Kansas Journal of Medicine最新文献

{"title":"Do Two Rights Make a Wrong? A Case Report on Reversible Neurotoxicity Induced by Coadministration of Clozapine and Lithium.","authors":"David D Masolak, Susanna Ciccolari Micaldi","doi":"10.17161/kjm.vol15.18501","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18501","url":null,"abstract":"425 Do Two Rights Make a Wrong? A Case Report on Reversible Neurotoxicity Induced by Coadministration of Clozapine and Lithium David D. Masolak, M.D., Susanna Ciccolari Micaldi, M.D., M.A. University of Kansas School of Medicine-Wichita, Wichita, KS Department of Psychiatry and Behavioral Sciences Received Sept. 12, 2022; Accepted for publication Oct. 20, 2022; Published online Nov. 28, 2022 https://doi.org/10.17161/kjm.vol15.18501","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"425-427"},"PeriodicalIF":0.0,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/f6/15-425.PMC9710508.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35209022","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":"Burnout, Depression, Anxiety, and Stress Among Resident Physicians 18 Months Into the COVID-19 Pandemic: A Cross-Sectional Study.","authors":"Samuel Ofei-Dodoo,&nbsp;Gretchen Irwin,&nbsp;Brynn Wright,&nbsp;Kimberly Krohn,&nbsp;Kimberly Williams,&nbsp;Philip Dooley,&nbsp;Maurice Duggins","doi":"10.17161/kjm.vol15.18420","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18420","url":null,"abstract":"<p><strong>Introduction: </strong>Burnout among resident physicians has been an area of concern that predates the COVID-19 pandemic. With the significant turmoil during the pandemic, this study examined resident physicians' burnout, depression, anxiety, and stress as well as the benefits of engaging in activities related to wellness, mindfulness, or mental wellbeing.</p><p><strong>Methods: </strong>A cross-sectional survey of 298 residents from 13 residency programs sponsored by the University of Kansas School of Medicine-Wichita was conducted in October and November 2021. A 31-item questionnaire measured levels of burnout, depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, one-way ANOVA/Kruskal-Wallis tests, adjusted odds ratios (aOR), and immersion-crystallization methods were used to analyze the data.</p><p><strong>Results: </strong>There was a 52% response rate, with 65.8% (n = 102) of the respondents reporting manifestations of burnout. Those who reported at least one manifestation of burnout experienced a higher level of emotional exhaustion (aOR = 6.73; 95% CI, 2.66-16.99; p < 0.01), depression (aOR = 1.21; 95% CI, 1.04-1.41; p = 0.01), anxiety (aOR = 1.14; 95% CI, 1.00-1.30; p = 0.04), and stress (aOR = 1.36; 95% CI, 1.13-1.64; p < 0.01). Some wellness activities that respondents engaged in included regular physical activities, meditation and yoga, support from family and friends, religious activities, time away from work, and counseling sessions.</p><p><strong>Conclusions: </strong>The findings suggested that the COVID-19 pandemic poses a significant rate of burnout and other negative mental health effects on resident physicians. Appropriate wellness and mental health support initiatives are needed to help resident physicians thrive in the health care environment.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"403-411"},"PeriodicalIF":0.0,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/bb/15-403.PMC9710504.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35209025","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":"Blueprint for Implementing and Improving Eligible Inferior Vena Cava Filter Retrieval Across Institutions.","authors":"Adam S Nygard,&nbsp;Nick M Hanna,&nbsp;Gerre A Fiore,&nbsp;Aaron M Rohr,&nbsp;Adam S Alli,&nbsp;Zach S Collins,&nbsp;Neville R Irani","doi":"10.17161/kjm.vol15.18449","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18449","url":null,"abstract":"<p><strong>Introduction: </strong>Placement of removable inferior vena cava filters (rIVCFs) has increased, but this has not been accompanied by timely removal, with retrieval rates as low as 8.5% at some institutions. Failure to remove rIVCFs that were not medically necessary resulted in increased complications. This study discussed the development of an inferior vena cava (IVC) filter follow-up protocol.</p><p><strong>Methods: </strong>A method to monitor IVC filter placement and retrieval was developed. A weekly report was generated detailing placement and removal of rIVCFs. A standardized retrieval calculator was utilized to determine efficacy of removal. An IVC filter Retrieval Assessment Form was developed. Managing physicians and patients with medically unnecessary filters were sent letters with a retrieval checklist and order form. If not removed within one year, additional letters were sent. Standardized IVC filter reporting templates were created and utilized after insertion of all filters with retrieval status. Letters eventually were built into the electronic medical record for direct routing.</p><p><strong>Results: </strong>From 2015 to 2020, IVC filters were placed in 719 patients. Of those, 58% were eligible for retrieval. Initial rates of rIVCF removal in eligible patients were as low as 30-33% in 2015. The retrieval rate of eligible filters rose to 44% in September 2018. The rate of retrieval rose to 61% in January 2021.</p><p><strong>Conclusions: </strong>Employing a systemic protocol to aid in follow-up of patients following rIVCF placement may improve rates of retrieval. Regular evaluation and revision of the process demonstrated a significant role in achieving an increase in retrieval rates.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"422-424"},"PeriodicalIF":0.0,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/61/15-422.PMC9710506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35208987","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":"Idiopathic Orbital Inflammation Underlying Drug-Associated Thyroid Eye Disease.","authors":"Hythem Abouodah,&nbsp;Stephen L Ambrose,&nbsp;Jordan E Miller,&nbsp;Mary K Mitchell,&nbsp;Jason A Sokol","doi":"10.17161/kjm.vol15.18210","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18210","url":null,"abstract":"380 Idiopathic Orbital Inflammation Underlying Drug-Associated Thyroid Eye Disease Hythem Abouodah, B.S.1, Stephen L. Ambrose, M.D.2, Jordan E. Miller, M.D.2, Mary K. Mitchell, B.A.1, Jason A. Sokol, M.D.2,3 1University of Kansas School of Medicine, Kansas City, KS University of Kansas Eye Center, Prairie Village, KS 2Department of Ophthalmology 3Oculofacial Plastic and Orbital Surgery Received June 15, 2022; Accepted for publication July 13, 2022; Published online Oct. 29, 2022 https://doi.org/10.17161/kjm.vol15.18210","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"380-381"},"PeriodicalIF":0.0,"publicationDate":"2022-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/99/15-380.PMC9612834.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661047","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":"Letter to the Editor: Before Blaming SARS-CoV-2 Infection or Vaccination for Takotsubo, Differentials Should be Ruled out.","authors":"Josef Finsterer,&nbsp;Claudia Stollberger","doi":"10.17161/kjm.vol15.18540","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18540","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"388"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/f0/15-388.PMC9612908.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661049","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":"Acute Chest Pain in an Acute Complicated Pancreatitis with Severe Hypophosphatemia.","authors":"Ahmad Mahdi,&nbsp;Mahmoud Mahdi,&nbsp;Omar M Abdelfattah,&nbsp;Freidy Eid","doi":"10.17161/kjm.vol15.18129","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18129","url":null,"abstract":"Pancreatitis with Severe Hypophosphatemia Ahmad Mahdi, M.D.1, Mahmoud Mahdi, M.D.1, Omar M. Abdelfattah, M.D.2, Freidy Eid, M.D., FACC1,3 1University of Kansas School of Medicine-Wichita, Wichita, KS Department of Internal Medicine 2Morristown Medical Center, Morristown, NJ Department of Internal Medicine 3Cardiovascular Care, P.A., Wichita, KS Received June 6, 2022; Accepted for publication July 26, 2022; Published online Oct. 24, 2022 https://doi.org/10.17161/kjm.vol15.18129","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"383-385"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/f3/15-383.PMC9612909.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661045","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":"Variations in Postpartum Opioid Prescribing Practices among Obstetrician-Gynecologists.","authors":"Nikhita Ravikanti,&nbsp;Hayrettin Okut,&nbsp;Jennifer Keomany,&nbsp;Elizabeth Ablah,&nbsp;Kent Bradley","doi":"10.17161/kjm.vol15.18246","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18246","url":null,"abstract":"<p><strong>Introduction: </strong>There have been many efforts to combat the United States opioid crisis that has been occurring for the past two decades, specifically with postpartum patients that often were prescribed opioids. Prior studies described how accounting for usage of inpatient opioids on the day prior to discharge had an impact on how much discharge opioids were prescribed on the day of discharge. These studies provided a guideline to use the inpatient opioid amount from the day before discharge to determine discharge opioid quantity and minimize how much was being prescribed. In July 2018, the American College of Obstetrics and Gynecologists (ACOG) published Committee Opinion 742, guidelines for obstetricians-gynecologists about post-partum pain management. Prescription pain medications (including opioids, if necessary) require a shared decision-making approach between the physician and patient to determine the medication type and quantity. This study aimed to determine if there were differences in prescribing practices based on the specific post-operative day that opioid prescriptions were written, and if there were differences in the prescribing practices for cesarean deliveries following the publication of ACOG Committee Opinion 742.</p><p><strong>Methods: </strong>This retrospective chart review included patients who had a live cesarean birth at one rural Midwest facility anytime between July 1, 2017 and February 28, 2021. This study excluded those with chorioamnionitis and those discharged after more than four days. Opioid amounts were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were stratified into two groups based on the day that their discharge opioid medication prescriptions were written (i.e., a day prior to discharge or the day of discharge). Patients were also stratified based on date of delivery, before or after the publication of ACOG Committee Opinion 742.</p><p><strong>Results: </strong>Of 411 cesarean patients, 93.9% (n = 386) had opioids prescribed at discharge, 86% (n = 330) of whom received a prescription written on the day of discharge. There was no difference in the quantity of MMEs, doses per day, or dosage from discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients whose deliveries occurred after the publication of ACOG Committee Opinion 742 (63.9%, n = 263) received discharge prescriptions with fewer average MMEs (159.53 ± 61.64) than those whose deliveries occurred before the publication (36%, n = 148; 187.35 ± 53.42; χ² (1, N = 411) = 17.71; p < 0.001), and they were prescribed fewer doses per day.</p><p><strong>Conclusions: </strong>After cesarean sections, the specific post-operative day did not seem to impact the prescribing trends as there were no differences in MMEs, doses per day, or dosage between prescriptions that were written on the day of di","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"373-379"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/e3/15-373.PMC9612903.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661050","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":"Symptomatic Colonic Metastasis in a Patient with Non-Small Cell Lung Carcinoma.","authors":"Aastha Bharwad,&nbsp;Chelsea Wuthnow,&nbsp;William Salyers","doi":"10.17161/kjm.vol15.18148","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18148","url":null,"abstract":"INTRODUCTION Lung cancer is the leading cause of death related to cancer in the United States.1 Of the various types of lung cancer, the majority are nonsmall cell lung cancer (NSCLC). A significant number of patients that present with NSCLC have distant metastases at the time of diagnosis, however, only a small percentage have abdominal metastasis.1,2 Abdominal metastases are most often squamous cell carcinoma and can be found in the liver, adrenal glands, pancreas, spleen, kidneys, gastrointestinal (GI) tract, peritoneum, or abdominal lymph nodes.1-3 Metastases to the GI tract are rare with a prevalence rate of 0.5 14% and are often asymptomatic but can present with abdominal pain, intestinal obstruction, bloody stool, diarrhea, or intestinal perforation.4,5 Colonic metastasis often is not diagnosed during life, with up to onethird diagnosed during an autopsy.2 We present a female with a history of Stage IV NSCLC diagnosed with sigmoid colon metastases after complaints of bright red blood per rectum.","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"382"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/12/15-382.PMC9612907.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661052","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":"Dacryocystitis Involving <i>Parvimonas micra</i> and <i>Bacteroides thetaiotaomicron</i> Infection.","authors":"Hythem Abouodah,&nbsp;David A Nasrazadani,&nbsp;Jason A Sokol","doi":"10.17161/kjm.vol15.18273","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18273","url":null,"abstract":"386 Dacryocystitis Involving Parvimonas micra and Bacteroides thetaiotaomicron Infection Hythem Abouodah, B.S.1, David A. Nasrazadani, M.D.2, Jason A. Sokol, M.D.3,4 1University of Kansas School of Medicine, Kansas City, KS 2Mattax Neu Prater Eye Center, Springfield, MO 3University of Kansas Eye Center, Prairie Village, KS 4University of Kansas Medical Center, Kansas City, KS Department of Ophthalmology Received July 13, 2022; Accepted for publication Sept. 8, 2022; Published online Oct. 24, 2022 https://doi.org/10.17161/kjm.vol15.18273","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"386-387"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/56/15-386.PMC9612906.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661048","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":"Debridement Versus Simple Scrubbing of External Fixator Pin Sites.","authors":"Jack Nolte,&nbsp;Johnathan Dallman,&nbsp;William Tucker,&nbsp;Erin Christensen,&nbsp;Archie Heddings","doi":"10.17161/kjm.vol15.18219","DOIUrl":"https://doi.org/10.17161/kjm.vol15.18219","url":null,"abstract":"<p><strong>Introduction: </strong>Irrigation and debridement of external fixator pin sites are methods utilized by some orthopedic surgeons to minimize the risk of surgical site infections in patients undergoing definitive internal fixation after temporization in an external fixation device. This study aimed to determine if irrigation and debridement of external fixator pin sites leads to fewer deep surgical site infections, compared to simply scrubbing the external fixator pin sites with a chlorhexidine scrub-brush.</p><p><strong>Methods: </strong>This single center retrospective cohort study was performed at a university level I trauma center. All cases in which a single surgeon removed an external fixator and followed this with definitive open reduction and internal fixation (ORIF) in the same operative setting between October 2007 and October 2018 were reviewed. A total of 313 patients were temporized in 334 external fixators prior to ORIF and were included in the study.</p><p><strong>Results: </strong>Eighteen of the 179 Irrigation and Debridement cohort (10.0%) and 8 of the 155 Simple Scrubbing cohort (5.2%) had infections that required a return to the operating room. No statistical difference (p = 0.10) or meaningful effect size (Cohen's d = 0.18) were found between irrigation and debridement and simple scrubbing of external fixator pin sites.</p><p><strong>Conclusions: </strong>Given no significant differences were found in deep infection rates between debridement of pin sites versus simply scrubbing, it is reasonable to ask whether the time and resources required for debriding external fixator pin sites is worthwhile.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":" ","pages":"369-372"},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/99/15-369.PMC9612902.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40661051","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}