A case of pituitary gland abscess associated with granulomatous hypophysitis.

BACKGROUND: Granulomatous hypophysitis is a rare disease that presents with chronic inflammation of the pituitary gland. In this study, we reported a case of granulomatous hypophysitis associated with a pituitary abscess. CASE PRESENTATION: A 39-year-old woman presented with a 2-year history of infertility. For the past six months, she has suffered from amenorrhea, decreased libido, headaches, and vertigo. She was referred to our hospital with a suspected diagnosis of nonfunctioning pituitary adenoma based on her presentation and brain MRI findings. She underwent trans-sphenoidal surgery (TSS). Direct observation during surgery revealed drainage of malodor pus and pituitary gland abscess. The histopathological evaluation also showed granulomatous hypophysitis and neutrophilic microabscess formation. The patient was initially treated with high doses of ceftriaxone (2 g twice daily) and metronidazole (500 mg (mg) four times per day). Also, the patient received cortisol replacement therapy after the operation. After obtaining the antibiogram and culture results, the treatment regimen was continued for 4 weeks postoperatively, followed by amoxicillin-clavulanate (500/125 mg three times daily) for a total duration of 12 weeks. CONCLUSION: The patient recovered uneventfully and the postoperative MRI was normal without any remnant lesions.

Education and Training on Electronic Medical Records (EMRs) for health care professionals and students: A Scoping Review.

BACKGROUND AND OBJECTIVES: The ability of health care providers and students to use EMRs efficiently can lead to achieving improved clinical outcomes. Training policies and strategies play a major role in successful technology implementation and ongoing use of the EMR systems. To provide evidence-based guidance for developing and implementing educational interventions and training, we reviewed and summarized the current literature on EMR training targeting both healthcare professionals (HCP) and students. METHODS: We used the Joanna Briggs Institute (JBI) approach for scoping reviews and the PRISMA extension of scoping reviews (PRISMA-ScR) checklist for reporting our review. 46 full-text articles that met the eligibility criteria were selected for the review. Narrative synthesis was performed to summarize the evidence using numerical and descriptive analysis. We used inductive content analysis for categorizing the training methods. Also, the modified version of the Kirkpatrick's levels model was used for abstracting the training outcome. RESULTS: Five types of training methods were identified: one-on-one training, peer-coach training, classroom training (CRT), computer-based training (CBT), and blended training. A variety of CBT platforms were used, including a prototype academic electronic medical record system (AEMR), AEMR/simulated EMR (Sim-EMR), mobile based AEMR, eLearning, and electronic educational materials. Each training intervention could have resulted in several outcomes. Most outcomes were related to levels 1-3 of the Kirkpatrick model that involves learners (n = 108), followed by level 4a that involves organizations (n = 7), and lastly level 4b that involves patients (n = 1). The outcomes related to participants' knowledge (level 2b) was the most often measured training outcome (n = 44). CONCLUSIONS: This review presents a comprehensive synthesis of the evidence on EMR training. A variety of training methods, participants, locations, strategies, and outcomes were described in the studies. Training should be aligned with the particular training needs, training objectives, EMR system utilized, and organizational environment. A training plan should include an overall goal and SMART (Specific, Measurable, Achievable, Realistic, Tangible) training objectives, that would allow a more rigorous evaluation of the training outcomes.