COVID-19 Vaccine Hesitancy Among Healthcare Providers.

Objective: Vaccine hesitancy among healthcare providers can compromise public confidence in vaccination during the ongoing COVID-19 global epidemic and increase susceptibility to life-threatening disease. We sought to investigate predictors of openness to vaccination among healthcare workers who choose not to be vaccinated against COVID-19 in order to explore potential solutions. Methods: Physicians, physician assistants, and nurses who chose not to be vaccinated were surveyed to decipher reasons for vaccine refusal and personal loss due to the virus along with demographic variables. Multivariate logistic regression analysis evaluated whether provider role, parenthood, and death of family or friends were associated with strong versus relative vaccine refusal. Results: The predominant reasons for vaccine hesitancy in this cohort of health care workers who had access to, but chose not to be vaccinated (n=500) were a concern for vaccine side effects (69.6%) and the belief that the vaccines are inadequately studied (61.6%). Being a physician, a parent, and having no experience of death in the family or friends had 2.64 times (95% CI: 1.65-4.23, p < 0.001), 1.72 times (95% CI: 1.05-2.81, p = 0.032), and 1.70 times (95% CI: 1.06-2.72, p = 0.028) the odds of strong vaccine refusal, respectively. Older age (35 and up) respondents were 1.83 times (95% CI: 1.24-2.68, p = 0.002) more likely to be open to vaccination.

The Emergency Department Patient Experience: In Their Own Words.

In this paper, the authors review the verbatim comments from patients' post-emergency department discharge survey results and highlight the impact that doctors and nurses have on the patient's experience. This paper also explores the benefits of delivering a positive experience on patients, clinicians, and healthcare systems. Many interventions that have worked are simple to implement and do not tend to require significant capital investment while having the potential of improving emergency department encounters for all those involved. There are always limitations, selection biases, and issues with generalizability in reviewing retrospective and subjective survey response data.

Symptomatic Pulmonary Hamartoma.

Pulmonary hamartoma is the most common benign tumor of the lungs. It is most often asymptomatic and is discovered incidentally. The condition is two to three times more common in men and is usually seen in the sixth to seventh decade of life. The authors present the case of a 44-year-old female in whom the condition was symptomatic, causing cough, shortness of breath, and fatigue. This case is unusual in that it occurred in a woman in her 40s and was symptomatic. The authors discuss the presentation, clinical features, and management of pulmonary hamartoma.

Gallbladder Hydrops.

The authors describe the case of a middle-aged female who presented to the emergency department with exquisite right upper quadrant pain. Computed tomography scan of the abdomen revealed a hydropic gallbladder, confirmed with abdominal ultrasonography. The clinical presentation, imaging findings, and management of this interesting condition are discussed.

Anterior Shoulder Dislocation Complicated by Hill-Sachs Lesion.

We present the case of a 60-year-old woman with a Hill-Sachs lesion caused by an anterior shoulder dislocation (SD) as a result of her falling on her left shoulder at a local restaurant. While the diagnosis of an anterior SD is commonplace, the involvement of a Hill-Sachs lesion can complicate the treatment needed to manage the SD. Crucial aspects of treatment include performing closed reduction followed by acute immobilization in a timely manner and prompt consultation with orthopedic surgery.

Bilateral Pulmonary Emboli on Dabigatran.

We present the case of a 44-year-old female who presented to the emergency department (ED) via emergency medical services with a chief concern of shortness of breath and was found to have bilateral pulmonary emboli (PE) while taking the direct oral anticoagulant dabigatran. The authors highlight the importance of considering PE even in patients who are on anticoagulation.

Hematemesis Secondary to Complex Incarcerated Pantaloon Hernia.

Hematemesis with concomitant small bowel obstruction is an uncommon emergency department presentation. We report the case of a patient who presented with hematemesis and an incarcerated pantaloon hernia. While the patient initially had intact bowel movements and flatus, he eventually developed complete obstruction that required open surgical repair. In a patient with an incarcerated hernia and a history of recurrent small bowel obstruction, predicting strangulation or compromised bowel and the need for rapid surgical intervention can be difficult. Hematemesis concurrent with hernia incarceration may be suggestive of impending complete bowel obstruction and ischemia.