Sarasota Memorial Health Care System

Abstract Purpose Ganser syndrome is a rare and debated dissociative condition, typically associated with custodial or forensic settings. This case report aims to describe a transient Ganser state emerging during a manic episode of bipolar disorder and to discuss its diagnostic implications within affective psychopathology. Methods A detailed clinical assessment, including serial mental status examinations, physical examination, routine laboratory investigations, and MRI brain, was conducted in a 29-year-old man admitted with acute mania. Longitudinal observation on an inpatient unit was used to characterize the phenomenology, course, and response to treatment of his approximate answers and associated cognitive disturbances. Results The patient presented with classical manic symptoms alongside striking approximate answers across orientation, general knowledge, calculations, naming, and motor commands, despite preserved comprehension and intermittent correct responses. There were no abnormalities on physical examination, laboratory tests, or MRI brain. He lacked external incentives or forensic context suggestive of malingering. With risperidone, clonazepam, a supportive ward milieu, and reduction of psychosocial stressors, both affective and Ganser-like symptoms resolved completely, and he was unable to recall his earlier approximate answers. Conclusions This case supports the view that Ganser syndrome–like phenomena may emerge as a dissociative response within severe mood episodes, independent of custodial settings or clear secondary gain. Clinicians should consider Ganser syndrome when faced with organized but incorrect “near-miss” responses and assess carefully for underlying affective pathology, as timely, integrated management may facilitate full clinical recovery.

Cryonics is infrequently encountered in hospice and palliative medicine literature. It is the practice of preserving the body and brain of a person who died with the aim for them to be revived in the future. As of 2022, it is estimated that around 500 people have been cryonically preserved globally. We report a case of a 78-year-old male who died from metastatic recurrence of his renal cell carcinoma and had made prior arrangements to pursue cryonic preservation with an out-of-state company. We intend to highlight logistical, ethical, legal, and psychological considerations unique to our patient. Topics discussed include: ethical objections of “First Do No Harm” seemingly at odds with the patient’s wishes, legal considerations of discrepancies between advanced directives and contract agreements, and a belief that death is not finite for their loved one may provide some comfort to families.

The research-to-practice gap often occurs when evidence-based practice (EBP) is inadequately implemented into clinical practice. Nurses are critical to bridging the gap in EBP implementation (EBPI) and identifying effective strategies to promote its use in practice; however, they need a supportive work environment to develop the necessary research capacity/culture (RCC). The purpose of this study was to examine relationships between nurses' perceptions of individual RCC and EBPI, team RCC and EBPI, and health care organization RCC and EBPI, adjusting for educational background, health care organization setting, and health care organization type. Survey data were collected from 175 nurses across the United States using a prospective cross-sectional study design. The Research Capacity in Context (RCC) tool and EBPI scale were used to measure nurses' perception of RCC and nurses' EBPI, respectively. Simple linear regression was used to assess the relationship between organizational, team, and individual RCC and EBPI. Multiple linear regression was used to adjust for pertinent participant demographics. The results of this study indicated that organization (R2 = 0.033, p = 0.016), team (R2 = 0.064, p < 0.001), and individual (R2 = 0.155, p < 0.001) RCC were significantly associated with nurse EBPI. Moreover, findings remained significant after adjusting for educational background, health care organization setting, and type. The regression model suggested that education significantly predicted EBPI (R2 = 0.142, p < 0.001). These results emphasize the importance of building RCC in health care organizations, as it can be an effective strategy to increase nurses' EBPI, which has been shown to impact patient outcomes directly. Future research should identify strategies to assist organizations and leadership in building RCC among nurses.

Gallstone ileus is rare complication of cholecystitis or cholelithiasis due to the formation of an aberrant communication between the gallbladder and small bowel. The movement of the gallstone to the small bowel may cause bowel obstruction. A patient presented with acute onset abdominal pain, nausea, vomiting, and tenderness around the umbilical area. Physical exam, laboratory tests, and computed tomography were performed. Within 24 hours the patient had developed peritonitis. He received an emergency exploratory laparotomy, and small bowel resection and anastomosis of the proximal jejunum. The patient had gallstone ileus complicated by the presence of an intraluminal abscess and perforation due to pressure necrosis caused by the gallstone. The patient recovered and was discharged on postoperative day 31. Despite having had a cholecystectomy 20 years prior this case highlights a patient who suffered a rare case of gallstone ileus.

Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses.This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%). In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.

A child’s first 1,000 days are a period of rapid brain development; negative environments and stressful events can impact their lifelong health, well-being, resiliency, and prosperity. First 1,000 Days Suncoast is a tri-county initiative in southwest Florida comprising 90 partner organizations supporting families and babies by connecting them with resources and tools through a large and comprehensive network. Following the Collective Impact model, the region’s public community hospital was designated as the backbone organization, with a nurse-led team guiding the operations. A steering committee, with leaders of regional nonprofits and foundations, ensures tactical alignment with county priorities, and has been key in building a strong partner infrastructure. Three key components guide the activities of the initiative: care coordination; parent empowerment; and targeted interventions. Through collaboration with community professionals and parents, the initiative identifies the most pervasive barriers to care for families and develops innovative solutions. This method has led to system-wide transformations, organization-specific enhancements, and process improvements.

Primary care NPs are central to the management of diabetes mellitus, which carries with it the risk of hypoglycemia. Fully understanding risk factors, prevention strategies, and treatment assist in reducing hypoglycemic events. This article details hypoglycemia, risk factors for hypoglycemia, prevention strategies, and appropriate treatment plans.

Standard single-agent nonplatinum chemotherapy provides only modest benefit in a small proportion of patients with platinum-resistant/-refractory ovarian cancer, with objective response rates of 6-20% and progression-free survival of ≈3-4months. Nemvaleukin alfa (nemvaleukin, ALKS 4230) is a novel cytokine designed to capture and expand the therapeutic potential of high-dose interleukin-2 (IL-2) while mitigating its associated toxicity issues. Nemvaleukin preferentially activates cytotoxic CD8+ T cells and natural killer cells with minimal, non-dose-dependent effects on CD4+ regulatory T cells. The global, randomized, open-label, phase III ARTISTRY-7 trial will compare efficacy and safety of nemvaleukin plus pembrolizumab with chemotherapy in patients with platinum-resistant ovarian cancer. The primary end point is investigator-assessed progression-free survival. Clinical Trial Registration: GOG-3063; ENGOT-OV68; NCT05092360 (ClinicalTrials.gov).

728 Background: Localized dual-balloon-mediated, intra-arterial delivery of Gemcitabine (IAG) directly into tumors/tissue can lead to higher local drug potency1. Furthermore, IAG may lead to decreased systemic drug concentration and associated side effects. In patients with Locally Advanced Pancreatic Cancer (LAPC), this approach is currently being tested in a contemporary Phase III clinical trial, TIGeR-PaC. Herein we report the results of a 10-patient PK analysis sub-study within TIGeR-PaC. Methods: We analyzed a total of 10 subjects from 5 sites who received intra-arterial gemcitabine with the RenovoCath dual balloon catheter at 1000mg/m2 over 20 minutes. The target treatment artery was either the celiac axis (n=5) or the superior mesenteric artery (n=5). Samples were drawn at T = -5, 10, 15, 20, 30, 40, 60, and 90 minutes from the onset of infusion. At each timepoint, we collected 2mL of blood in heparinized tubing containing 25 mcg/mL of tetrahydrouridine. The blood samples were then centrifuged collect, freeze, and ship the plasma to a reference lab to perform a gemcitabine assay. The PK parameters for a single dose was estimated for Cmax, AUC, clearance, and distribution volume based on the terminal phase. These values are compared to historical data for intravenous gemcitabine (IVG) infusion at 1000mg/m2 over 30 minutes2. Results: At this time, data has been analyzed for 4 of 8 collected samples. We expect to complete collection and analysis of all 10 samples by November of 2022. We show results available so far; historical values for IVG are given as a reference point. The results suggest that IAG is associated with decreased systemic exposure of gemcitabine compared to IVG. Conclusions: Localized dual-balloon-mediated, intra-arterial delivery of gemcitabine can lead to decreased systemic levels of gemcitabine. This approach increased local potency and may be beneficial in decreasing gemcitabine-related systemic side effects. 1. Farsad K, et al. 04:21 PM Abstract No. 392 . J Vasc Intervent Radiol 2019;30(3):S172. doi:10.1016/j.jvir.2018.12.467. 2. Chow ECY, Zirkelbach JF. Clinical Pharmacology and Biopharmaceutics Review(s) {209604Orig1s000}. FDA: Center for Drug Evaluation and Research. Clinical trial information: NCT03257033 . [Table: see text]