OpenMed/multicare-articles huggingface dataset:
How to bridge the nurse innovation-diffusion gap? An in-depth case study of Create4Care
Authors: Coen Rigtering, Lara J Spaans, Jeroen P J de Jong
Journal: Front Public Health (2023)
Keywords: ecosystems, innovation diffusion, nurse, practice guidelines, single case study
MeSH terms: Diffusion of Innovation, Ecosystem, Hospitals, Humans, Netherlands, Problem Solving

Introduction:
Nurses frequently innovate in response to operational failures, regulations, procedures, and/or other workflow barriers that prevent them from delivering high-quality patient care. Unfortunately, most nurse innovations do not diffuse to a broader audience, depriving other nurses from taking advantage of solutions that have already been developed elsewhere. This under-diffusion is problematic from a societal and welfare point of view. The goal of this paper is to understand how diffusion shortage of nurse innovations can be reduced.
Methods:
We develop a qualitative case study of a medical makerspace at the largest academic hospital in the Netherlands. This medical makerspace reported unusually high rates of nurse innovation diffusion. Our data collection includes on-site observations, archival data, secondary data, and fifteen in-depth interviews with key informants. Qualitative coding procedures and a combination of deductive and inductive reasoning are used to analyze the data.
Results:
Our data show that personal, organizational, regulatory, and market barriers prevent nurses from further developing and diffusion their innovations in an anticipatory manner. That is, because nurses expect that transforming an initial solution into an innovation that can be shared with others will be too time consuming and difficult they do not proceed with the further development. The medical makerspace that we investigated adequately addresses this problem by developing an innovation ecosystem that largely takes over the innovation and diffusion process.
Discussion:
We provide a concrete example of how a medical makerspace, and innovation support systems in a broader sense, can be designed to more adequately address the nurse innovation-diffusion gap. The two main elements of the practical solution that we identified are: (1) Support systems should facilitate that others may lead the development and diffusion of innovations and (2) The support system should promote that actors integrate their functional specializations within an innovation ecosystem. We make two theoretical contributions. First, we contribute to understanding barriers in the nurse innovation-diffusion process from a psychological point. Second, we identified that an ecosystem perspective is beneficial to develop innovation support systems in which diffusion occurs more often.
Relentless placoid chorioretinitis: A review of four cases in pediatric and young adult patients with a discussion of therapeutic strategies
Authors: Haniah A Zaheer, Jamie Odden, Meghal Gagrani, Fatma Zaguia, Careen Lowder, Andreea Coca, Margalit E Rosenkranz, Preeti Patil-Chhablani, Raphaelle Ores, Francois Boussion, Chad Indermill, José-Alain Sahel, Ken Nischal, Debra A Goldstein, Marie-Helene Errera
Journal: Front Pediatr (2023)
Keywords: adalimumab, infliximab, interferon-alpha-2a, relentless placoid chorioretinitis, tocilizumab, uveitis
MeSH terms: Review

Introduction:
Relentless placoid chorioretinitis (RPC) is a rare, bilateral disease of the retinal pigment epithelium. The clinical course is prolonged and relapsing. No standard treatment has been established to date. The purpose of this case series is to report four cases of RPC in pediatric and young adult patients in which varying treatments were used, comparing them to previously published cases.
Methods:
A literature review was conducted to investigate currently published presentations and treatment options for RPC. A multicenter retrospective chart review was also performed on four consecutive patients. These patients were diagnosed with RPC because of new chorioretinitis lesions continuing to appear without or despite therapy for 5-36 months (2 patients), with a clinical course prolonged and relapsing, or because of the atypical location of the multiple lesions (>50) extending from the posterior pole to the equator and mid-peripheral retina (all four patients), which were not consistent with other entities like acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis.
Results:
All four cases of RPC received oral or IV steroids acutely, and three of these patients were transitioned to a steroid-sparing agent and biologic therapy: anti-TNF alpha or anti-IL-6. Quiescence of the chorioretinitis lesions was obtained after 7 months, 1 month, and 36 months; however, the latter had issues with treatment adherence. Mycophenolate mofetil was insufficient to control the disease in one patient, but tocilizumab and infliximab thereafter were effective after cessation of adalimumab due to side effects. Adalimumab when started the first month after the presentation was effective in controlling the disease in one patient. After the failure of interferon-alpha-2a, one patient displayed long-term control with infliximab. One patient did not require a steroid-sparing agent after oral prednisone taper as there was no evidence of progression or recurrence.
Conclusion:
This case series adds to the current knowledge regarding potential treatments for RPC, specifically the use of anti-TNF-alpha treatment and anti-IL-6 tocilizumab. In this case study, relapses of RPC were found among patients on mycophenolate mofetil and interferon-alpha-2a, and one case did not relapse on oral steroids without a steroid-sparing agent. Our findings suggest that adalimumab, infliximab, and tocilizumab may be useful medications to obtain quiescence of RPC.
Parathyroid adenoma in pregnancy: A case report and systematic review of the literature
Authors: I Pliakos, A Chorti, Moysis Moysidis, G Kotsovolis, T Kaltsas, A Pana, A Ioannidis, T S Papavramidis
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: endocrine surgery, parathyroid adenoma, parathyroid surgery, pregnancy, primary hyperparathyroidism
MeSH terms: Adenoma / complications, Adenoma / diagnosis, Adenoma / surgery, Parathyroid Neoplasms / complications, Parathyroid Neoplasms / diagnosis, Parathyroid Neoplasms / surgery, Pregnancy Complications, Neoplastic / diagnosis, Pregnancy Complications, Neoplastic / surgery, Case Reports, Systematic Review, Adult, Calcium, Female, Humans, Parathyroidectomy / methods, Pregnancy, Calcium

Objective:
Primary hyperparathyroidism is a common disorder of the parathyroid glands. Parathyroid adenoma (PA) in pregnancy is a relatively rare disease, whose diagnosis and treatment is a challenging task. The aim of the present study is to present a new case of parathyroid adenoma during pregnancy and to give a detailed account of all reported cases of parathyroid adenoma during pregnancy in the literature.
Study design:
A bibliographic research was performed, and characteristics of parathyroid adenomas in pregnancy such as age, gestational week at diagnosis, ionized calcium levels, genetic testing result, symptomatology, radiological method of localization, treatment method, gestational week at operation, and maternal/fetal complications were recorded.
Results:
A 34-year-old woman at her 25 weeks' gestation was diagnosed with parathyroid adenoma and was referred to our Surgical Department due to contraindication for conservative treatment. A parathyroidectomy was performed, and the maternal and fetal postoperative period was uneventful. Two hundred eleven cases of parathyroid adenoma in pregnancy were recorded in the literature, and statistical analysis was performed. The median gestational week at diagnosis was 21 ± 9.61 weeks. The mean level of ionized calcium was 2.69 mmol/l [SD = 0.75 (2.55-2.84 95% CI)]. Most cases were familiar (72.4%), while surgery was the preferred treatment option (67.3%). The majority of cases were asymptomatic (21.7%), and the main radiological method applied for localization was ultrasound (63.4%).
Conclusion:
Parathyroid adenoma in pregnancy is a rare condition. The early diagnosis is of great importance as surgical treatment at the second trimester of pregnancy outweighs the maternal and fetal risks.
Use of Cetuximab in Combination with Cisplatin and Adjuvant Pelvic Radiation for Stage IIIB Vulvar Carcinoma
Authors: Jennifer Bergstrom, Michael Bidus, Edward Miles, Jay Allard
Journal: Case Rep Obstet Gynecol (2015)

Vulvar cancer is a rare carcinoma constituting only 4% of gynecologic malignancies and 0.6% of female cancers. Most chemotherapy regimens have been created from extrapolation from anal and cervical cancer research. Advanced stages have the worst prognosis and oftentimes invasive surgical procedures are needed to cure disease with high recurrence rates. Case. A 50 yo G2P2 presented for a 2 cm mass in her right labia. The patient underwent a partial radical vulvectomy and bilateral superficial and deep inguinal lymph node dissection. Bilateral inguinal lymph nodes were positive for residual disease. The patient underwent whole pelvic radiation with cisplatin as a radiosensitizer. The primary tumor was epidermal growth factor receptor (EGFR) positive and cetuximab, a monoclonal antibody to EGFR, was added. The patient underwent seven cycles of chemotherapy including cisplatin and cetuximab with adjuvant radiation therapy to the pelvis. She currently is without evidence of disease recurrence since completing treatment 4 years ago. Conclusion. One previous case report showed short-term palliative success of five months for recurrent, metastatic vulvar cancer. This case suggests that cetuximab could possibly be used in initial management of patients with advanced stages of vulvar cancer to improve prognosis.
The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report
Authors: Jichan Shi, Wenjie Wu, Kang Wu, Chaorong Ni, Guiqing He, Shilin Zheng, Fang Cheng, Yaxing Yi, Ruotong Ren, Xiangao Jiang
Journal: Front Cell Infect Microbiol (2022)
Keywords: co-infection, early diagnosis, leptospirosis, mngs, pulmonary tuberculosis (ptb)
MeSH terms: Leptospira / genetics, Leptospirosis / complications, Leptospirosis / diagnosis, Mycobacterium tuberculosis / genetics, Tuberculosis, Tuberculosis, Pulmonary / complications, Tuberculosis, Pulmonary / diagnosis, Tuberculosis, Pulmonary / microbiology, Case Reports, Aged, High-Throughput Nucleotide Sequencing, Humans, Male, Sensitivity and Specificity, Sputum / microbiology

Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira. Leptospirosis is transmitted mainly through contact with contaminated rivers, lakes, or animals carrying Leptospira. Human leptospirosis has a wide range of non-specific clinical manifestations ranging from fever, hypotension, and myalgia to multi-organ dysfunction, which severely hampers the timely clinical diagnosis and treatment of leptospirosis. Therefore, there is an urgent clinical need for an efficient strategy/method that can be used for the accurate diagnosis of leptospirosis, especially in critically ill patients. Here, we report a case of a 75-year-old male patient with clinical presentation of fever, cough, and diarrhea. Initial laboratory tests and a computed tomography (CT) scan of the chest suggested only tuberculosis. The patient was finally diagnosed with pulmonary tuberculosis (PTB) combined with leptospirosis by sputum Xpert MTB RIF, epidemiological investigations, and delayed serological testing. Furthermore, through metagenomic next-generation sequencing (mNGS) of clinical samples of cerebrospinal fluid (CSF), urine, plasma and sputum, the causative pathogens were identified as Mycobacterium tuberculosis complex and Leptospira spp. With specific treatment for both leptospirosis and tuberculosis, and associated supportive care (e.g., hemodialysis), the patient showed a good prognosis. This case report suggests that mNGS can generate a useful complement to conventional pathogenic diagnostic methods through more detailed etiological screening (i.e., at the level of species or species complex).
A delayed diagnosis of Pallister-Hall syndrome in an adult male following the incidental detection of a hypothalamic hamartoma
Authors: Eliza Courtney, Du Soon Swee, Diana Ishak, Joanne Ngeow
Journal: Hum Genome Var (2018)
MeSH terms: Case Reports

Pallister-Hall syndrome is a rare autosomal dominant condition that is associated with polydactyly and hypothalamic hamartoma and is caused predominantly by frameshift or nonsense pathogenic variants in the GLI3 gene. The majority of cases are identified during childhood; however, rare reports of diagnoses during adulthood exist. Here, we describe the identification of a novel nonsense GLI3 pathogenic variant in an adult male following the incidental detection of a hypothalamic hamartoma.
Dermatofibrosarcoma Protuberans Over Right Lumbar Region: A Case Report
Authors: Bhavinee Pathak, Sabiha Maimoon
Journal: Cureus (2023)
Keywords: case report, dermatofibrosarcoma protuberans, histopathology, lumbar region, spindle cells
MeSH terms: Case Reports

Dermatofibrosarcoma protuberans is a rare, low-grade dermal soft-tissue tumor with a high propensity for recurrence but a low propensity for metastatic spread. It mostly affects the head, neck, proximal extremities, and trunk. We report a case of dermatofibrosarcoma protuberans over the right lumbar region. The patient presented with swelling in the right lumbar region measuring 3 cm × 3 cm. The local region ultrasonography (USG) revealed a well-defined hypoechoic lesion in the subcutaneous area. The patient was provisionally diagnosed with a peripheral nerve sheath tumor under evaluation. USG-guided fine needle aspiration cytology (FNAC) suggested a spindle cell tumor. Wide local excision of the tumor was performed. Monomorphic spindle cells in a storiform pattern were observed by histological evaluation. The neighboring adipose tissue was invaded by the tumor cells in a honeycomb-shaped pattern. The histological features were suggestive of Dermatofibrosarcoma Protuberans. Due to the high likelihood of recurrence, it is crucial to monitor these patients for an extended period of time.
A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report
Authors: Selcuk Sarikaya, Berkan Resorlu, Ekrem Ozyuvali, Omer Faruk Bozkurt, Ural Oguz, Ali Unsal
Journal: Case Rep Med (2013)

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.
All Roads Lead to Rome: Exploring Human Migration to the Eternal City through Biochemistry of Skeletons from Two Imperial-Era Cemeteries (1st-3rd c AD)
Authors: Kristina Killgrove, Janet Montgomery
Journal: PLoS One (2016)
MeSH terms: Bone and Bones / chemistry, Human Migration / history, Tooth / chemistry, Historical Article, Research Support, Non-U.S. Gov't, Adolescent, Adult, Age Factors, Carbon Isotopes / chemistry, Cemeteries, Child, Child, Preschool, Diet, Emigrants and Immigrants, Female, Geography, History, Ancient, Humans, Infant, Infant, Newborn, Male, Middle Aged, Oxygen Isotopes / chemistry, Roman World, Rome, Sex Factors, Strontium Isotopes / chemistry, Young Adult, Carbon Isotopes, Oxygen Isotopes, Strontium Isotopes

Migration within the Roman Empire occurred at multiple scales and was engaged in both voluntarily and involuntarily. Because of the lengthy tradition of classical studies, bioarchaeological analyses must be fully contextualized within the bounds of history, material culture, and epigraphy. In order to assess migration to Rome within an updated contextual framework, strontium isotope analysis was performed on 105 individuals from two cemeteries associated with Imperial Rome-Casal Bertone and Castellaccio Europarco-and oxygen and carbon isotope analyses were performed on a subset of 55 individuals. Statistical analysis and comparisons with expected local ranges found several outliers who likely immigrated to Rome from elsewhere. Demographics of the immigrants show men and children migrated, and a comparison of carbon isotopes from teeth and bone samples suggests the immigrants may have significantly changed their diet. These data represent the first physical evidence of individual migrants to Imperial Rome. This case study demonstrates the importance of employing bioarchaeology to generate a deeper understanding of a complex ancient urban center.
Glomus tumor of the cheek: a case report
Authors: Konstantinos Veros, Konstantinos Markou, Chrysa Filitatzi, Dionysios E Kyrmizakis
Journal: Case Rep Med (2012)

Glomus tumors are benign, subcutaneous neoplasms of the perivasculature. Though facial location is rare, the diagnosis of a glomus tumor should be considered in cases of undiagnosed painful facial nodules or chronic facial pain. Imaging aids in defining the tumor and planning a complete excision in order to avoid recurrence. Histological examination is mandatory after every attempted excision. A case of glomus tumor of the cheek along with the possible pitfalls of diagnosis and treatment and a brief review of the limited associated literature are presented.
Endoscopic right lobectomy axillary-breast approach: a report of two cases
Authors: Nina Irawati
Journal: Int J Otolaryngol (2010)
MeSH terms: Case Reports

Background. We reported our two initial experiences in the treatment of thyroid disease with endoscopic thyroidectomy. Minimally invasive video-assisted technique (MIVAT) was initially introduced by Miccoli. The modification was made by using axillary and breast technique. Method. Two young women patients, with 4 and 5 cm right lobe thyroid disease suspected to be benign. From physical examination, sonography, and FNAB findings, the two cases were categorized as benign. We performed endoscopic right lobectomy through incision of 5-10 mm on axillary line and breast using CO2 insufflation. Result. Duration of first operation was 300 minutes and the second one was 120 minutes, with minimal blood loss and no major complication. Patients were discharged 24 hours after operation. Cosmetic result was excellent. Postoperative complications were shoulder discomfort and neck swelling. Conclusion. We reported two cases of endoscopic right lobectomy as a safe, reproducible technique with an indication in a minority of patients candidates for thyroidectomy and is characterized by less postoperative discomfort.
Sudden onset methaemoglobinaemia in a previously well Ugandan child: a case report and literature review
Authors: Nicolette Nabukeera-Barungi, Edison Mworozi
Journal: Pan Afr Med J (2012)
Keywords: hemoglobine, methaemoglobinaemia, uganda, food preservatives, intoxication, nitrites
MeSH terms: Methemoglobinemia / diagnosis, Case Reports, Review, Age of Onset, Child, Preschool, Female, Food Contamination, Health, Humans, Methemoglobinemia / drug therapy, Methemoglobinemia / epidemiology, Methemoglobinemia / etiology, Methylene Blue / administration & dosage, Nitrites / toxicity, Uganda / epidemiology, Nitrites, Methylene Blue

Methaemoglobinaemia is a rare condition of unknown prevalence. Diagnostic tests in resource limited settings are very rare but clinical signs can be a good guide. We set out to describe a case of Methaemoglobinaemia, raise awareness among practitioners in resource limited settings and to share experiences in its diagnosis and management. A previously well three and a half year old girl was admitted with central cyanosis of sudden onset. She underwent clinical, laboratory and radiological evaluation. Having been in a resource limited setting, the process of making a diagnosis was slow and difficult. After the diagnosis, the treatment was not available in the country but we managed to get it all the way from Nairobi, Kenya. A diagnosis of Methaemoglobinaemia was made using Spectrophotometry and she was successfully treated using 2 doses of intravenous Methylene blue. The cause of Methaemoglobinaemia was established to have been nitrites from food preservatives.
Aortic valve replacement in a young patient with essential thrombocytosis
Authors: Kashif Ahmed, Hunaid A Vohra, Alison Milne, Stephen M Langley
Journal: J Cardiothorac Surg (2008)
MeSH terms: Aortic Valve Stenosis / surgery, Heart Valve Prosthesis Implantation / methods, Thrombocythemia, Essential / complications, Case Reports, Aortic Valve Stenosis / complications, Aortic Valve Stenosis / diagnostic imaging, Echocardiography, Follow-Up Studies, Humans, Male, Young Adult

Essential Thrombocythcythaemia (ET) is an uncommon type of myeloproliferative disorder, characterised by both thrombotic and haemorrhagic diathesis. No clear guidelines exist for the pre- and post-operative management of patients undergoing cardiac surgery in the haematological and surgical literature. This condition has profound implications in patients undergoing cardiac surgery with the use of cardiopulmonary bypass, where heparin is used for anti-coagulation. This dilemma is further compounded in the setting of a young patient undergoing aortic valve replacement (AVR), where insertion of a mechanical prosthesis would be the procedure of choice. This would require life-long anticoagulation with warfarin which can predispose these patients to catastrophic bleeding. Using a tissue valve will subject the patient to multiple redo operations in the patient's lifetime. We report a young patient with ET requiring AVR and discuss the dilemmas surrounding the choice of prosthesis in this patient.