Kansas Journal of Medicine最新文献

{"title":"Air Embolism as a Complication of Lung Biopsy and IV Contrast Administration.","authors":"Wissam Karam, Atiyeh Samadi, Eric Acosta, 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":"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}

{"title":"2021 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System.","authors":"Stephen L Thornton,&nbsp;Lisa K Oller,&nbsp;Kathy White,&nbsp;Robert Stockdale,&nbsp;Elizabeth Silver","doi":"10.17161/kjm.vol16.19525","DOIUrl":"https://doi.org/10.17161/kjm.vol16.19525","url":null,"abstract":"<p><strong>Introduction: </strong>This is the 2021 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC serves the state of Kansas 24-hours a day, 365 days a year with certified specialists in poison information and clinical and medical toxicologists.</p><p><strong>Methods: </strong>Encounters reported to the KSPCC from January 1, 2021 through December 31, 2021 were analyzed. Data recorded includes caller demographics, exposure substance, nature and route of exposure, interventions, medical outcome, disposition, and location of care.</p><p><strong>Results: </strong>The KSPCC logged 18,253 total encounters in 2021, including calls from every county in Kansas. A majority of human exposure cases (53.6%) were female. Approximately 59.8% were pediatric exposures (defined as 19 years of age or less). Most encounters occurred at a residence (91.7%) and most were managed there (70.5%). Unintentional exposures were the most common reason for exposures (70.5%). The most common reported substance in pediatric encounters was household cleaning products (n = 815) and cosmetics/personal care products (n = 735). For adult encounters, analgesics (n = 1,241) and sedative/ hypnotics/antipsychotics (n = 1,013) were the most frequently reported. Medical outcomes were 26.0% no effect, 22.4% minor effect, 10.7% moderate effect, and 2.7% major effects. There were 22 deaths.</p><p><strong>Conclusions: </strong>The 2021 KSPCC annual report demonstrated that cases were received from the entire state of Kansas. Pediatric exposures remained most common but cases with serious outcomes continued to increase. This report supported the continued value of the KSPCC to both public and health care providers in the state of Kansas.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"121-130"},"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/9c/62/16-121.PMC10241204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963431","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":"Infection and Recurrence Rates in Rural Inguinal Hernia Repair.","authors":"Brooke Fowler,&nbsp;Dorothy Hughes","doi":"10.17161/kjm.vol16.18552","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18552","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal hernia repair (IHR) is a common procedure performed by general surgeons in rural community hospitals. Infection and recurrence rates for three types of IHR over two years at a rural Kansas hospital were analyzed. Previous research has shown outcomes regarding pain at six weeks were typically no different, and neither were long-term results, between open and laparoscopic techniques. However, there were fewer data showing the outcomes of these three hernia repair approaches in rural settings.</p><p><strong>Methods: </strong>This was a retrospective, cross-sectional study using data collected from the electronic medical record (EMR) of a small hospital in central Kansas. Data from adult patients who had undergone IHRs over a two-year period (2018-2019) were deidentified and described using frequencies and percentages. This study used multi-variate logistic regression to examine the association of patient, surgeon, and surgical procedure characteristics on the occurrence of post-operative complications.</p><p><strong>Results: </strong>Of the patients who received IHR, 46 were male and 5 were female. Mean age was 66 years, with a minimum of 34 and maximum ≥ 89 years. There were 14 total post-operative complications; two were superficial infections. There were no recurrences.</p><p><strong>Conclusions: </strong>The sample size for each procedure type was too small to allow for statistical testing. However, the hospital had no recurrences. Future research should follow-up with this and other rural hospitals and perform a direct comparison of hernia surgery outcomes with those at a larger, more urban hospital, to understand potential differences by hospital size.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"65-68"},"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/45/3f/16-65.PMC10035649.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192180","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":"Evaluation of Outcomes and Treatment Options Among Trauma Patients with Abdominal Vascular Injuries.","authors":"David Kurt,&nbsp;Chad Ammar,&nbsp;Elizabeth Ablah,&nbsp;Kelly Lightwine,&nbsp;Hayrettin Okut,&nbsp;Liuqiang Lu,&nbsp;James M Haan","doi":"10.17161/kjm.vol16.18711","DOIUrl":"https://doi.org/10.17161/kjm.vol16.18711","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal vascular injuries are associated with significant morbidity and mortality. Treatment options include non-operative management, open repair, and endovascular procedures. This study aimed to characterize patients and detail treatment modalities among those who sustained a traumatic abdominal vascular injury.</p><p><strong>Methods: </strong>A six-year descriptive retrospective study was conducted at a level 1 trauma center and included all adult patients who sustained an abdominal vascular injury. Data abstracted included demographics, admitting characteristics, mechanism of injury, admitting vitals, injury details, diagnostic and treatment information, hospital course, and follow-up data.</p><p><strong>Results: </strong>Fifty-seven patients were admitted with abdominal vascular injuries, however, 14 patients sustained injuries to smaller vascular branches and were excluded. Most vascular injuries involved the iliac artery (27.9%, n = 12), abdominal aorta (25.6%, n = 11), and inferior vena cava (25.6%, n = 11). Twenty-seven percent (n = 12) of patients sustained an injury to more than one vascular structure. Thirty-four percent of patients (n = 15) died before treatment of the abdominal vascular injury. Among the 28 patients (65.1%) treated for their vascular injuries, 46.4% (n = 13) were treated with open surgery, 32.1% (n = 9) were treated non-operatively, and 21.4% (n = 6) with coil embolization. Sixty-four percent of the patients (n = 18) who survived to discharge presented for follow-up care with a mean follow-up period of 3 ± 4.1 months. There were no vascular reinterventions after discharge for patients who followed up with our hospital.</p><p><strong>Conclusions: </strong>Study findings suggested that appropriately selected cases of traumatic vascular injuries may be managed non-operatively and safely, as there were no mortalities, complications, or reinterventions among these patients.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"11-16"},"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/ba/5e/16-11.PMC9872503.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632361","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}