Kansas journal of medicine最新文献

{"title":"A Preliminary Study of Clinical Practice and Prenatal Nutrition in Rural Kansas.","authors":"Kelsey J Tenpenny, Adrianne K Griebel-Thompson, Morgan C Weiler, Susan E Carlson, Michael Kennedy","doi":"10.17161/kjm.vol15.15803","DOIUrl":"10.17161/kjm.vol15.15803","url":null,"abstract":"<p><strong>Introduction: </strong>The primary purpose of this study was to determine if new recommendations for prenatal supplements of docosahexaenoic acid (DHA) and choline have been implemented into care by physicians who care for pregnant women in rural Kansas communities. Both nutrients are inadequate in the diet of most pregnant women in the U.S., and not all prenatal supplements provide DHA and choline.</p><p><strong>Methods: </strong>A cross sectional web-based survey was developed and provided by the University of Kansas Medical Center (KUMC) students to 44 rural Kansas clinics believed to have physicians who provide obstetrical care. Questions about DHA and choline were embedded in a larger survey focused on prenatal care. A total of 29 surveys were returned, however, only 21 were completed by physicians who provided obstetrical care.</p><p><strong>Results: </strong>DHA (3/21) and choline (0/21) rarely were singled out for recommendation in contrast to folic acid (16/21) and iron (14/21). Participants stated that most women sought prenatal care during the first trimester of their pregnancy and indicated that they recommended prenatal vitamins at the first visit. Eleven gave patients a prescription for prenatal vitamins. The remaining patients either chose traditional over the counter prenatal vitamin capsules or less traditional chewable (gummy) vitamins, which provided lower concentrations of nutrients. Common barriers to nutritional counseling were limited resources and time constraints. Clinicians assessed their confidence and ability to provide nutritional counseling as moderate and competent, respectively.</p><p><strong>Conclusions: </strong>New nutritional recommendations for DHA and choline have not been implemented into standard of care in rural Kansas.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49421694","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":"Disseminated Infection Due to Neocosmospora (Fusarium) falciformis in a Patient with Acute Myelogenous Leukemia","authors":"Ra’ed Jabr, R. Liesman, V. R. Sethapati, D. Shoemaker, A. Spec, W. El Atrouni","doi":"10.17161/kjm.vol15.15921","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15921","url":null,"abstract":"       ","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"67 - 69"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41371188","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":"Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review","authors":"Fabian Delgado, F. Valverde, Richard Vaca","doi":"10.17161/kjm.vol15.15881","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15881","url":null,"abstract":"70 Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review Fabian Delgado, M.D., FACP1, Adrian Valverde2, Richard G. Vaca, M.D.3 1Vantage Healthcare, Canton, MA 2Universidad de Guayaquil, School of Medicine, Guayaquil, Ecuador 3Universidad Católica de Santiago de Guayaquil, School of Medicine, Guayaquil, Ecuador Received Sept. 24, 2021; Accepted for publication Nov. 29, 2021; Published online Feb. 9, 2022 https://doi.org/10.17161/kjm.vol15.15881","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"70 - 72"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42225990","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":"Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers.","authors":"Deborah Tyokighir, Ashley M Hervey, Christy Schunn, Daniel Clifford, Carolyn R Ahlers-Schmidt","doi":"10.17161/kjm.vol15.15853","DOIUrl":"10.17161/kjm.vol15.15853","url":null,"abstract":"<p><strong>Introduction: </strong>Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period.</p><p><strong>Methods: </strong>Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework.</p><p><strong>Results: </strong>Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations.</p><p><strong>Conclusions: </strong>Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47502067","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":"Cut Cortical Screw Purchase in Diaphyseal Bone: A Biomedical Study","authors":"Alexander Wendling, J. White, B. Cooper, C. Corrigan, Bradley R. Dart","doi":"10.17161/kjm.vol15.16115","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16115","url":null,"abstract":"Introduction During fracture osteosynthesis, traumatologists may remove screws which are too long, cut the excess length from the screw tip, then reinsert the cut screw (CS) to minimize implant waste. The purpose of this study was to determine if this practice influences screw purchase. Methods Using an axial-torsion load device, the maximal insertion torque (MIT) required to insert 3.5 mm stainless steel cortical screws into normal and osteoporotic bone models was measured. MIT was determined in three different test conditions: (1) long screw (LS) insertion; (2) LS insertion, removal, and insertion of a normal-length screw (NS); and, (3) LS insertion, removal, cutting excess length from the screw tip, and reinserting the CS. Results In the normal bone model, mean (± SD) MIT of LS insertion was 546 ± 6 Newton-centimeters (N-cm) compared to 496 ± 61 N-cm for NS reinsertion and 465 ± 69 N-cm for CS reinsertion. In the osteoporotic bone model, MIT of LS insertion was 110 ± 11 N-cm, whereas the values for NS and CS reinsertions were 98 ± 9 N-cm and 101 ± 12 N-cm, respectively. There was no significant difference in MIT between CS and NS reinsertions in the osteoporotic bone analog. Conclusions Cutting excess length from a 3.5 mm stainless steel cortical screw did not decrease its purchase regardless of bone density. During osteosynthesis, orthopaedists may remove screws which are too long, cut the screw tip, and reinsert the shortened screw as a cost-saving measure without compromising fracture fixation.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"59 - 62"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45823371","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":"Morphea and Autoimmunity: HLA behind the scene?","authors":"N. Boutrid, H. Rahmoune","doi":"10.17161/kjm.vol14.15774","DOIUrl":"https://doi.org/10.17161/kjm.vol14.15774","url":null,"abstract":"We read with deep attention the case report recently published  about the peculiar association of morphea, celiac disease, dermatitis herpetiformis and dermatomyositis , and we would discuss the particular genetics that lay behind morphea and related autoimmune disorders, with a focus on HLA genes.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42463302","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":"Electrocardiographic Limb Leads Placement and Its Clinical Implication","authors":"R. T. Tung","doi":"10.17161/kjm.vol14.15259","DOIUrl":"https://doi.org/10.17161/kjm.vol14.15259","url":null,"abstract":"INTRODUCTION Since its introduction, the electrocardiography (ECG) has become the most commonly performed cardiac diagnostic procedure and a fundamental tool of clinical practice.1,2 It is indispensable for the diagnosis and prompt treatment of patients with acute coronary syndromes and is an accurate, noninvasive tool for diagnosing cardiac conduction disturbances and arrhythmias. Proper, standard ECG leads placement is essential in providing accurate information from the recordings. Modified limb leads placement on the torso has the important advantages of ease and speed of application, particularly in emergent situations and has become commonplace. However, modified limb placement was reported to have unwanted abnormal ECG findings.3 Clinically significant abnormal ECG findings due to this modified, non-standard limb placement are illustrated by two cases.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41400986","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":"Letter to the Editor: A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine","authors":"J. Hagan","doi":"10.17161/kjm.vol1315733","DOIUrl":"https://doi.org/10.17161/kjm.vol1315733","url":null,"abstract":"I am an experienced and published researcher using timolol betablocker ophthalmic eyedrops for the successful treatment of acute migraines.1-5 The above referenced paper contains many errors in study design and conduct.6 The statistics, discussion, and conclusion are misleading. Beta blockers are FDA approved and often effective for chronic migraine prevention by taking daily oral doses that maintain therapeutic blood levels. For acute migraine, oral beta blockers have not worked well because they take too long to achieve therapeutic blood levels.1,2 There are three other ways beta blocker solutions can be used to quickly achieve therapeutic blood levels. The first is promptly and properly applied topical beta blocker eyedrops to normal eyes/eyelids/nasolacrimal ducts/nasal mucosa. Faster is sublingual beta blocker drops and the fastest is beta blocker nasal spray.1,2 These last two preferred methods were not discussed in Aggarwal’s paper.6 Ophthalmologists spend their careers listening to patients complain about the difficulties of using eye drops. Sublingual application has been studied and found effective for glaucoma control in a subgroup of dropchallenged patients.7 Most acute migraine patients I have treated with timolol 0.5% eye drops prefer to take them sublingual for ease of application and efficacy rather than topical to the eyes. Absorption of beta blockers and subsequent beta receptor blockade has been studied.1,8 Of these three methods, nasal application has been shown to the be fastest and equivalent to intravenous beta blocker administration in a study of 80 human volunteers.8 Until recently, no beta blocker nasal spray was commercially available. O’Brien Pharmacy (https://obrienrx.com/) now prepares a compounded nasal spray of timolol with MucoluxTM delivering 0.125 mg/0.1 ml spray. The nasal spray is shaken and one spray delivered into each nostril at first onset of migraine symptoms. Patients may also take their other acute migraine medications with the beta blocker nasal spray. If migraine headache persists a second set of one spray per nostril is repeated in 10-15 minutes. A maximum of 4 sprays per 24 hours is specified. An O’Brien pharmacist contacts the patient on receiving a prescription from a licensed physician and inquires about beta blocker contra-indication and instructs on use. The cost of the medication at this writing is $30 for a 10 ml bottle plus postage. All future research on using beta blockers for acute migraine should be done using nasal delivery. I have no financial interest in this product. The Aggarwal study6 has so many other deficiencies that for reasons of space I can only list them without much discussion: patients not beta blocker naïve were included; retrospective exclusion of them taints the already scant data; the patients were not instructed to take the eye drops as quickly as possible with migraine onset; instead they had to fill out a questionnaire about the migraine; the study does not state if","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42899489","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":"Comparative Prevalence of Incidentally Detected Lung Malignancies on CTAC for MPI","authors":"Joseph C. Lee, J. Chong","doi":"10.17161/kjm.vol1415037","DOIUrl":"https://doi.org/10.17161/kjm.vol1415037","url":null,"abstract":"We read with interest the study published by Tung and Heyns.1 It echoes the sentiments we espoused in our findings.2 We, too, support thorough investigation of incidental findings on computed tomography for attenuation correction (CTAC) during myocardial perfusion imaging (MPI). In particular, we share concerns about lung malignancies discovered by this avenue. Interestingly, there were considerable similarities as well as significant differences in the respective patient cohorts. The age group was comparable. In both groups, there was a range of histologic types represented. On the other hand, we noted that the series of patients studied by Tung and Heyns1 was entirely male. Most surprisingly was the occurrence rate of malignancies being discovered incidentally on MPI. The frequency of malignancy of chest in the patients who underwent MPI in this series was 0.73% (8/1,098 patients). By contrast, we identified 10 primary thoracic cancers amongst 3,122 patients. This equates to 0.32%. This is less than half the frequency suggested by Tung and Heyns. We wonder if the CTAC settings (in terms of voltage, current, collimator, rotation time and pitch) were comparable. Other factors which determine spatial resolution on CT scan include field of view, pixel size, focal spot size, magnification, patient motion, kernel, slice thickness, detector size.3 We are at a loss to explain the difference in detection rates otherwise. Perhaps the authors can give suggestions on why our respective cohorts, and prevalences, differed so significantly.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"14 1","pages":"29 - 29"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49357654","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":"Effectiveness of a Pilot Breastfeeding Educational Intervention Targeting High BMI Pregnant Women","authors":"L. Jacobson, Rosalee Zackula, Kelsey Lu","doi":"10.17161/kjm.v13i.14630","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14630","url":null,"abstract":"Introduction Overweight and obesity during pregnancy are associated with adverse health outcomes leading to increased maternal and neonatal morbidity and mortality. Women with a high body mass index (BMI) also experience low breastfeeding rates. There is limited evidence of effective educational programs that aim to improve length of breastfeeding among this population. The main objective of this pilot educational intervention was to determine knowledge and skills retention at six weeks after completion of a breastfeeding class. Methods A two-hour breastfeeding class was offered during the second and third trimester of pregnancy targeting high BMI women. A longitudinal, survey study design was conducted using two data collection points. No comparator group was employed. Results Baseline mean age of respondents was 26.6 years (SD = 5.7). Respondents who completed post-intervention surveys were largely white (69.2%) followed by Hispanic (15.4%) and non-Hispanic black (15.4%), some college (57.1%), earned less than $50,000/year (64.3%), had employer-provided insurance (53.8%), and did not receive WIC benefits (78.6%). Most respondents had a pre-pregnancy BMI category of overweight (28.6%) or obese (57.1%). The intervention appeared to have some impact on responses. The following were observed: an increased understanding that baby may be fussy in the evening hours and wants to nurse more often (p < 0.002), how to bring baby to the breast (p = 0.004), knowing what to do if breastfeeding hurts (p = 0.031), and knowing what to do when baby has trouble breastfeeding (p = 0.021). Conclusion Consistent with previous findings, all participants in our study reported increased knowledge to breastfeed. Thus, women’s confidence to breastfeed their infant is enhanced through knowledge obtained from breastfeeding education. Additional studies are underway to assess breastfeeding behaviors.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"219 - 227"},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.17161/kjm.v13i.14630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49615056","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}