Kansas journal of medicine最新文献

{"title":"Outpatient Oncology Fall Risk: A Quality Improvement Project.","authors":"Stephanie Hammontree,&nbsp;Maryellen Potts,&nbsp;Adam Neiberger,&nbsp;Danielle Olds,&nbsp;Daniel English,&nbsp;Jamie S Myers","doi":"10.17161/kjm.vol16.20271","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20271","url":null,"abstract":"<p><strong>Introduction: </strong>Patients receiving cancer treatment are at high risk for falls. No current guidelines or standards of care exist for assessment and prevention of outpatient oncology falls. This quality improvement project's purpose was to 1) describe and evaluate outpatient oncology falls data to determine root cause(s), and develop, implement, and evaluate intervention strategies for future policy refinement, and 2) compare fall rates pre/post implementation of a system-wide Ambulatory Fall Risk Bundle.</p><p><strong>Methods: </strong>Retrospective data were used to describe and categorize fall incidence for the University of Kansas Cancer Center over 12 months. Further analyses were conducted to describe fall rates per 10,000 kept appointments pre/post implementation of an Ambulatory Fall Risk Bundle protocol. Semi-structured interviews were conducted with medical assistants and nurse managers to evaluate the initiative's impact, staff satisfaction, and recommendations for refinement.</p><p><strong>Results: </strong>The initial 12-month assessment yielded 58 patient falls retained for further analyses. Most patients were receiving chemotherapy (46, 79%). Common contributing symptoms included dizziness/ faintness and weakness (25, 43%). Tripping/falling over a hazard (12, 24%) and falls during transfer (10, 5.8%) also were cited. Subsequent analyses of fall rates indicated no change. Recommendations resulting from the qualitative interviews included: orthostatic vital sign protocol implementation, redesign of the electronic medical record fall risk alert, stakeholder involvement in protocol development, staff training, and related patient education strategies, and the procurement of additional assistive devices/equipment.</p><p><strong>Conclusions: </strong>System-related policy and culture change, investment in physical and human resource enhancements, and evidence-based protocols are needed to improve outpatient oncology fall rates.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"200-206"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/6c/16-200.PMC10544871.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171424","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":"Parental Vaccine Hesitancy in a COVID-19 World: A Qualitative Study of Midwestern Parents' Decisions Regarding COVID-19 Vaccination for Their Children.","authors":"Simon D Beatty,&nbsp;Jamison B Macke,&nbsp;Kellie M Griffin,&nbsp;Jennifer A Villwock","doi":"10.17161/kjm.vol16.20049","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20049","url":null,"abstract":"<p><strong>Introduction: </strong>With the launch of the SARS-CoV-2 (COVID-19) vaccines, a new cohort of people exists who do not consider themselves to be completely vaccine-hesitant, but are specifically COVID-19 vaccine hesitant (CVH). There is a need to learn from CVH parents, to ensure their concerns are addressed, and allow them to comfortably vaccinate their children against the COVID-19 virus.</p><p><strong>Methods: </strong>Surveys were used to identify CVH parents. Using semistructured interviews, we assessed the attitudes of CVH parents toward COVID-19 vaccination in children. An inductive coding method was used to analyze transcripts and develop themes.</p><p><strong>Results: </strong>Fourteen parents were interviewed. Seven (50%) had received the COVID-19 vaccine even though they had doubts. Six reported that education about mRNA vaccine production was helpful in deciding to get vaccinated. Parents were reluctant regarding pediatric vaccination due to lack of long-term studies and concerns about adverse impact on childhood development. Personal physicians were the most trusted source of information and direct conversations with them were the most influential, as opposed to public health leaders like the U.S. Centers for Disease Control and Prevention and the National Institutes of Health.</p><p><strong>Conclusions: </strong>Our findings suggested that physicians are among the most trusted sources of information regarding the COVID-19 vaccine for CVH parents. Rather than use broad public health messaging and advertising to increase rates of vaccination, further investigation into training health professionals on how to counsel CVH patients effectively may be a higher impact area of opportunity to improve vaccine response rates.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"194-199"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/d1/16-194.PMC10544882.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166062","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 Persistent Postictal and Inter-ictal Delirium.","authors":"Vy Le,&nbsp;Kylee Wollard,&nbsp;Ricky W Lee,&nbsp;Kamalakar Surineni","doi":"10.17161/kjm.vol16.20116","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20116","url":null,"abstract":"214 A Case of Persistent Postictal and Inter-ictal Delirium Vy Le, D.O.1,2, Kylee Wollard1, Ricky W. Lee, M.D.3,4, Kamalakar Surineni, M.D.1,2 1University of Kansas School of Medicine-Wichita, Wichita, KS 2Department of Psychiatry and Behavioral Sciences 3Department of Internal Medicine 4Ascension Via Christi, Wichita, KS Received April 19, 2023; Accepted for publication July 12, 2023; Published online Aug. 24, 2023 https://doi.org/10.17161/kjm.vol16.20116","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"214-217"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/15/93/16-214.PMC10544873.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171234","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":"The Effect of Bone Quality on Treatment of Intertrochanteric Fractures with Helical Blade Versus Lag Screw Fixation in Cephalomedulary Nails.","authors":"Alexander C M Chong,&nbsp;Jillian V Schommer,&nbsp;Jordan D Shearer,&nbsp;Tysen K Timmer,&nbsp;Anthony N Brown","doi":"10.17161/kjm.vol16.20105","DOIUrl":"10.17161/kjm.vol16.20105","url":null,"abstract":"<p><strong>Introduction: </strong>The specific aim of this retrospective study was to determine whether bone quality has any effect on the complication rates or overall survivorship between helical blades and lag screws in cephalomedullary nails used for intertrochanteric hip fractures.</p><p><strong>Methods: </strong>The authors reviewed clinical charts and radiographic studies of patients between January 2012 and August 2019. We reviewed radiographic images (pre-, intra-, and post-operative) to evaluate fracture fixation type, fracture reduction grade, and post-operative complications. We collected dual energy x-ray absorptiometry scan results (T-score) and serum alkaline phosphatase (ALP) isoenzyme activity values to evaluate patient bone quality.</p><p><strong>Results: </strong>We included 303 cases (helical: 197, screw: 106) in the study. Complications were found in 31 (16%) helical blade cases and 23 (22%) lag screw cases. No statistically significant difference was detected when comparing complication rates with patient bone quality between the two groups. These two groups had similar one-year implant survivorship with respect to T-score, the low ALP level group, and normal ALP level group. The helical blade had higher implant survivorship compared to lag screw in five-year survival rate with respect to osteoporotic group, high ALP level group, and normal ALP level group (osteoporotic: 77% vs 69%, high ALP: 73% vs 67%, normal ALP: 70% vs 64%).</p><p><strong>Conclusions: </strong>Similar complication rates were observed between helical blade and lag screw constructs in cephalomedullary femoral nails when accounting for patient bone quality. However, the helical blade design had a higher five-year survival rate.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"207-213"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/c6/16-207.PMC10544885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147914","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":"Non-HIV Kaposi Sarcoma in an Immunocompetent Patient with High-Risk Behavior: Elucidating Subtypes and Risk Factors for Diagnosis.","authors":"Timothy Nguyen,&nbsp;Craig Beavers,&nbsp;Alex Hydock,&nbsp;Eli J Brumfield","doi":"10.17161/kjm.vol16.20657","DOIUrl":"10.17161/kjm.vol16.20657","url":null,"abstract":"Non-HIV Kaposi Sarcoma in an Immunocompetent Patient with High-Risk Behavior: Elucidating Subtypes and Risk Factors for Diagnosis Timothy Nguyen, D.O.1,2, Craig Beavers, D.O.1,2, Alex Hydock, M.S.1, Eli J. Brumfield, D.O., FACP1,2 1University of Kansas School of Medicine-Wichita, Wichita, KS 2Department of Internal Medicine Received June 3, 2023; Accepted for publication July 24, 2023; Published online Aug. 24, 2023 https://doi.org/10.17161/kjm.vol16.20657","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"220-221"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/cc/16-220.PMC10544872.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172501","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":"Vaginal Delivery Following Thrombolytic Therapy in the Third Trimester: A Case Report.","authors":"Grace K Noonan,&nbsp;Kelly Gorman,&nbsp;Angela Martin","doi":"10.17161/kjm.vol16.20355","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20355","url":null,"abstract":"INTRODUCTION Stroke in pregnancy is a leading cause of maternal mortality, as it is estimated that 7.7-15% of all maternal deaths are due to stroke.1 Risk factors for stroke in women include the prothrombic state of pregnancy and pregnancy-associated complications including preeclampsia and eclampsia.2 Due to the commonly applied ethical barrier of including pregnant patients in randomized control trials, there are no clear guidelines for the management of pregnancy-associated stroke (PAS). Animal models suggest tissue plasminogen activator (tPA) does not cross the placenta, and a handful of case reports imply favorable outcomes with the use of tPA to treat ischemic infarcts in pregnancy.3-6 Despite the increased acceptance of tPA treatment in pregnancy, there remains a gap of knowledge pertaining to the timing of delivery in patients following tPA administration in the late third trimester. This is especially true in patients who have conditions in which immediate delivery is indicated, such as preeclampsia with severe features. The use of neuraxial anesthesia soon after tPA administration poses an additional clinical dilemma in which limited data exists. We present a patient with preeclampsia with severe features and persistent abnormal coagulation studies after tPA administration for presumed ischemic stroke who had an uncomplicated spontaneous vaginal delivery with epidural anesthesia.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"218-219"},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/df/16-218.PMC10544886.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174763","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":"Causes of Anemia in Patients Seen in a Rural Community Hematology Clinic","authors":"S. Featherstone, W. Cathcart-Rake, R. Zackula, L. Beck","doi":"10.17161/kjm.vol15.16363","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16363","url":null,"abstract":"Introduction Anemia is a common medical disorder seen in consultation by hematologists. This study was performed to determine the incidence of the etiologies causing anemia in patients referred to the hematologists at Tammy Walker Cancer Center (TWCC) in the rural Kansas community of Salina. An additional goal of the study was to compare the frequencies of different etiologies for anemia in this cohort of patients with those previously reported by four academic medical centers. Methods A retrospective review of the medical records of 152 patients seen at TWCC between August 2015 and May 2019 was performed. The patient’s history and physical exam, complete blood count, and various additional hematologic studies ordered at the discretion of the TWCC hematologist were used to determine the etiology of each patient’s anemia. Results The most common causes of anemia found in the chart review were iron deficiency (48.7%), hematologic malignancy (14.5%), chronic inflammation (13.8%), renal insufficiency (11.2%), and unexplained anemia (9.9%). While the incidences of anemia due to hematologic malignancy, chronic inflammation, and renal insufficiency were like that reported previously by four academic medical centers, significantly more iron deficiency and less unexplained anemia were found in the patients referred to TWCC. Conclusions The causes of anemia in patients seen at TWCC were similar to those reported by academic medical centers; however, the incidences were different. The differences in findings may reflect dissimilarities in the demographics of referral populations, the duration, and extent of the evaluation at TWCC, or referral patterns.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"170 - 174"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45749669","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":"2020 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System","authors":"S. Thornton, L. Oller, Kathy White, Doyle M. Coons, E. Silver","doi":"10.17161/kjm.vol15.16291","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16291","url":null,"abstract":"Introduction This is the 2020 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC receives calls from the public, law enforcement, healthcare professionals, and public health agencies. Methods Encounters reported to the KSPCC from January 1, 2020 through December 31, 2020 were analyzed for caller location, demographics, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, and location of care. Encounters were classified as human or animal exposure, confirmed non-exposure, or information call (no exposure). Results There were 19,780 total encounters, including 18,492 human exposure cases. These cases were primarily female (53.6%, n = 9,911) and pediatric (19 years of age or less; 59.5%, n = 10,995). Acute cases (82.7%, n = 15,294), unintentional exposures (73.8%, n = 13,643), and ingestions (85.9%, n = 15,901) were most common. The most common reported substance was household cleaning products (n = 937) in pediatric (children ≤ 5) and analgesics (n = 1,335) in adults. An increase in exposures to disinfectants and household cleaning products was seen. Moderate (n = 1,812) or major (n = 482) clinical outcomes were seen in 12.4% of cases. There were 18 deaths in 2020 reported to the KSPCC. Conclusions Over 18,400 exposures were managed by the KSPCC in 2020. Pediatric exposures remained the most common encounter. An increase in exposures to disinfectants and other household cleaning products was seen. This report supported the continued value of the KSPCC to both public and acute healthcare in the state of Kansas.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"160 - 169"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42330744","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":"Role of Buprenorphine in an Adolescent with Opioid Abuse","authors":"E. Weesner, Jaya Sri Konakanchi, Roopa Sethi","doi":"10.17161/kjm.vol15.16525","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16525","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"197 - 197"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43029172","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":"Pandemic Food Response in Primary Care to Minimize Exposure for Elderly Food Insecure Population.","authors":"Kristina M Bridges, Jennifer Woodward, Megan Murray, Emma Mumm, K Allen Greiner","doi":"10.17161/kjm.vol15.15913","DOIUrl":"10.17161/kjm.vol15.15913","url":null,"abstract":"<p><strong>Introduction: </strong>Stay-at-home orders during the first wave of the COVID-19 pandemic encouraged individuals, especially the elderly, to stock up on food and supplies and remain home to limit exposure to the SARS-CoV-2 virus. However, individuals with food insecurity may be able only to afford a few days of food at a time, causing frequent outings to obtain food. An emergency food delivery system decreases the need for frequent outings. This study investigated: (1) whether elderly family medicine patients with previously reported food insecurity were making frequent trips to obtain food during the lockdown, and (2) if social determinants of health screening data could be used successfully to identify patients in need of emergency food delivery during the pandemic.</p><p><strong>Methods: </strong>Primary care patients 65 years and older with previously reported food insecurity were screened for referral to a community food delivery program. A cross-sectional secondary analysis of screening and referral data were conducted.</p><p><strong>Results: </strong>Clinic staff called 52 patients and completed screening of 30. For 23/30 respondents (76.7%), reported monthly outings to obtain food exceeded the recommended stay-at-home guidelines. In our sample, 22/30 (73.3%) reported current food need, 14/30 (46.7%) reported two or fewer days of food, 28/30 (93.3%) reported receiving home food delivery would keep them from going out, 24/30 (80.0%) agreed to food delivery, and 17 patients received a food delivery.</p><p><strong>Conclusions: </strong>Targeted screening and referral for food delivery may reduce the need for patients experiencing food insecurity to leave home during a pandemic or other disaster, potentially decreasing community exposure for a high-risk population. Primary care practices can utilize previously collected food insecurity and other social determinants of health data to identify and assist high-risk patients in a pandemic.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"148-154"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41883856","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}