The HIV/AIDS pandemic richly illustrates the historian Charles Rosenberg's construct of epidemics as four-act plays: progressive revelation, the management of randomness, the negotiation of a public response, and subside...The HIV/AIDS pandemic richly illustrates the historian Charles Rosenberg's construct of epidemics as four-act plays: progressive revelation, the management of randomness, the negotiation of a public response, and subsidence and retrospection. In developed countries, we are now in Act Four. Among the numerous areas of HIV/AIDS that invite reflection, I've focused on its implications for medicine as a profession as opposed to a job or trade. The availability of effective technology determines the relative importance of competence (doing the right thing well; basic professionalism) and "compassion" (service that clearly transcends self-interest; higher professionalism). Those of us who became "AIDS doctors" during the pandemic's early years were privileged to live through what amounted to a truncated history of medicine. It was quite a ride. But most of all, I remember patients, both individually and collectively, from those early years. My proudest achievement is that none of my private patients died in a hospital. My most-cherished memento is a paperback book bequeathed to me by the widow of "Jake"-the early AIDS victim who never told his wife how he got those scars on his forearms. She'd inscribed it: "Dear Dr. Bryan, Thank you for letting me die gracefully." She and many others gave me lessons in courage and in what it means to be a doctor.
Appendiceal mucoceles are rare lesions with a variable clinical presentation often identified incidentally on imaging or at laparotomy/laparoscopy for an unrelated diagnosis. Mucocele of the appendix may be a benign or m...Appendiceal mucoceles are rare lesions with a variable clinical presentation often identified incidentally on imaging or at laparotomy/laparoscopy for an unrelated diagnosis. Mucocele of the appendix may be a benign or malignant process, making early recognition based on symptoms and key radiographic characteristics of the utmost importance for optimal patient management. Here we present the case of a patient presenting with non-specific abdominal complaints suffering from appendiceal mucocele perforation due to low-grade mucinous adenocarcinoma.
Johnson BK, James CW, Ritchie G
… +2 more, Morgan RR, McMillan HR
J S C Med Assoc
· 2014 · PMID 27125004
Components of a Perioperative Surgical Home (PSH), implemented at a large State University Medical Center (SUMC), have driven significant reductions in Surgical Site Infections (SSIs) and Day of Surgery (DOS) cancellatio...Components of a Perioperative Surgical Home (PSH), implemented at a large State University Medical Center (SUMC), have driven significant reductions in Surgical Site Infections (SSIs) and Day of Surgery (DOS) cancellations. Refined methodology for efficient and accurate assessment of these reductions was developed based on available electronic data systems and proven strategies adapted from literature. At our institution, the practice of evidence-based protocol-driven medicine has contributed to the prevention of an estimated 1073 SSIs over a 6 year period, representing avoided costs in excess of $24M. Management of logistics surrounding patients' surgeries starting in the preoperative clinic has yielded exceedingly low DOS cancellation rates (3.47% of scheduled procedures). This level of efficiency is critical given that a 1% increase in DOS cancellation rates can represent as much as a $5.6M loss of revenue to a large SUMC.
In the era of global travel, clinicians can no longer consider just influenza and Respiratory Synctial Virus (RSV) and ignore other causes of presumptive viral respiratory tract infections. Since the recognition of Sever...In the era of global travel, clinicians can no longer consider just influenza and Respiratory Synctial Virus (RSV) and ignore other causes of presumptive viral respiratory tract infections. Since the recognition of Severe Acute Respiratory Syndrome (SARS) coronavirus in 2003, novel viruses seem to emerge more frequently. Novel influenza strains, the novel coronavirus (MERS-CoV) identified last year in the Middle East, other novel viruses, and increasing numbers of immunocompromised patients that can be felled by acute respiratory infections all demand a need for rapid recognition of the etiology of viral respiratory illnesses. This article will review viral respiratory PCR tests currently available or in development and how they can be used to improve patient care both within the hospital setting and in the outpatient setting.
The Epilepsy Monitoring Unit (EMU) was established at the Medical University Hospital to assist in the diagnosis of epilepsy and the evaluation of other paroxysmal neurological symptoms, including non-epileptic events (N...The Epilepsy Monitoring Unit (EMU) was established at the Medical University Hospital to assist in the diagnosis of epilepsy and the evaluation of other paroxysmal neurological symptoms, including non-epileptic events (NEEs), which are often confused with epileptic seizures. Correct diagnosis can prevent inappropriate treatment with antiepileptic drugs, avoid some of the restrictions imposed by epileptic seizures, and facilitate appropriate treatment for NEEs. A retrospective review of patients admitted to the EMU over a two year period showed the percentage of patients diagnosed with NEEs (39%) is greater than those diagnosed with epilepsy alone (36%). This incidence of NEE is higher than in other academic medical centers. The explanations for this disparity are not fully defined, but warrant further study as to patient demographics, risk factors, and referral patterns in South Carolina. The average time from when patients began having events to accurate diagnosis of NEEs was 4.5 years, and 21 patients had NEEs for at least 10 years prior to diagnosis.