Documenting chaplain involvement: a pilot project exploring Pastoral Care and the integration of data science in a Central Florida Hospital.

This paper intends to outline a data integration response to the demands placed on the pastoral care department through the COVID-19 pandemic. Uniquely, these demands accelerated the need to implement documentation of care directed towards staff to complement the data derived from patient visitation. The motivation for this initiative is in part, to provide a complete picture of the care provided by hospital chaplains using an evidence-based approach through the implementation of data science.

Prevalence and risk factors for sleep disordered breathing in a Puerto Rican middle-aged population.

BACKGROUND: The Berlin Questionnaire [an outcome of a primary care physicians' conference held in Berlin, Germany, in 1996 that was created to identify patients at high risk for sleep disordered breathing (SDB)] was administered to a representative sample of middle-age population in Puerto Rico in order to document the prevalence of SDB and its associated risk factors. MATERIALS AND METHODS: The island was divided in six regions to maintain heterogeneity and to have a representative sample of the population per region. Puerto Rican subjects between 30-60 years old were recruited in shopping malls, and questionnaires were filled. For each subject, body weight, neck circumference, and height were measured. Information regarding the diagnosis of hypertension was based upon a positive or negative response from study subject in a questionnaire. Data was collected for 6 months. RESULTS: A total of 290 subjects, all of Puerto Rican origin, were interviewed. Fifty-eight percent of the evaluated sample was found at high risk of SDB. Being male, hypertensive, and obese were the strongest risk factors for the development of SDB. In women, a neck size above 15 cm was a significant risk factor. CONCLUSIONS: This is the first time a prevalence study for SDB is done among a representative sample of subjects of Puerto Rican origin. It is the first step in documenting how SDB affects this ethnic group.

Ludwig's angina: an uncommon cause of chest pain.

A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. Neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, Ludwig's angina remains a potentially lethal infection in which early recognition plays a crucial role.

Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial.

CONTEXT: Gulf War veterans' illnesses (GWVI), multisymptom illnesses characterized by persistent pain, fatigue, and cognitive symptoms, have been reported by many Gulf War veterans. There are currently no effective therapies available to treat GWVI. OBJECTIVE: To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI. DESIGN, SETTING, AND PATIENTS: Randomized controlled 2 x 2 factorial trial conducted from April 1999 to September 2001 among 1092 Gulf War veterans who reported at least 2 of 3 symptom types (fatigue, pain, and cognitive) for more than 6 months and at the time of screening. Treatment assignment was unmasked except for a masked assessor of study outcomes at each clinical site (18 Department of Veterans Affairs [VA] and 2 Department of Defense [DOD] medical centers). INTERVENTIONS: Veterans were randomly assigned to receive usual care (n = 271), consisting of any and all care received from inside or outside the VA or DOD health care systems; CBT plus usual care (n = 286); exercise plus usual care (n = 269); or CBT plus exercise plus usual care (n = 266). Exercise sessions were 60 minutes and CBT sessions were 60 to 90 minutes; both met weekly for 12 weeks. MAIN OUTCOME MEASURES: The primary end point was a 7-point or greater increase (improvement) on the Physical Component Summary scale of the Veterans Short Form 36-Item Health Survey at 12 months. Secondary outcomes were standardized measures of pain, fatigue, cognitive symptoms, distress, and mental health functioning. Participants were evaluated at baseline and at 3, 6, and 12 months. RESULTS: The percentage of veterans with improvement in physical function at 1 year was 11.5% for usual care, 11.7% for exercise alone, 18.4% for CBT plus exercise, and 18.5% for CBT alone. The adjusted odds ratios (OR) for improvement in exercise, CBT, and exercise plus CBT vs usual care were 1.07 (95% confidence interval [CI], 0.63-1.82), 1.72 (95% CI, 0.91-3.23), and 1.84 (95% CI, 0.95-3.55), respectively. The OR for the overall (marginal) effect of receiving CBT (n = 552) vs no CBT (n = 535) was 1.71 (95% CI, 1.15-2.53) and for exercise (n = 531) vs no exercise (n = 556) was 1.07 (95% CI, 0.76-1.50). For secondary outcomes, exercise alone or in combination with CBT significantly improved fatigue, distress, cognitive symptoms, and mental health functioning, while CBT alone significantly improved cognitive symptoms and mental health functioning. Neither treatment had a significant impact on pain. CONCLUSION: Our results suggest that CBT and/or exercise can provide modest relief for some of the symptoms of chronic multisymptom illnesses such as GWVI.

Tuberculosis prevention questionnaire: common practices among pulmonary medicine and infectious disease specialists in Puerto Rico

A survey about tuberculosis infection status, surveillance and protection practices among pulmonologists and infectologists was performed.A fourteen-item questionnaire was mailed. The survey was addressed to 108 pulmonologists and 61 infectologists. Responses were collected from 35 pulmonologists (32 percent) and 18 infectologists (29 percent). Sixteen out 35 pulmonologists had a positive tuberculin test (TST) (46 percent). Nine of fourteen took at least 6 months of preventive therapy with isoniazid when converted. Three out of eighteen infectologists had a positive TST. 63 percent of the pulmonologists and 38 percent of the infectologists evaluate their TST every 12 months. 40 percent of the pulmonologists and 66 percent of the infectologists answered that they treat more than ten patients with tuberculosis annually. Interestingly, 50 percent of the responder bronchoscopists use surgical masks instead of recommended HEPA filter masks. 73 percent of the responders reported not having negative pressure rooms when performing procedures. Despite stamped-addressed envelopes and the relation of these professionals with the related issue, low participation was observed.Among the responders a low frequency of TST was observed, especially in those exposed to higher-risk procedures. Non-adequate facilities and lack of use of protective equipment was reported. Even though not representative of the entire medical community the results of this survey are concerning regarding educational and safety policies of our professionals and institutions

Asthma knowledge among internal medicine residents

OBJECTIVES: To assess the medical knowledge about asthma among residents from the Accreditation Council on Graduate Education (ACGME) accredited Internal Medicine programs. BACKGROUND: Asthma prevalence and morbidity has increased significantly in the last 20 years. Recent morbidity data suggests that approximately 14 to 15 million Americans suffer from asthma and 5,000 of them die annually due to this illness. Previous studies have suggested that Puerto Ricans are disproportionally affected by asthma. In order to impact both morbidity and mortality relates to asthma, primary care givers should be knowledgeable about the disease. METHODS: Based in the 1993 National Heart, Lung and Blood Institute (NHLBI) guidelines, a questionnaire was developed to evaluate the knowledge of asthma in physicians in the Internal Medicine Residency Programs. It consisted of 27 questions covering the areas of diagnosis and treatment of asthma. RESULTS: The questionnaire was answered by 90 per cent of the 138 residents active at the moment of the study. Fifty-one percent of the residents failed to obtain a score of 70 per cent or greater. Score on asthma diagnosis was less than 70 per cent and did not improve through year of training. Score obtained on asthma treatment improved through training year although no statistical difference was obtained. CONCLUSIONS: In view of these results it is imperative to reinforce the state of the art asthma education of physicians. Research initiatives must evaluate educational strategies to improve asthma education