Impact of profession and wards on moral distress in a community hospital.

BACKGROUND: Recently, a singular survey titled "Measure of Moral Distress-Healthcare Professionals," which addresses shortcomings of previous instruments, has been validated. AIM: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. PARTICIPANT AND RESEARCH CONTEXT: We distributed a self-administered, validated survey titled "Measure of Moral Distress-Healthcare Professionals" to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. FINDINGS: A total of 101 surveys were included in the study. The mean Measure of Moral Distress-Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress-Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p < .001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress-Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress-Healthcare Professionals score mildly greater than the emergency room. ETHICAL CONSIDERATIONS: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center's Institutional Review Board. DISCUSSION: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. CONCLUSION: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress-Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians.

Presentation of Diffuse Large B-Cell Lymphoma with Shoulder Pain: A Case Report.

BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a type of aggressive lymphoid malignancy, which can present with an array of clinical features. DLBCL is notorious for having the highest rate of mortality in the developed areas of the world among the non-Hodgkin lymphomas (NHL). Although lymph node involvement is most commonly encountered, extranodal occurrence is also seen in up to 30% of the cases with involvement of structures such as the skin, lung, gastrointestinal tract, and musculoskeletal tissues. In view of the high mortality, especially in patients with delayed diagnoses, recognizing symptoms of this disease is vital for timely diagnosis and successful treatment. CASE REPORT We present the case of a 31-year-old white man with isolated shoulder pain. After the most common causes of shoulder pain were investigated and ruled out, further evaluation with an X-Ray, magnetic resonance imaging (MRI) scan, and biopsy revealed that B-cell lymphoma was the unlikely source of the pain. The patient received appropriate chemotherapy and achieved remission, as confirmed by a positron emission tomography scan. CONCLUSIONS This case highlights the uncommon clinical presentation of DLBCL with isolated shoulder pain. With primary bone DLBCL accounting for less than 2% of bone malignancies involving structures such as the femur, humerus, vertebra, and pelvis, this case reiterates the importance of further investigations and the possibility that bone pain may be the only clinical presentation of an underlying lymphoma. Examination by X-ray, MRI, and bone biopsy should be done to confirm diagnosis, followed by treatment with combined chemotherapy and immunotherapy.

Manifestation of Pleomorphic Undifferentiated Aortic Sarcoma with Splenic Infarction: A Case Report.

Aortic spindle cell sarcoma is a rare neoplasm with poor prognosis that is often found incidentally due to its adverse effects. CT and MRI with contrast are useful imaging modalities, but a tissue biopsy is the gold standard for diagnosis. Tumor resection is the ultimate treatment followed by chemotherapy. Our case was an adult female who presented mainly for shortness of breath, and further imaging workup demonstrated a soft tumor juxtaposed to a major vein with compressive effect. The patient's tumor was resected, and the pathology result confirmed undifferentiated aortic sarcoma. The patient's condition improved and she was discharged with outpatient oncology follow-up and possible treatment.

Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection: A case report.

RATIONALE: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. PATIENT CONCERNS: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. DIAGNOSIS: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. INTERVENTIONS: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. OUTCOMES: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. LESSONS: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.

Spontaneous Recurrent Pneumoperitoneum due to Opioid-Induced Constipation: A Case Report.

Long-term treatment with or addiction to methadone and other opiates can lead to serious complications such as opioid-induced constipation (OIC). Here we report a case where a long-term opioid user presents in the ER in respiratory distress. Radiographic findings concerning pneumoperitoneum and cooperation with specialists lead to a diagnosis of stercoral colitis with possible micro-perforations. Through fecal disimpaction and counseling on chronic opioid use, the patient initially improved, but consecutively had a fatal outcome.

Primary Pyomyositis: Contact Sports as the Rare Risk Factors.

Primary pyomyositis is an infectious disorder that mostly involves children and adults. Direct injury to the muscle or any traumatic process that can cause bacteremia has been described as the common risk factor. Contact sports without direct contusion or injury to the muscle is an uncommon culprit for the manifestation of this disease. In our case, a young male athlete presented to the emergency room with vague signs and symptoms including right leg muscle pain and fever. He denied any direct injury or contusion of the muscle. CT scan was done and showed edematous gluteus minimus muscle. MRI as one of the best tools for investigating soft tissues was done and exhibited myositis. Blood culture became positive for the methicillin-susceptible Staphylococcus aureus. Appropriate antibiotics were started, and the patient condition was improved. Considering prominent risk factors, early diagnosis and treatment of pyomyositis are major key factors for the management of these infectious conditions as it may cause loss of the limb or even result in mortality.