Solitary CNS Metastasis on Initial Presentation of High Grade Serous Carcinoma of the Fallopian Tube.

A 68-year-old woman presented with a three-week history of confusion and anomic aphasia. Imaging of her head demonstrated a single large left frontal mass. Pathology revealed metastatic adenocarcinoma of Müllerian origin. Subsequent surgery revealed a small primary site in a fallopian tube, high left para-aortic lymphadenopathy, and no disseminated intraperitoneal disease. This case was remarkable in that CNS metastasis was her presenting symptom and was restricted to a solitary brain lesion, and other disease sites were limited to retroperitoneal lymphadenopathy and a small fallopian tube primary.

Assessing written communication during interhospital transfers of emergency general surgery patients.

BACKGROUND: Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. METHODS: We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. RESULTS: A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. CONCLUSIONS: This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers.

Predictors of chronic pain in traumatically injured hospitalized adult patients.

It is unclear what causes chronic pain in traumatically injured hospitalized adults. A total of 101 patients admitted to a level 1 trauma center completed interviews during their inpatient stay and at 4 months, and data on biologic, psychologic, and sociologic variables were collected. Statistical analysis used hierarchical logistical regression,χ, and independent-samples t tests. Prevalence of chronic pain at 4 months was 79.2%. Those with chronic pain at 4 months had more posttraumatic stress disorder, anxiety, and depression. High initial pain score was the only significant predictor of chronic pain. Initial pain intensity predicts chronic pain.