and the severity of symptoms during COVID-19 infection.

Abstract Background: Digital health competence, particularly proficiency in electronic health records, is crucial for nursing practice globally but faces challenges in low-resource settings. Cambodian nursing students encounter linguistic barriers due to limited English proficiency and lack of bilingual digital training tools. This study evaluates a novel bilingual simulated electronic health record platform designed to improve digital health competencies among Cambodian nursing students. Methods: A quasi-experimental design with pre- and post-intervention assessments was conducted among first-year nursing students at three Cambodian institutions. Survey instruments were developed, validated, and administered in both Khmer and English. Reliability of survey scales was evaluated using Cronbach's alpha. Data were analyzed using the Shapiro-Wilk test for normality, descriptive statistics (medians and interquartile ranges), the Mann-Whitney U test for group comparisons, and the Hodges-Lehmann estimator for median difference estimation. Results: A total of 584 students completed the pre-intervention survey, and 291 completed the post-intervention survey. The majority preferred using the platform in Khmer or a combination of Khmer and English. Self-perceived competence in electronic health record knowledge improved significantly post-intervention (p &lt; 0.001). Students reported increased confidence and readiness for workplace digital health tasks. Challenges included technical issues, limited computer literacy, and language difficulties; however, bilingual support mitigated language barriers. Nearly all participants recommended the platform for future cohorts. Conclusions: The bilingual simulated electronic health record platform effectively enhanced digital health competencies and confidence among Cambodian nursing students. Language accessibility and mobile compatibility were critical to the platform's success in this low-resource, multilingual setting. Integrating bilingual digital health education and addressing infrastructural barriers can better prepare nursing students for clinical practice in contexts with limited English proficiency and digital resources.

Background: Carotid artery stenosis (CAS) is a major cause of ischemic stroke, particularly in the anterior circulation, due to atherosclerotic narrowing or occlusion. Doppler ultrasonography provides a non-invasive, cost-effective diagnostic method for detection and grading of CAS.Objective: To determine the frequency and severity of carotid artery stenosis in patients presenting with anterior circulation ischemic stroke and to correlate stenosis with major vascular risk factors.Methods: A cross-sectional study was conducted in the Department of Neurology, Services Hospital Lahore, on 151 patients aged 18–65 years with anterior circulation ischemic stroke confirmed on CT scan. Carotid Doppler ultrasound was performed to assess degree of stenosis and associated risk factors (hypertension, diabetes, smoking, ischemic heart disease). Data were analyzed using SPSS 25. Chi-square test was applied; p &lt; 0.05 was considered significant.Results: Out of 151 patients, 93 (61.6 %) were males and 58 (38.4 %) females with mean age = 55.3 ± 7.2 years. Hypertension (68.9 %) and diabetes (46.4 %) were the most frequent comorbidities. Carotid artery stenosis was detected in 97 patients (64.2 %): mild 28 (18.5 %), moderate 43 (28.5 %), and severe 26 (17.2 %). A significant association was found between hypertension and degree of stenosis (p = 0.004) as well as between diabetes and moderate–severe stenosis (p = 0.03). Smoking showed borderline significance (p = 0.06).Conclusion: In conclusion, our results reaffirm that carotid artery stenosis is highly prevalent in anterior circulation stroke, particularly among hypertensive and diabetic males. Early screening through Doppler ultrasonography, aggressive risk-factor modification, and targeted vascular intervention can play a vital role in reducing morbidity and recurrence.