The Cooper Rowan Medical Journal最新文献

{"title":"A Case of Cervical Chordoma","authors":"Michael Nicolette, Swar Vimawala, Xinmin Zhang, Corey Mossop, Brian Swendseid","doi":"10.31986/issn.2578.3343_vol5iss1.12","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.12","url":null,"abstract":"A 48 year old male presented with neck pain and left arm pain that worsened with movement alongside left arm weakness, numbness, and tingling. The differential diagnosis for a patient with symptoms of a neck mass includes benign tumors like neurofibromas, malignant tumors like chordomas, and non-neoplastic conditions like cervical spondylitis. A magnetic resonance imaging (MRI) study of the cervical spine with and without contrast identified a T1 hypointense, T2 hyperintense, heterogeneously enhancing prevertebral mass with parapharyngeal extension. A direct laryngoscopy with biopsy was performed and revealed a paraspinal tumor. The patient’s diagnosis of cervical chordoma was confirmed upon detection of Brachyury, a gene that encodes a transcription factor which promotes epithelial mesenchymal transition (EMT) in chordoma pathogenesis. Chordomas are slow-growing tumors located within the body’s midline and they are associated with poorer outcomes because of neurovascular encasement at time of presentation. Chordomas are rare, with an incidence of 1 in 1,000,000. Approximately 6% of chordomas are located in the cervical spine. They are typically treated with surgery followed by radiation therapy. The patient underwent anterior resection for the prevertebral mass in the C2-C6 section of the cervical spinal cord. Surgery achieved subtotal resection and involved removal of the spinous processes of C3-C5 and reconstruction of the cervical spine with implants. The patient will be starting proton beam radiotherapy for his adjuvant treatment. Although rare, it is important to keep chordomas in the differential diagnosis when evaluating a patient with a neck mass.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140990782","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":"Fundal Anterior to Posterior Hysterotomy and Cesarean Myomectomy in Fibroid Uterus","authors":"Ashni Nadgauda, Sarah Dreibelbis, Jonathan D. Rodger, Andrew Fieo","doi":"10.31986/issn.2578.3343_vol5iss1.13","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.13","url":null,"abstract":"Fibroids are a common benign tumor located in the female reproductive tract and affect up to 10 percent of women, leading to challenges during cesarean section. Few cases of myomectomy at the time of cesarean section have been described and most describe uteri with only a few fibroids present. Our case describes a 39 year old G1P0101female with extensive fibroids including large fibroids located at the lower uterine segment. This patient underwent cesarean section and myomectomy at 27 weeks and five days gestation with a fundal, vertical hysterotomy, extending from the anterior to posterior wall of uterus. This is the first case described in the literature of a cesarean section performed on a uterus with innumerable intramural fibroids and first case documented of a fundal, anterior to posterior hysterotomy.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140992146","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":"Understanding the LGBTQ+ Divide: A review on the impact of geographic location and political climate on LGBTQ+ patient care in the United States.","authors":"Connor Clark","doi":"10.31986/issn.2578.3343_vol5iss1.11","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.11","url":null,"abstract":"Background:\u0000\u0000In the United States, laws and policies are proposed and passed daily that either protect or restrict transgender patients’ access to care. The objective of this study is to review the existing body of literature on the effect of state-level policy on transgender patients’ overall health.\u0000\u0000Methods:\u0000\u0000Primary literature was identified through PubMed and the National Institutes of Health. Search terms included keywords related to the following concepts: LGBTQ terms, differentiating terms, regional terms, and health outcome terms. Inclusion criteria: Quantifiable studies conducted on the American LGBTQ and Transgender population from January 2015 to April 2023. Exclusion criteria: Studies not conducted in English, on the American population, and not relevant to the research question. Results were individually discussed and then synthesized using a narrative approach.\u0000\u0000Results:\u0000\u0000A total of 6 studies were identified for review. The difference in rates of suicidality, suicide attempt, depression, and anxiety between Democratic and Republican states was statistically significant (p\u0000\u0000Conclusion:\u0000\u0000Republican-run states, on average, had policies in place restricting access and treatment for transgender patients which is correlated with worse health outcomes. Advocacy is greatly needed to help protect this at-risk population and further research is needed to better understand how state-level barriers impact transgender patients across the US.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":"13 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527448","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":"How to Respond to Racist Patients: Recommendations from a Literature Review","authors":"Benjamin Caplan, Jocelyn Mitchell-Williams","doi":"10.31986/issn.2578.3343_vol5iss1.9","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.9","url":null,"abstract":"amed. Investigation of published recommendations for handling these situations can give victims, peers, and institutions the tools necessary to prepare, protect, and support providers through these challenging encounters.\u0000\u0000Methods: This paper is a literature review. For inclusion in this review, studies must have met the criteria of providing recommendations for healthcare providers or institutions on how to deal with racist patients. Excluded articles did not include recommendations on how to handle such situations or did not otherwise meet inclusion criteria. PubMed Medline was searched in January 2022 using a combination of the following keywords and associated MeSH terms: “Racism” AND “Physician-Patient relations”. The resulted articles then underwent forward and backward citation searching. A total of 44 articles were included after evaluation of 272 articles via this process.\u0000\u0000Results: For the affected individual, recommended responses include addressing the comment firmly and directly in real time, setting boundaries and behavior expectation, reporting the incident to supervisors and to the hospital, and seeking support from peers and/or professionals. At the peer level, core practices are supporting the victim, addressing the patient if necessary, debriefing with the victim and team, and checking-in with the victim in the following days. At the institution level, core practices are enacting reporting system and tracking incidents, developing specific policies and procedures about biased patients, and training staff with focused antibias and antidiscrimination sessions.\u0000\u0000Discussion: There are steps to be taken at every level to create a supportive and inclusive practice that protects providers against racist patients. One limitation of this study was that it was not a systematic review so there may be other recommendations published that are not reflected here.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":"44 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139532284","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":"Effect of Maternal Adverse Childhood Experiences (ACEs) and Maternal Resiliency on Early Childhood Outcomes on Vaccination Adherence and Emergency Department Visits","authors":"Leslie Abraham, Hsiao-Wei Banks, John Gaughan, Alla Kushnir","doi":"10.31986/issn.2578.3343_vol5iss1.10","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.10","url":null,"abstract":"Introduction: Adverse Childhood Experiences (ACEs) are traumatic events that occurred to an individual during ages 0-17 years. The 1998 Adverse Childhood Experiences (ACE) suggested higher ACE scores contributed to negative future health outcomes. The tool is now used to screen at-risk populations for the development of chronic health conditions. Protective factors, such as resilience, were later studied and found to offset the negative health impacts of traumatic childhood events. The 7Cs questionnaire was a tool developed to measure resilience in adolescents and demonstrated better health outcomes despite the presence of higher ACE scores. This pilot study evaluated whether higher maternal ACEs would result in more frequent pediatric ED visits and less vaccination adherence and whether higher 7Cs would be protective.\u0000\u0000Methods: This IRB approved study recruited pregnant women and new mothers in a tertiary NJ urban hospital, between their second trimester and their child’s one month well visit at the pediatric clinic. All subjects completed the Adverse Childhood Events (ACEs) survey, 7Cs resilience tool, and a Maternal Health questionnaire at the time of recruitment. A review of children’s electronic medical records was conducted at 2-, 4-, 6-, and 12-months to evaluate pediatric outcomes, adherence to AAP recommended vaccine schedule and emergency department visits.\u0000\u0000Results: Total of 34 women were enrolled, their and their children’s medical and demographic data collected. There was no difference in higher ACE scores and number of ED visits for the babies (OR 0.9645 [CI 0.7643 - 1.2172]), with no effect seen with higher resilience scores and number of ED visits (OR 0.8477 [0.6192 – 1.1604]). Increase in ACE scores resulted in reduction in vaccination adherence (OR 0.3555 [CI 0.1417 – 0.8923]). Increase in resilience scores decreased vaccination adherence by 44% (OR 0.5578 [CI 0.4164 - 0.7471]).\u0000\u0000Conclusion: There was no significant relationship between ACE or resilience scores and pediatric ED visits. A higher ACE score and lower levels of resilience were associated with decreased child vaccine adherence rate. ACE scores relate to higher traumatic childhoods, suggest poorer outcomes in offspring. Women with higher ACE scores could benefit from closer interventions and resources from obstetricians, and closer follow up of their children by the pediatricians.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":"51 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533232","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":"The Challenges of Implementing and Documenting Ottawa Ankle Rules in the Pediatric Emergency Department: A Retrospective Study","authors":"Emmalee M. Kugler, Michael Gillman, Olivia Toner","doi":"10.31986/issn.2578.3343_vol5iss1.8","DOIUrl":"https://doi.org/10.31986/issn.2578.3343_vol5iss1.8","url":null,"abstract":"INTRODUCTION \u0000Acute ankle sprains account for nearly 2% of visits to the pediatric emergency department (PED). The Ottawa Ankle Rules (OAR) were developed as a safe and effective clinical decision-making tool for detecting the need for radiographs in adults with acute ankle pain. OAR state radiographs are required with at least one of the following: \u0000\u00001. Inability to bear weight immediately following the injury and for four steps in the ED \u00002. Bony tenderness at the posterior edge of the lateral or medial malleolus \u0000\u0000OBJECTIVE\u0000Few prospective cohort studies have attempted to assess OAR pediatric populations. This study investigates the validity and documentation of OAR within a single academic institution’s PED. \u0000\u0000METHODS \u0000This retrospective chart review included previously healthy patients aged 2-19 years who presented to the PED with a traumatic ankle injury between 2019 and 2021. Exclusion criteria were met with documented parental insistence for imaging studies. We compared calculated OAR predictive values to those in literature using Chi-squared tests and WINPEPI. \u0000\u0000RESULTS\u0000A total of 295 subjects were included. When only considering clinically significant fractures in the data analysis, 247 patients received X-rays and 42 clinically significant fractures were found. OAR were 100% sensitive (95% confidence interval 93.1–100.0), 12.2% specific (95% CI 8.2–17.2), with a positive predictive value (PPV) of 18.9% (95% CI 16.6–26.5), and negative predictive value (NPV) of 100% (95% CI 88.7–100.0). When comparing this study’s findings to those with similar design protocol, specificity was lower (p<0.05) and there was no significant difference in sensitivity, PPV, or NPV. \u0000\u0000CONCLUSION\u0000Implementing the highly sensitive OAR yielded zero missed fractures. Their poor specificity results in unnecessary radiation exposure, which also increases expense and wait time. Excess imaging may be attributed to ambiguous OAR criteria, their dependence on pediatric cooperation, and parental expectations for imaging studies.","PeriodicalId":415794,"journal":{"name":"The Cooper Rowan Medical Journal","volume":"21 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139532601","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}