Kansas journal of medicine最新文献

{"title":"Use of Ultrasound-Guided Tendon Fenestration and Injection Procedures for Treatment of Tendinosis.","authors":"Garrett Koehn, Lexi Jackson, Elizabeth Ablah, Hayrettin Okut, Andrew Porter","doi":"10.17161/kjm.vol16.18511","DOIUrl":"10.17161/kjm.vol16.18511","url":null,"abstract":"<p><strong>Introduction: </strong>Overuse injuries such as tendinosis are a common complaint at sports medicine clinics. When conservative management for tendinosis has failed, ultrasound-guided tendon fenestration and injection procedures, such as dry needling, needling tenotomy, autologous whole blood injections, and prolotherapy, can be utilized for treatment. This study examined the effectiveness of these procedures for pain improvement and ability to return to activity for patients with tendinosis.</p><p><strong>Methods: </strong>This study involved a chart review of patients 15 years or older who underwent at least one treatment for tendinosis at a sports medicine clinic between January 1, 2014 and April 17, 2019. Eligible patients had at least one of the following procedures: 1) percutaneous dry needling, 2) percutaneous needle tenotomy, 3) autologous whole blood injection, and/or 4) prolotherapy. A Current Procedural Terminology (CPT) code query was used to screen patient charts for study inclusion.</p><p><strong>Results: </strong>In total, 680 patients' data were reviewed, and 343 patients met inclusion criteria. Patients underwent a total of 598 unique procedures. Dry needling represented most procedures (62.8%, n = 375). Most patients reported diminished pain at follow up (73.0%, n = 268). Prolotherapy had the highest percentage among the follow up patients reporting diminished pain (81.0%, n = 17). Most patients were able to return to activity at follow-up (47.4%, n = 172). A greater proportion of patients with autologous whole blood injection were able to return to activity (60.7%, n = 85).</p><p><strong>Conclusions: </strong>Most patients with tendinosis who underwent tendon fenestration or injection procedures reported diminished pain at follow-up. Autologous whole blood injection may be more likely to diminish patient pain and allow return to activity than other procedure types. More research is needed across all anatomical sites to compare the generalized effectiveness of these procedures.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"258-260"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721418","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":"Preoperative Marking to Approximate Forehead Rhytids for Precisely Camouflaging Scars.","authors":"Felipe B Cerci, Bruno C Fantini, Stephanie Matthews, Stanislav N Tolkachjov","doi":"10.17161/kjm.vol16.21184","DOIUrl":"10.17161/kjm.vol16.21184","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"271"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721415","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":"Xylazine Use in Pregnancy: The Effects of the Fentanyl Adulterant Xylazine on Pregnant Patients and the Developing Fetus.","authors":"Grace Noonan, Roopa Sethi","doi":"10.17161/kjm.vol16.20624","DOIUrl":"10.17161/kjm.vol16.20624","url":null,"abstract":"<p><strong>Objective: </strong>A literature review was completed to outline the effects of xylazine on the pregnant patient while raising awareness of the increasing prevalence of opioid use disorder in pregnancy and the increase in adulterants in non-prescribed controlled substances.</p><p><strong>Data sources: </strong>PubMed and Google Scholar were searched using the key words \"xylazine, adulterant,\" \"xylazine, humans,\" \"xylazine, pregnancy,\" and \"xylazine, placenta\" to identify the studies evaluating xylazine's effects on humans and the pregnant patient.</p><p><strong>Study selection: </strong>Studies were included if they provided information on symptoms of xylazine exposure, the prevalence of xylazine in pregnant humans and the hemodynamic effects of xylazine on both human and animal pregnant populations. Animal studies were included given the limited data on xylazine in pregnant humans. Four studies were utilized for background data and five studies were included in the final review of the effects of xylazine on pregnancy.</p><p><strong>Results: </strong>Studies involving humans show that xylazine toxicity can cause respiratory depression, bradycardia, and central nervous system depression. There is evidence of xylazine in human umbilical cord tissue, showing that the fetus is exposed to xylazine. Animal studies show decreased uterine blood flow, increased uterine vascular resistance, and decreased fetal growth in response to xylazine.</p><p><strong>Conclusions: </strong>Due to the limited studies on the effects of xylazine on pregnant populations, providers rely on animal studies for knowledge on xylazine's effects throughout pregnancy. Animal studies suggest an increased risk of adverse effects during pregnancy in response to xylazine. Future studies should focus on the pregnancy outcomes in patients exposed to xylazine to create more robust recommendations for treatment and pregnancy surveillance.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"277-279"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721419","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":"Postoperative Posterior Ischemic Optic Neuropathy Following Coronary Artery Bypass Surgery: A Case Report.","authors":"Robert E Boyle,&nbsp;Lieu Nguyen Lowrie,&nbsp;Jennifer K Burgoyne","doi":"10.17161/kjm.vol16.20943","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20943","url":null,"abstract":"Postoperative Posterior Ischemic Optic Neuropathy Following Coronary Artery Bypass Surgery: A Case Report Robert E. Boyle, M.D.1, Lieu Nguyen Lowrie, B.S.1, Jennifer K. Burgoyne, M.D.1,2,3 1University of Kansas School of Medicine-Wichita, Wichita, KS 2Department of Surgery 3ICT Eye, Wichita, KS Received June 13, 2023; Accepted for publication Aug. 23, 2023; Published online Sept. 25, 2023 https://doi.org/10.17161/kjm.vol16.20943","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"242-243"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/97/16-242.PMC10544878.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177702","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":"Educating Family Physician Residents for Anesthetic Preoperative Evaluation and Assessment.","authors":"Ben Gerber,&nbsp;Eyan P Roth,&nbsp;Tyler A Laubach,&nbsp;Luke De Jong,&nbsp;Travis J Kasper,&nbsp;Jarrett Perry,&nbsp;Allan Johnson,&nbsp;William L Krogman,&nbsp;Felecia A Newton,&nbsp;Sara Powell,&nbsp;Dee Ann Bragg,&nbsp;Jared Regehr","doi":"10.17161/kjm.vol16.20986","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20986","url":null,"abstract":"<p><strong>Introduction: </strong>Encounters for preoperative assessments are common within primary care offices, so it is imperative that family medicine residents learn how to perform preoperative evaluations. We assessed family medicine residents' knowledge of preoperative evaluation in preparation for surgery by providing a pre- and post-test alongside a didactic seminar.</p><p><strong>Methods: </strong>A didactic seminar on preoperative evaluations was presented at a family medicine resident didactics session by two senior anesthesiology residents. A 16-question, multiple choice test was used as both a pre-test and post-test to assess family medicine residents' knowledge.</p><p><strong>Results: </strong>A total of 31 participants took the pre-test (residents = 24; medical students = 7), and 30 participants took the post-test (residents = 23; medical students = 7). Mean scores and standard deviations were calculated for both tests with an average score of 37.50% ± 10.58% and 45.42% ± 11.12% on the pre- and post-test, respectively. Using the Kruskal-Wallis test, residents showed a significant improvement in test scores following the didactic presentation (p = 0.041), while overall results (residents and medical students) also reported a significant difference (p = 0.004).</p><p><strong>Conclusions: </strong>Our results demonstrated that educating family medicine residents and medical students on preoperative evaluation showed significant, quantifiable gains in knowledge following a brief didactic presentation. Given the current gap between guidelines and practice, our results emphasize the need for a formal medical school and residency-based curriculum related to preoperative patient evaluation.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"234-236"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/e7/16-234.PMC10544880.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165993","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":"Applications for Machine Learning in Mohs Micrographic Surgery: Increased Efficiency and Accuracy.","authors":"Kevin J Varghese","doi":"10.17161/kjm.vol16.20947","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20947","url":null,"abstract":"Mohs micrographic surgery (MMS) is a precise method of skin cancer treatment via removal in stages for complete resection of malignancy. 1 Machine learning (ML) offers multiple potential applications to the procedure, some of which are discussed here. The first step in MMS is identifying patients who meet criteria for referral, which often is completed via the histologic confirmation of skin cancer. ML may accelerate referral to a Moh’s surgeon by automatically categorizing histologic findings. For example, an image classification system was developed using a cascade of three independently-trained convolutional neural networks (CNN) to sort digitized dermatopathol-ogy slides into categories of basaloid, squamous, melanocytic, and other; this system demonstrated an accuracy of up to 98%. 2 A system such as this would allow a dermatologist who interprets biopsies to review cases of a certain category (i.e., basaloid or squamous) and refer other cases. 2 Clinical dermatologists may identify patients who meet criteria for MMS and direct them to Mohs surgeons in a timelier manner with the assistance of ML.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"246"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/23/16-246.PMC10544879.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169839","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":"Patient Polypharmacy use Following a Multi-Disciplinary Dementia Care Program in a Memory Clinic: A Retrospective Cohort Study.","authors":"Jaime Perales-Puchalt,&nbsp;Crystal Burkhardt,&nbsp;Jordan Baker,&nbsp;Colin Cernik,&nbsp;Ryan Townley,&nbsp;Michelle Niedens,&nbsp;Jeffrey M Burns,&nbsp;Dinesh Pal Mudaranthakam","doi":"10.17161/kjm.vol16.20976","DOIUrl":"10.17161/kjm.vol16.20976","url":null,"abstract":"<p><strong>Introduction: </strong>Dementia increases the risk of polypharmacy. Timely detection and optimal care can stabilize or delay the progression of dementia symptoms, which may in turn reduce polypharmacy. We aimed to evaluate the change in polypharmacy use among memory clinic patients living with dementia who participated in a dementia care program compared to those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in standard care.</p><p><strong>Methods: </strong>We retrospectively analyzed data extracted from electronic medical records from a university memory clinic. Data from a total of 381 patients were included in the study: 107 in the program and 274 matched patients in standard care. We used adjusted odds ratios to assess the association between enrollment in the program and polypharmacy use at follow-up (five or more concurrent medications), controlling for baseline polypharmacy use and stratified polypharmacy use by prescription and over-the-counter (OTC).</p><p><strong>Results: </strong>The two groups did not differ in the use of five or more overall and prescription medications at follow-up, controlling for the use of five or more of the respective medications at baseline and covariates. Being in the program was associated with a three-fold lower odds of using five or more OTC medications at follow-up (adjusted odds ratio = 0.30; p <0.001; 95% Confidence interval = 0.15-0.58) after controlling for using five or more OTC medications at baseline and covariates.</p><p><strong>Conclusions: </strong>Dementia care may reduce polypharmacy of OTC medications, potentially reducing risky drug-drug interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"237-241"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/85/16-237.PMC10544887.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151466","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 Effects of COVID-19 on General Surgery Residency Programs in the United States.","authors":"Katherine Foerster,&nbsp;Karl Fischer,&nbsp;Michael Nguyen,&nbsp;Brian W Gilbert,&nbsp;Karson R Quinn,&nbsp;Stephen D Helmer,&nbsp;George Philip","doi":"10.17161/kjm.vol16.20094","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20094","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic impacted multiple aspects of surgical education. This survey delineates steps taken by general surgery residency programs to meet changing patient-care needs while continuing to provide adequate education.</p><p><strong>Methods: </strong>A survey was administered to program directors and coordinators of all United States general surgery residency programs to assess the early effects of the pandemic on residents from March 1 through May 31, 2020.</p><p><strong>Results: </strong>Of 303 programs contacted, 132 (43.6%) completed the survey. Residents were asked to work in areas outside of their specialty at 27.3% of programs. Residency curriculum was changed in 35.6% of programs, and 76.5% of programs changed their academic conferences. Resident schedules were altered at a majority of programs to limit resident-patient exposure, increase ICU coverage, or improve resident utilization. Surgical caseloads decreased at 93.8% of programs; 31.8% of those programs reported concerns regarding residents' achieving the minimum case numbers required to graduate.</p><p><strong>Conclusions: </strong>These results provided insight into the restructuring of general surgery residency programs during a pandemic and may be used to establish future pandemic response plans.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"228-233"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/e7/16-228.PMC10544883.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171425","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":"Navigating the Path to Publication: A Guide for the Novice Researcher.","authors":"Mason A Fawcett,&nbsp;Micah K Sinclair","doi":"10.17161/kjm.vol16.21169","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21169","url":null,"abstract":"INTRODUCTION Case reports are some of the most fundamental forms of medical research. Their importance is often under-estimated, and they can be very useful ways to communicate new knowledge. Writing and publishing a case report is an excellent way for new researchers to practice presenting patient information and gain experience in the publication process. They also serve as a conduit for seasoned clinicians to convey their knowledge and experience with unique diagnoses, those which may not be found in text or cohort studies, for others to build on in their treatment strategy. This article serves to provide general information on the logistics of publishing case reports in a medical journal and may be applicable to other types of scientific literature. Significance of Case Reports. Case reports are regarded as some of the oldest ways to communicate medical information, with the earliest forms of case reports dating back to the 17th century.1 While case reports include limited scientifically significant evidence in the hierarchy of medical research, their importance is undeniable. Case reports are excellent ways to investigate new or unique presentations of a disease or treatment processes and have historically been responsible for many significant medical discoveries, such as the identification of Thalomide as a cause of congenital abnormalities in the 1960s.2 Case reports also can be an excellent way for the novice medical researcher to develope familiarity with the process of publishing. Most researchers are eager for research and publication opportunities early in their career and case reports can facilitate this process.3 Additionally, for seasoned clinicians, there are a variety of situations that benefit from publication in the form of a case report as seen in Table 1.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"247-250"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/e8/16-247.PMC10544869.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173517","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":"Cocaine Induced Aneurysmal Dilation of Left Main Coronary Artery.","authors":"Lawrence Zhou,&nbsp;Rajeev Seecheran,&nbsp;Abhiram Challa,&nbsp;Rhythm Vasudeva,&nbsp;Wassim Shaheen","doi":"10.17161/kjm.vol16.20048","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20048","url":null,"abstract":"244 Cocaine Induced Aneurysmal Dilation of Left Main Coronary Artery Lawrence Zhou, M.D.1,2, Rajeev Seecheran, M.D., MHA1,3, Abhiram Challa, M.D.1,3, Rhythm Vasudeva, M.D., M.S.1,2, Wassim Shaheen, M.D.4 1University of Kansas School of Medicine-Wichita, Wichita, KS 2Department of Medicine-Pediatrics 3Department of Internal Medicine 4Heartland Cardiology, Wichita, KS Department of Cardiology Received April 27, 2023; Accepted for publication Aug. 24, 2023; Published online Sept. 25, 2023 https://doi.org/10.17161/kjm.vol16.20048","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"244-245"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/7f/16-244.PMC10544888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159363","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}