Kansas journal of medicine最新文献

{"title":"Moral Injury Among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling.","authors":"Hannah S David, Tarris Rosell, Dorothy Hughes","doi":"10.17161/kjm.vol16.21171","DOIUrl":"10.17161/kjm.vol16.21171","url":null,"abstract":"<p><strong>Introduction: </strong>Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end-of-life counseling (EOLC) has proven to significantly reduce provider stress and burnout. The purpose of this study was to determine whether training in EOLC reduces levels of moral injury among transplant providers.</p><p><strong>Methods: </strong>This was a mixed methods study. We interviewed 10 patient participants and administered a survey to staff in the solid organ transplant department at the University of Kansas Health System. Respondents indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, we conducted semi-structured interviews with transplant providers, then performed inductive coding followed by thematic network analysis.</p><p><strong>Results: </strong>Thirty-seven percent (14/38) of respondents reported a moral injury score at or above the threshold for psychosocial dysfunction associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p = 0.362, power (1-β) = 0.842). Thematic network analysis demonstrated high-level themes of \"challenges\", \"training\", and \"stress relief\".</p><p><strong>Conclusions: </strong>Our study demonstrated a concerning prevalence of moral injury among transplant staff and suggested that EOLC training did not significantly mitigate the threat of moral injury.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"324-327"},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652421","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":"Hold off That Olanzapine! The Development of Neuroleptic Malignant Syndrome in a Dehydrated Pediatric Patient.","authors":"Maryam Tariq, Danielle N Wentzel, Joshua B Beggs","doi":"10.17161/kjm.vol16.21303","DOIUrl":"10.17161/kjm.vol16.21303","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"328-329"},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652469","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":"Unveiling the Mystery: Correlating Physical Findings with Endoscopy to Diagnose an Uncommon Lesion.","authors":"Hitanshu Dave, Aastha Bharwad, Lana Hattar, Nathan Tofteland","doi":"10.17161/kjm.vol16.21074","DOIUrl":"10.17161/kjm.vol16.21074","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"332-333"},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652423","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":"Recurrent Breast Angiosarcoma.","authors":"Allison M Coy, Mark C Meyer","doi":"10.17161/kjm.vol16.21273","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21273","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"294-296"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815785","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":"Human Parechovirus Associated Critical Illness in Neonates and Infants: Case Series and Review of Literature.","authors":"Aimee Daccache, Kate Waldeck, Jacob T Kilgore, Mariana Lanata, Robert R Wittler, Nisha Agasthya","doi":"10.17161/kjm.vol16.21190","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21190","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"289-293"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815773","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":"Lipoic Acid as a Trigger for NELL-1 Positive Membranous Nephropathy.","authors":"Rayane Nassar, Salam A Kadhem, Mohammed Shakir","doi":"10.17161/kjm.vol16.20996","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20996","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"297-298"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815782","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":"'Just the Way it Was': Perspectives on Sexual Harassment in Medical School and #MeToo of Women Graduating Prior to 1975.","authors":"Anne Walling, Morgan Gillam, Kari Nilsen","doi":"10.17161/kjm.vol16.20961","DOIUrl":"https://doi.org/10.17161/kjm.vol16.20961","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to assess gender-based mistreatment during medical education recalled by women who attended medical school between 1948 and 1975 and their perspectives on the #MeToo movement.</p><p><strong>Methods: </strong>Methods included a qualitative analysis of video-recorded structured interviews.</p><p><strong>Results: </strong>The 37 participants graduated in classes of 2-20% women. They described pervasive, multi-faceted gender-based mistreatment during training. Twenty (54%) disclosed personal experience of serious sexual mistreatment. Interviewees stressed that attitudes and behaviors toward women and trainees, now regarded as unacceptable, were previously widely accepted or tolerated. The majority (86%) expressed overall positive opinions of their training. Twenty-eight (76%) supported the #MeToo movement, four (11%) had negative opinions, and five (13.5%) were ambivalent or unwilling to comment. Seventeen (46%) were concerned that #MeToo damaged working relationships, twelve (32%) were concerned about overreach, and eight (22%) about false accusations.</p><p><strong>Conclusions: </strong>This group of older female physicians reported extensive experience of gender-based mistreatment and strong support of #MeToo. Nevertheless, about one quarter of the group did not support the #MeToo movement and even supporters expressed high rates of concern about the movement going too far, falsely accusing men of inappropriate behavior, and damaging working relationships. The interviewees did not want their medical training to be characterized as entirely negative, or to be portrayed as victims.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"280-285"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815779","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":"Impact of JayDoc Free Clinic on Emergency Department Usage in Kansas City.","authors":"Ethan Kallenberger, Eilidh Chowanec, Andrew Pirotte","doi":"10.17161/kjm.vol16.21392","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21392","url":null,"abstract":"<p><strong>Introduction: </strong>JayDoc Free Clinic (JayDoc) serves medical needs of uninsured patients in the Kansas City metropolitan area. It is known that patients who have access to primary care are less likely to visit their local Emergency Department (ED) for non-emergent needs. However, it is not well described if JayDoc lowers usage of The University of Kansas Health System (TUKHS) ED. This is the first study to assess the patient referral process between TUKHS ED and JayDoc.</p><p><strong>Methods: </strong>The authors administered a voluntary survey to every patient triaged at JayDoc, even if they were ultimately not accepted for a visit. Items on the questionnaire included health insurance status, primary language, and access to a primary care physician. The authors included questions on the usage of TUKHS ED in the last 12 months.</p><p><strong>Results: </strong>Seventy-three patients completed the questionnaire. Approximately 10% of respondents reported they visited the ED in the last 12 months and received a referral to JayDoc from staff. However, authors observed no statistically significant difference in the proportion of new patients who used the ED in the last 12 months compared to that of returning patients.</p><p><strong>Conclusions: </strong>Results of this study demonstrated an existing referral system between JayDoc and TUKHS ED. However, the authors could not conclude that JayDoc reduces non-emergent ED visits among its patient population. Future initiatives will include further education to ED providers to increase the number of patients being referred to JayDoc.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"286-288"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815775","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":"Suspected Hyperkalemia-Induced Cardiac Arrest and Recovery Following Succinylcholine Use in a Trauma Patient.","authors":"Anton Rogachov, Collin Kitzerow, John Peterson, James Walker","doi":"10.17161/kjm.vol16.21009","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21009","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"299-301"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815789","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":"Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-Analysis.","authors":"Nicholas Dombrowski, Jake Enos, Erik Henkelman, Damon Mar, Armin Tarakemeh, Bryan Vopat","doi":"10.17161/kjm.vol16.21262","DOIUrl":"https://doi.org/10.17161/kjm.vol16.21262","url":null,"abstract":"<p><strong>Introduction: </strong>Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy.</p><p><strong>Methods: </strong>This systematic review utilized PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through December 22, 2022. Key words used in the search included: \"tranexamic acid,\" \"TXA,\" \"foot,\" \"ankle,\" \"calcaneal,\" and \"surgery.\" The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour post-operative blood loss, blood loss from hour 24 to hour 48, post-operative hemoglobin (Hgb), and post-operative hematocrit [Hct]), as well as wound complications and vascular events. Meta-regression was included to assess the impact of age on between-study variation.</p><p><strong>Results: </strong>Ten studies met preliminary inclusion criteria. Upon further inspection, eight met full inclusion criteria for the meta-analysis. Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour post-operative blood loss (MD=-183.41 mL, 95% CI=-247.49 to -119.34 mL, p<0.001), increased post-operative hemoglobin (MD=0.71 g/dL, 95% CI=0.11 to 1.31 g/dL, p=0.020) and hematocrit (MD=2.66%, 95% CI=0.07 to 5.24%, p=0.040) when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications. Meta-regression indicated no clinically relevant association of age to between-study variation.</p><p><strong>Conclusions: </strong>TXA was found to be a safe treatment that did affect wound healing or infection rates while decreasing perioperative blood loss. Further research should be performed to evaluate the long-term effects of TXA administration on patient outcomes after foot and ankle surgery.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"16 ","pages":"302-308"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815791","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}