Southern medical journal
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Southern medical journal · Dec 2024
Reducing Unnecessary Laboratory Testing: A Quality Improvement Initiative at Wellstar Spalding Medical Center.
The healthcare industry is grappling with escalating expenses, partially attributed to the inefficient use of medical resources, particularly by ordering unnecessary laboratory tests. Such practices not only increase costs but also result in extended hospital stays, patient discomfort, and potential clinical complications such as iatrogenic anemia. Blood tests, although essential for guiding medical decisions, are associated with significant clinical and financial costs. This quality improvement project aimed to decrease unnecessary laboratory testing at Wellstar Spalding Medical Center, a community hospital with a newly established residency program. ⋯ Our project has yielded clinically and administratively meaningful results. We have seen a measurable decrease in costs and the prevention of unnecessary laboratory testing. If it also can be shown that we have prevented iatrogenic anemia, our project could be seen as enhancing the patient experience and reducing hospital length of stay. We also have raised awareness about high-value care and instilled clinical awareness among residents regarding ordering daily blood tests contributing to an improvement in patient care.
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This study used a qualitative research approach to grounded theory to identify factors that contributed to resident distress during 2021-2022 in multiple different specialties and at different postgraduate years of residency. By better understanding these contributors to distress, the aim was to inform the design of optimal interventions to reduce burnout and other emotional distress. ⋯ The findings of the grounded theory qualitative analysis were used to examine ways to better mitigate the sources of distress that the residents enrolled in this study described. As institutions strive to diminish distress among residents, they can consider opportunities to assess environmental factors and design targeted interventions for their institutions or programs.
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Southern medical journal · Dec 2024
Multicenter Study Comparative StudyComparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.
Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19. ⋯ The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.
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Free clinics provide care to underserved populations nationwide. The Birmingham Free Clinic offers dermatology care and operates an onsite dispensary. Little is known about specialty care services and medication optimization in the free clinic setting. This study analyzed dermatologic diagnoses and medication distribution patterns to optimize the dermatologic formulary at a free clinic. ⋯ Eighty-gram tubes of triamcinolone 0.1% ointment were added to the dermatologic formulary, and low-cost alternatives were suggested for ketoconazole 2% shampoo. This study provides a model for formulary optimization in free clinics with specialty care services.
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Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare, autosomal recessive condition characterized by fibroblast growth factor 23 signaling pathway dysregulation, hyperphosphatemia and ectopic calcifications (which manifest as joint motion limitations), inflammatory bony pain, and disability. Given the rarity and multiorgan involvement of HFTC, a multidisciplinary approach including Dermatology, Ophthalmology, Dentistry, Nephrology, Endocrinology, Rheumatology, and Genetics is necessary for diagnosis and treatment. We present a multidisciplinary diagnostic and treatment approach for a patient with HFTC due to a GALNT3 gene mutation with unique imaging highlighting the extent of calcinosis seen in HFTC. ⋯ Genetic testing revealing a homozygous c.1319C > A variant in GALNT3 predicted to result in a missense mutation p. Ala440Glu. HFTC should be considered for patients presenting with diffuse calcinosis cutis-like features, and a multidisciplinary evaluation should be pursued.