demystifying-venous-excess-ultrasound-vexus-image-acquisition

Demystifying Venous Excess Ultrasound (VExUS): Image Acquisition and Interpretation

Providers in many medical specialties must accurately assess the hemodynamic circuit to deliver appropriate patient care. Venous congestion is ...

Hospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials.

Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study.

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician's evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.

Point-of-care ultrasound in diagnosis and management of congestive nephropathy.

The Rethinking Incarceration and Empowering Recovery (RIvER) Clinic was launched in June 2021 to address the health disparities experienced during and after incarceration. The RIvER Clinic's multidisciplinary, community-centered team engages patients during jail detention and after release via telehealth, collocated in community locations, on a mobile van, and in clinic. The clinic serves as a bridge between incarceration and the establishment of permanent health care and social services in the community. In 2022, a total of 479 visits were completed. The clinic provided multidisciplinary substance use support to all eligible patients, paying for 104 medication for opioid use disorder (MOUD) prescriptions for uninsured patients. Twenty-five percent of patients were transitioned to community-based care, and less than 5% of patients were reincarcerated. Despite some limitations, results demonstrate that the RIvER Clinic is successfully reintegrating a marginalized population into its community. The purpose of this article is to describe the implementation and preliminary outcomes of this postincarceration clinic.

RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic.

Glycogen storage disease type 1A (GSD1A), also known as Von Gierke's disease, is a rare autosomal recessive disorder affecting glycogen metabolism in the liver. It most commonly presents in infancy with hypoglycaemia and failure to thrive, but cases have been reported as undiagnosed until adulthood. A woman in her early 20s with diabetes mellitus presented with right upper quadrant pain and was found to have several haemorrhagic hepatic adenomas. This patient had insulin-dependent diabetes since a pancreatectomy at age 9 months due to continued episodes of hypoglycaemia and suspected insulinoma. During the hospital stay, the hepatic adenomas were embolised, but significant lactic acidosis and hypoglycaemia continued. Further workup revealed a chronic lactic acid level, during several hospital stays, of above 5 mmol/L. After cytology of hepatic tissue ruled out hepatocellular carcinoma, the patient was discharged and recommended to follow-up for genetic testing, which confirmed the diagnosis of GSD1A.

Previously undiagnosed genetic disease in adult patient with hepatic masses and reported history of congenital hyperinsulinism.

Hepatitis C (HCV) can be treated in the primary care setting; however, most patients are referred to subspecialists. Marginalized populations may be refused treatment due to stigma or substance use. We aimed to treat HCV in these high-risk patients, and prevent a delay in time from diagnosis to the time of treatment and sustained virologic response (SVR), by utilizing a multidisciplinary treatment team in a primary care clinic. Outcomes assessed included achieving SVR at 3 months, time from diagnosis to treatment initiation, and liver fibrosis stage compared between cohorts with previous subspecialty referral and those treated initially from primary care. Among the 32 patients who initiated treatment, 29 (90.6%) completed the regimen and 27 (84.3%) had documented SVR. Patients treated in a primary care setting without prior referral had a significantly shorter median time from viral load testing to treatment initiation (161 days), compared to those who were previously referred (median time of 954 days). Aggregated fibrosis scores suggest those referred to subspecialists had significantly higher scores. We demonstrate successful HCV treatment in primary care achieving SVR, and a decrease in the median days between viral load and treatment initiation, with lower fibrosis scores.

Outcomes of Low Barrier Hepatitis C Treatment in High Risk Populations From Primary Care.

The incidence of babesiosis is increasing and clinicians should have a high index of suspicion due to its diagnostic challenges and variable disease course, from asymptomatic infection to fulminant disease. We present a case of fatal secondary hemophagocytic lymphohistiocytosis (sHLH) due to acute babesiosis in a previously healthy adult. We also present a comprehensive review of previously reported sHLH cases triggered by babesiosis. Host factors, such as immunocompromising conditions or medications, appear to be a risk factor for developing sHLH while it is unclear if percent parasitemia of babesia correlates with development or outcomes of HLH. Increasing awareness to improve time to diagnosis is vital for treating both babesiosis and sHLH, while future studies should investigate the role for immunomodulator therapy in this setting.

Article	Year
Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study. Journal of general internal medicine\| PubMed ID: 35657465	2022
Point-of-care ultrasound in diagnosis and management of congestive nephropathy. World journal of critical care medicine\| PubMed ID: 37034023	2023
RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic. Journal of public health management and practice : JPHMP\| PubMed ID: 38603749	2024
Previously undiagnosed genetic disease in adult patient with hepatic masses and reported history of congenital hyperinsulinism. BMJ case reports\| PubMed ID: 38782444	2024
Outcomes of Low Barrier Hepatitis C Treatment in High Risk Populations From Primary Care. Journal of community hospital internal medicine perspectives\| PubMed ID: 39839167	2024
Babesiosis with low parasitemia as a cause of secondary hemophagocytic lymphohistiocytosis in a previously healthy adult. IDCases\| PubMed ID: 39980845	2025

Thomas Robertson

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