Kansas Journal of Medicine最新文献

{"title":"Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Post-Operative Urologic Surgery Patient.","authors":"David M Warnky,&nbsp;Jennifer H Diebolt,&nbsp;Bao V Ho,&nbsp;Aaron D Brake,&nbsp;Emilie L French,&nbsp;Mark R Villwock,&nbsp;Kevin J Sykes,&nbsp;Jennifer A Villwock","doi":"10.17161/kjm.vol16.18742","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18742","url":null,"abstract":"<p><strong>Introduction: </strong>The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient's opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used.</p><p><strong>Methods: </strong>This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables.</p><p><strong>Results: </strong>Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p < 0.001 and 0.643, p < 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, \"Walking outside the room\" significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001).</p><p><strong>Conclusions: </strong>This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"35-40"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/ed/16-35.PMC9957595.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9356975","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":"Impact of Aspirin Supplementation for Pre-Eclampsia Prevention on Neonatal Outcomes.","authors":"Bertha Campo,&nbsp;Joshua Fogel,&nbsp;Sean Na,&nbsp;Lennox Bryson","doi":"10.17161/kjm.vol16.18138","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18138","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-eclampsia negatively affects pregnancy. In 2018, the American College of Obstetricians and Gynecologists (ACOG) updated their low dose aspirin (LDA) supplementation recommendation to include pregnant women at moderate risk for pre-eclampsia. In addition to the potential benefit of LDA supplementation for delaying or preventing pre-eclampsia, LDA supplementation can affect neonatal outcomes. The association of LDA supplementation was studied with six neonatal outcomes in a sample of mostly minority pregnant women from Hispanic and Black race/ethnicities that included those of low, moderate, and high-risk designation for pre-eclampsia.</p><p><strong>Methods: </strong>This was a retrospective study of 634 patients. The main predictor variable was maternal LDA supplementation for six neonatal outcomes: NICU admission, neonatal readmission, one- and five-minute Apgar scores, neonatal birth weight (BW), and hospital length of stay (LOS). Demographics, comorbidities, and maternal high-or moderate-risk designation were adjusted for per ACOG guidelines.</p><p><strong>Results: </strong>High-risk designation was associated with neonatal increased rate of NICU admission (OR: 3.80, 95% CI: 2.02, 7.13, p < 0.001), LOS (B = 0.15, SE = 0.04, p < 0.001), and decreased BW (B = -442.10, SE = 75.07, p < 0.001). No significant associations were found with LDA supplementation or moderate-risk designation for NICU admission, readmission, low one- and five-minute Apgar scores, BW, and LOS.</p><p><strong>Conclusions: </strong>Clinicians recommending maternal LDA supplementation should be aware that LDA supplementation did not appear to provide any benefits for the above neonatal outcomes.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"41-47"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/62/16-41.PMC9957593.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9356982","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":"Air Embolism as a Complication of Lung Biopsy and IV Contrast Administration.","authors":"Wissam Karam,&nbsp;Atiyeh Samadi,&nbsp;Eric Acosta,&nbsp;Zubair Hassan","doi":"10.17161/kjm.vol16.18682","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18682","url":null,"abstract":"71 Air Embolism as a Complication of Lung Biopsy and IV Contrast Administration Wissam Karam, M.D.1, Atiyeh Samadi, M.S.1, Eric Acosta, M.D.1, Zubair Hassan, M.D.1,2 1University of Kansas School of Medicine-Wichita, Wichita, KS Department of Internal Medicine 2Robert J Dole Department of Veterans Affairs Medical Center, Wichita, KS Received Nov. 13, 2022; Accepted for publication Feb. 13, 2023; Published online March 15, 2023 https://doi.org/10.17161/kjm.vol16.18682","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"71-73"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/d3/16-71.PMC10035646.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192181","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":"Disparities in Referral Initiation and Completion at an Urban FQHC Look-alike (FQHC-LA) Clinic.","authors":"Amanda K Emerson,&nbsp;Dorothy Hughes","doi":"10.17161/kjm.vol16.19524","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19524","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to determine referral initiation and completion disparities across primary care encounters at the Hope Family Care Center (HFCC) in Kansas City, MO, by payor type (primary insurance): private insurance, Medicaid, Medicare, and self-pay.</p><p><strong>Methods: </strong>Data were collected and analyzed for all encounters (N = 4,235) over a 15-month period, including payor type, referral initiation and completion, and demographics. Referral initiation and completion were calculated by payor type and differences analyzed using Chi-square tests and t-tests. Logistic regression examined payor type association with referral initiation and completion, accounting for demographic variables.</p><p><strong>Results: </strong>Our analysis showed a meaningful difference in rate of referral to specialists by payor type. The Medicaid encounter referral initiation rate was higher than rates for all other payor types (7.4% vs. 5.0%), and self-pay encounters' referral initiation rate was lower than rates for all other payor types (3.8% vs. 6.4%). Using logistic regression, Medicaid encounters had 1.4 greater odds, and self-pay encounters 0.7 greater odds, of initiating a referral compared to private insurance encounters. There was no difference in referral completion by payor type or demographic category.</p><p><strong>Conclusions: </strong>Equal referral completion rates across payor types suggested HFCC may have had well-established referral resources for patients. Higher referral initiation rates for Medicaid and lower for self-pay may suggest that insurance coverage offered financial confidence when seeking specialist care. Higher odds of Medicaid encounters initiating a referral could imply greater health needs among Medicaid patients.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"131-136"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/20/16-131.PMC10241200.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963430","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":"Not Just a Rash: Herpes Zoster-induced Progressive Cardiac Block.","authors":"Ahmad Mahdi,&nbsp;Grace Nassim,&nbsp;Mahmoud Mahdi,&nbsp;Freidy Eid","doi":"10.17161/kjm.vol16.19522","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19522","url":null,"abstract":"147 Not Just a Rash: Herpes Zoster-induced Progressive Cardiac Block Ahmad Mahdi, M.D.1, Grace Nassim, M.D., MPH1,2, Mahmoud Mahdi, M.D.1, Freidy Eid, M.D., FACC1,3 1University of Kansas School of Medicine-Wichita, Wichita, KS Department of Internal Medicine 2Wesley Medical Center, Wichita, KS 3Cardiovascular Care, P.A., Wichita, KS Received Feb. 14, 2023; Accepted for publication April 24, 2023; Published online June 20, 2023 https://doi.org/10.17161/kjm.vol16.19522","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"147-148"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/4a/16-147.PMC10291977.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10085442","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":"Severe Laryngeal Edema after Extubation with Prior Use of ACEi Medications.","authors":"Ayaan Parikh,&nbsp;Collin S Kitzerow,&nbsp;James Walker","doi":"10.17161/kjm.vol16.18945","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18945","url":null,"abstract":"79 Severe Laryngeal Edema after Extubation with Prior Use of ACEi Medications Ayaan Parikh1, Collin S. Kitzerow, M.D.2, James Walker, M.D.3 1Wichita Collegiate School, Wichita, KS 2University of Kansas School of Medicine-Wichita, Wichita, KS Department of Anesthesiology Received Dec. 21, 2022; Accepted for publication Feb. 13, 2023; Published online March 15, 2023 https://doi.org/10.17161/kjm.vol16.18945","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"79-80"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/19/16-79.PMC10035643.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192177","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":"Locked-In Presentation of Guillain-Barre Syndrome Following SARS-COVID-19 Infection.","authors":"Olivia Moore,&nbsp;Scott McLaren,&nbsp;Felecia Newton","doi":"10.17161/kjm.vol16.18922","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18922","url":null,"abstract":"hyperintensities","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"151-152"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/c6/16-151.PMC10291979.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10085437","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 of Low Ejection Fraction Unrelated to Anthracycline Therapy: Chemo Tells a Fib.","authors":"Deya Alkhatib,&nbsp;Kimberly DeCarr,&nbsp;Issa Pour-Ghaz,&nbsp;Omar Al-Taweel,&nbsp;Buthainah Alhwarat,&nbsp;Addison Bond,&nbsp;Tracy Wineinger,&nbsp;John Alexander,&nbsp;Sharif Kayali,&nbsp;Neeraja Yedlapati,&nbsp;Isaac Rhea","doi":"10.17161/kjm.vol16.19669","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19669","url":null,"abstract":"were obtained using transthoracic echocardiography. AF = atrial fibrillation. AFL = atrial flutter. CMR = cardiac magnetic resonance. GLS = global longitudinal strain. LVEF = left ventricular ejection fraction. R-CHOP = rituximab-cyclo-phosphamide-hydroxydaunorubicin-oncovin-prednisone.","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"176-178"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/a8/16-176.PMC10395767.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939507","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":"Cardiac POCUS: Another Tool in the Armory.","authors":"Rhythm Vasudeva,&nbsp;Abhiram Challa,&nbsp;Nourhan Chaaban,&nbsp;Hamna Shah,&nbsp;Elisha Brumfield,&nbsp;Brent Duran,&nbsp;Mohinder Vindhyal","doi":"10.17161/kjm.vol16.19802","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19802","url":null,"abstract":"<p><strong>Introduction: </strong>This study assessed the educational impact of hybrid cardiac Point of Care Ultrasonography (POCUS) training in a community-based academic setting.</p><p><strong>Methods: </strong>Internal Medicine and Medicine/Pediatrics residents across all post-graduate years (PGY) at a midwestern medical school under-took a structured hybrid (online and hands-on teaching) model of POCUS training. Anonymous surveys with Likert-type scale responses were administered before and after the curriculum. Questions were categorized into domains to assess the residents' interest in learning POCUS, their understanding of fundamental cardiac ultrasound (US) concepts, and their confidence in its application. The authors used Fisher's Exact and t-test, and estimated odds ratios to gauge the impact of the training to achieve net scores above 0 on each domain.</p><p><strong>Results: </strong>A total of 27 and 26 residents completed the pre-and post-training surveys, respectively. Experience with previous cardiac US use showed a positive skew. The training resulted in a significant increase in both, the understanding of the principles, and the residents' confidence in its application. These findings were most significant amongst PGY 2 and 3 residents. Post-training mean scores were similar across all domains for subgroups of PGY level and previous ultrasound experience.</p><p><strong>Conclusions: </strong>Residents displayed greater understanding of the fundamental cardiac ultrasound concepts with improved confidence levels after implementing a structured hybrid teaching model for POCUS. Future studies with objective assessment tools are needed to gauge the clinical impact of POCUS and its adoption rate in clinical practice to guide a recommendation for its incorporation into the residency curriculum.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"172-175"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/8d/16-172.PMC10395770.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939506","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":"Ischemic Stroke in the Setting of Anabolic Androgenic Steroid Use.","authors":"Allan Johnson,&nbsp;William Krogman,&nbsp;John Peterson","doi":"10.17161/kjm.vol16.19507","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19507","url":null,"abstract":"INTRODUCTION Stroke occurs in approximately 795,000 people in the United States every year, with 87% being ischemic.1 Age is an important risk factor for stroke,2 with 62% of stroke patients being ≥ 65 years old, with a 13% 30-day mortality in patients ≥ 85 years old.3 Stroke risk consisted of 87% of important modifiable risk factors and included hypertension, obesity, hyperglycemia, hyperlipidemia, diabetes mellitus, and renal dysfunction.2 Behavioral risk factors included 47% of risk and included smoking, physical inactivity, and diet. While there were overlaps in risk factors for older adults, risk factors for young adults (≤ 50 years old) also included migraine, hormonal contraceptives, and pregnancy, along with other known etiologies such as cervical arterial dissection, vasculitis, hematologic diseases, and substance abuse.4 Anabolic androgenic steroid (AAS) abuse is used for enhancement of athletic performance, physical appearance, and sexual function.5 Adverse effects of AAS usage include secretion suppression of gonadotropins, neuropsychiatric effects, dyslipidemia, hypertension, arrhythmia, erythrocytosis,5 and decreased arterial plasticity.6 This report summarizes an instance of ischemic stroke in a young male who reported using both stanozolol and clenbuterol in preparation for a bodybuilding contest. Written, informed consent was obtained for the publication of this report.","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"141-142"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/36/16-141.PMC10241198.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947171","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}