Kansas Journal of Medicine最新文献

{"title":"The “Neglected aVR Lead”:  Kounis Syndrome of MINOCA Type, Severe Left Main or 3-Vessel Disease and Type A Dissecting Ascending Aortic Aneurysm","authors":"Nicholas Kounis","doi":"10.17161/kjm.vol17.22352","DOIUrl":"https://doi.org/10.17161/kjm.vol17.22352","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"31 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Long-Term Neurologic Sequelae Among Trauma Patients who Received Flexion-Extension Radiographs","authors":"Shelby Durler, Kelly L. Lightwine, Elizabeth Ablah, Thomas Cox, James M Haan","doi":"10.17161/kjm.vol17.21379","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21379","url":null,"abstract":"Introduction. This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs. \u0000Methods. Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up.\u0000Results. Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation.\u0000Conclusions. The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury. ","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"52 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Cuff Dehiscence after Robotic Hysterectomy in Endometrial Cancer vs. Non-Cancer Patients","authors":"Paige Nichols, Adrienne Esposito, Maria Kolojeski, Jennifer Keomany, Hayrettin Okut, Jacqueline Morgan, Kevin Miller","doi":"10.17161/kjm.vol17.21651","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21651","url":null,"abstract":"Introduction: Vaginal cuff dehiscence (CD) after hysterectomy is a relatively uncommon but potentially serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for benign and malignant indications. This study aimed to determine if there is a difference in the incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer.\u0000Methods: This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from 2013 through 2018. Patients who underwent conversion to laparotomy, chemotherapy and/or radiation within a year before or after RLTH, and with malignancies other than uterine cancer were excluded. Data were abstracted from patient medical records.\u0000Results: Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While controlling for other variables, obese patients were 25.1% less likely than non-obese patients to experience CD (p=.011). Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon A compared to surgeon B (p=0.027). No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD.\u0000Conclusions: Endometrial cancer patients were not at greater risk of experiencing CD compared to non-cancer patients. Surgeon differences and BMI were associated with incidence of CD, and patients with a normal BMI were most likely to report experiencing CD.","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"50 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141807667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Extensive Cholangiocarcinoma Highlighting Challenges in Diagnosis and Treatment","authors":"Wissam Karam, Timothy Nguyen, William Salyers","doi":"10.17161/kjm.vol17.21875","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21875","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"24 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Obligation of Adequate Pain Management in Long Term Care Residents with Dementia","authors":"Donna Ewy","doi":"10.17161/kjm.vol17.22135","DOIUrl":"https://doi.org/10.17161/kjm.vol17.22135","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"60 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Leclercia adecarboxylata Pyogenic Arthritis","authors":"Hitanshu Dave, Lawrence Zhou, Deva Zamzow, Robert Wittler","doi":"10.17161/kjm.vol17.20588","DOIUrl":"https://doi.org/10.17161/kjm.vol17.20588","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk.","authors":"Bradley J Newell, Ashley M Kells, Amy D Robertson, Tasha M Braun, Kimberly S Ward, Brent J Rohling, Brittany L Melton","doi":"10.17161/kjm.vol16.18514","DOIUrl":"10.17161/kjm.vol16.18514","url":null,"abstract":"<p><strong>Introduction: </strong>Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population.</p><p><strong>Methods: </strong>This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found.</p><p><strong>Results: </strong>A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol.</p><p><strong>Conclusions: </strong>Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"88-93"},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/e7/16-88.PMC10136613.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Dispositions Toward Noninvasive Non-Hormonal Contraception.","authors":"Alexandra V Davidson, Faith M Butler","doi":"10.17161/kjm.vol16.18958","DOIUrl":"10.17161/kjm.vol16.18958","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols. They are preferred by some patients due to medical contraindications to hormonal contraceptives, lack of side effects, religious convictions, preference to avoid hormones or contraceptive devices, improved body literacy, or a combination of the above. FABMs are infrequently covered in medical school curricula and are often perceived by physicians to be of low efficacy. There is an opportunity for improvement of physicians' evidence-based knowledge of FABMs, which has the potential to improve patient understanding of and access to the full menu of family planning options.</p><p><strong>Methods: </strong>A self-administered, cross-sectional survey was distributed to assess physician knowledge and opinions of FABMs by key university contacts. Univariate and bivariate statistics were calculated for close-ended questions and responses to open-ended questions were analyzed for common themes.</p><p><strong>Results: </strong>A total of 79 participants completed the entire survey. Another 11 submitted partially completed surveys. For completed surveys, questions assessing knowledge of key concepts underlying FABMs, performance by specialty was 55% correct for OB/GYN (n = 16), 55% (n = 47) correct for family medicine, 36% (n = 10) correct for internal medicine, and 35% (n = 6) correct for pediatrics. Negative, neutral, mixed, and positive opinions related to FABMs were represented.</p><p><strong>Conclusions: </strong>There are opportunities to improve physicians' evidence-based knowledge of FABMs; this may improve patient-centered contraceptive care.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"94-104"},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/44/16-94.PMC10136678.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Series of Spouses Undergoing Rapid Micro-Induction Technique of Buprenorphine Initiation from Methadone.","authors":"Kyle R Rampetsreiter, Iryna Salapenka, Jaya Sri Konakanchi, Jordan Anders, Roopa Sethi","doi":"10.17161/kjm.vol16.18433","DOIUrl":"10.17161/kjm.vol16.18433","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/9c/16-74.PMC10035645.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Post-Operative Pain in Orthopedic Patients: An International Comparison.","authors":"Jack M Ayres, Johnathan Dallman, Jack A Nolte, Nicholas Higginbotham, Jordan Baker, Greg Horton, Jonathon Salava, John Sojka, Kimberly J Templeton, Radu Ioan Malancea, Archie Heddings","doi":"10.17161/kjm.vol16.18744","DOIUrl":"10.17161/kjm.vol16.18744","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences.</p><p><strong>Methods: </strong>Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed.</p><p><strong>Results: </strong>Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients.</p><p><strong>Conclusions: </strong>Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"56-60"},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/5f/16-56.PMC9957592.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}