A Resident-Led Quality Improvement Initiative to Increase End-of-Life Planning in Primary Care.

Despite many benefits of end-of-life (EOL) planning, only 1 in 3 adults has EOL documentation, with low rates in resident primary care clinics as well. To increase clinic completion of life-sustaining treatment (LST) notes and advance directives (AD) for veterans at highest risk for death. The setting was a Veterans Affairs (VA) internal medicine primary care clinic.

Breaking Patterns: A Case of Dieulafoy Lesion in a Young Patient Without Comorbid Conditions.

A Dieulafoy lesion is an abnormal artery located in the gastric submucosa that represents a rare cause of upper gastrointestinal bleeding. These lesions typically present as massive hemorrhages in older patients, with multiple medical comorbidities. The lesions are diagnosed with endoscopy and treated with hemostasis by clip placement or coagulation.

Resident-led improvement project to screen for primary hyperaldosteronism in patients with resistant hypertension in an outpatient clinic.

Clinical practice guidelines recommend screening for primary hyperaldosteronism (PH) in patients with resistant hypertension. However, screening rates are low in the outpatient setting. We sought to increase screening rates for PH in patients with resistant hypertension in our Veterans Affairs (VA) outpatient resident physician clinic, with the goal of improving blood pressure control.

Optimizing Nutrition to Enhance the Treatment of Patients With Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) consists of chronic, relapsing-remitting autoimmune diseases of the gastrointestinal (GI) tract with an increasing global disease burden. Pathogenetic mechanisms are not well understood, but current hypotheses involve the role of environmental factors, including dietary antigens, in immune dysregulation and proinflammatory shifts in microbial composition (gut dysbiosis) in genetically susceptible individuals. Increased metabolic demand and malabsorption secondary to systemic inflammation, coupled with significant GI symptoms that lead to reduced oral food intake, may leave patients with IBD vulnerable to developing malnutrition.

Recurrent infection in an HIV+ patient.

Although infection with is often subclinical, some infections persist for decades due to the parasite's autoinfective lifecycle. Hyperinfection syndrome, however, characterized by a massive increase in parasite burden as a result of host immunosuppression causes a myriad of clinical symptoms and is associated with high mortality. Use of corticosteroids and infection with HTLV-1 virus are the biggest traditional risk factors for hyperinfection syndrome, though its development can occur with virtually any degree of immunosuppression.

Male infertility rate: a retrospective study.

Introduction: Worldwide, male responsible infertility is on the rise. In this retrospective study, we evaluated the infertility rate of this area.

Materials And Methods: Cases reported from 1989 to 1993 to the Institute for Post Graduate Teaching and Research in Ayurved University were studied.

Level of copper in human split ejaculate.

Purpose: The purpose of this study was to understand the details of splits of an ejaculate and to locate the origin of release of copper into semen.

Methods: Laboratory methods routinely followed for semen analysis were carried out. Copper was estimated by employing atomic absorption spectrophotometry.