Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.22352
Nicholas Kounis
{"title":"The “Neglected aVR Lead”: Kounis Syndrome of MINOCA Type, Severe Left Main or 3-Vessel Disease and Type A Dissecting Ascending Aortic Aneurysm","authors":"Nicholas Kounis","doi":"10.17161/kjm.vol17.22352","DOIUrl":"https://doi.org/10.17161/kjm.vol17.22352","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"31 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808399","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}
Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.21379
Shelby Durler, Kelly L. Lightwine, Elizabeth Ablah, Thomas Cox, James M Haan
Introduction. This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs. Methods. Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up. Results. Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation. Conclusions. The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury.
{"title":"Evaluating the Long-Term Neurologic Sequelae Among Trauma Patients who Received Flexion-Extension Radiographs","authors":"Shelby Durler, Kelly L. Lightwine, Elizabeth Ablah, Thomas Cox, James M Haan","doi":"10.17161/kjm.vol17.21379","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21379","url":null,"abstract":"Introduction. This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs. \u0000Methods. Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up.\u0000Results. Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation.\u0000Conclusions. The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury. ","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"52 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806900","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}
Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.21651
Paige Nichols, Adrienne Esposito, Maria Kolojeski, Jennifer Keomany, Hayrettin Okut, Jacqueline Morgan, Kevin Miller
Introduction: Vaginal cuff dehiscence (CD) after hysterectomy is a relatively uncommon but potentially serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for benign and malignant indications. This study aimed to determine if there is a difference in the incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer. Methods: This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from 2013 through 2018. Patients who underwent conversion to laparotomy, chemotherapy and/or radiation within a year before or after RLTH, and with malignancies other than uterine cancer were excluded. Data were abstracted from patient medical records. Results: Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While controlling for other variables, obese patients were 25.1% less likely than non-obese patients to experience CD (p=.011). Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon A compared to surgeon B (p=0.027). No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD. Conclusions: Endometrial cancer patients were not at greater risk of experiencing CD compared to non-cancer patients. Surgeon differences and BMI were associated with incidence of CD, and patients with a normal BMI were most likely to report experiencing CD.
导言：子宫切除术后阴道袖带开裂（CD）是机器人辅助腹腔镜全子宫切除术（RLTH）的一种相对少见但潜在的严重并发症，RLTH适用于良性和恶性适应症。本研究旨在确定子宫内膜癌患者与非子宫内膜癌患者相比，RLTH术后CD的发生率和风险因素是否存在差异：这项回顾性研究纳入了2013年至2018年期间由一家机构的两名外科医生之一实施RLTH手术的18岁或18岁以上女性。排除了在RLTH前后一年内接受开腹手术、化疗和/或放疗的患者，以及患有子宫癌以外的恶性肿瘤的患者。数据摘自患者病历：在符合纳入标准的 950 名患者中，50.7%（n=482）患有子宫内膜癌。在所有患者中，2.5%（24 人）患有子宫内膜癌。在控制其他变量的情况下，肥胖患者发生子宫内膜癌的几率比非肥胖患者低 25.1%（p=.011）。此外，与外科医生 B 相比，由外科医生 A 进行手术的患者发生 CD 的几率是后者的 2.8 倍（p=0.027）。其他变量（癌症状况、年龄、手术后的性活动、从家中到手术地点的距离、从手术到失去随访的时间间隔）都不能预测CD的发生：与非癌症患者相比，子宫内膜癌患者发生子宫内膜异位症的风险并不大。外科医生的差异和体重指数与子宫内膜异位症的发生率有关，体重指数正常的患者最有可能出现子宫内膜异位症。
{"title":"Vaginal Cuff Dehiscence after Robotic Hysterectomy in Endometrial Cancer vs. Non-Cancer Patients","authors":"Paige Nichols, Adrienne Esposito, Maria Kolojeski, Jennifer Keomany, Hayrettin Okut, Jacqueline Morgan, Kevin Miller","doi":"10.17161/kjm.vol17.21651","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21651","url":null,"abstract":"Introduction: Vaginal cuff dehiscence (CD) after hysterectomy is a relatively uncommon but potentially serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for benign and malignant indications. This study aimed to determine if there is a difference in the incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer.\u0000Methods: This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from 2013 through 2018. Patients who underwent conversion to laparotomy, chemotherapy and/or radiation within a year before or after RLTH, and with malignancies other than uterine cancer were excluded. Data were abstracted from patient medical records.\u0000Results: Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While controlling for other variables, obese patients were 25.1% less likely than non-obese patients to experience CD (p=.011). Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon A compared to surgeon B (p=0.027). No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD.\u0000Conclusions: Endometrial cancer patients were not at greater risk of experiencing CD compared to non-cancer patients. Surgeon differences and BMI were associated with incidence of CD, and patients with a normal BMI were most likely to report experiencing CD.","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"50 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141807667","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}
Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.21875
Wissam Karam, Timothy Nguyen, William Salyers
{"title":"A Case of Extensive Cholangiocarcinoma Highlighting Challenges in Diagnosis and Treatment","authors":"Wissam Karam, Timothy Nguyen, William Salyers","doi":"10.17161/kjm.vol17.21875","DOIUrl":"https://doi.org/10.17161/kjm.vol17.21875","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"24 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806217","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}
Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.22135
Donna Ewy
{"title":"Ethical Obligation of Adequate Pain Management in Long Term Care Residents with Dementia","authors":"Donna Ewy","doi":"10.17161/kjm.vol17.22135","DOIUrl":"https://doi.org/10.17161/kjm.vol17.22135","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"60 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806961","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}
Pub Date : 2024-07-24DOI: 10.17161/kjm.vol17.20588
Hitanshu Dave, Lawrence Zhou, Deva Zamzow, Robert Wittler
{"title":"A Case Report of Leclercia adecarboxylata Pyogenic Arthritis","authors":"Hitanshu Dave, Lawrence Zhou, Deva Zamzow, Robert Wittler","doi":"10.17161/kjm.vol17.20588","DOIUrl":"https://doi.org/10.17161/kjm.vol17.20588","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808010","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}
Pub Date : 2023-06-20eCollection Date: 2023-01-01DOI: 10.17161/kjm.vol16.19952
Jennifer L Hartwell, Paul Barach, Tracy D Gunter, Kyra Reed, Heather Kelker, Julie Welch, Kristine Olson, Elizabeth Harry, Samantha Meltzer-Brody, Mariah Quinn, Jennifer Ferrand, Sharon C Kiely, Jane Hartsock, Emily Holmes, Kristin Schroeder, Rami Ahmed
{"title":"Navigating Work-Life Integration, Legal Issues, Patient Safety: Lessons for Work-Life Wellness in Academic Medicine: Part 1 of 3.","authors":"Jennifer L Hartwell, Paul Barach, Tracy D Gunter, Kyra Reed, Heather Kelker, Julie Welch, Kristine Olson, Elizabeth Harry, Samantha Meltzer-Brody, Mariah Quinn, Jennifer Ferrand, Sharon C Kiely, Jane Hartsock, Emily Holmes, Kristin Schroeder, Rami Ahmed","doi":"10.17161/kjm.vol16.19952","DOIUrl":"10.17161/kjm.vol16.19952","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"153-158"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/3c/16-153.PMC10291991.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9781800","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}
Pub Date : 2023-06-20eCollection Date: 2023-01-01DOI: 10.17161/kjm.vol16.19953
Rami Ahmed, Jennifer L Hartwell, Heather Farley, Julia MacRae, David A Rogers, Elizabeth C Lawrence, Chantal Mlr Brazeau, Eliza M Park, Anna Cassidy, Jane Hartsock, Emily Holmes, Kristen Schroeder, Paul Barach
{"title":"Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3.","authors":"Rami Ahmed, Jennifer L Hartwell, Heather Farley, Julia MacRae, David A Rogers, Elizabeth C Lawrence, Chantal Mlr Brazeau, Eliza M Park, Anna Cassidy, Jane Hartsock, Emily Holmes, Kristen Schroeder, Paul Barach","doi":"10.17161/kjm.vol16.19953","DOIUrl":"10.17161/kjm.vol16.19953","url":null,"abstract":"","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"159-164"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/7b/16-159.PMC10291990.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10085444","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}
Pub Date : 2023-04-24eCollection Date: 2023-01-01DOI: 10.17161/kjm.vol16.18514
Bradley J Newell, Ashley M Kells, Amy D Robertson, Tasha M Braun, Kimberly S Ward, Brent J Rohling, Brittany L Melton
Introduction: Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population.
Methods: This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found.
Results: A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol.
Conclusions: Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.
{"title":"Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk.","authors":"Bradley J Newell, Ashley M Kells, Amy D Robertson, Tasha M Braun, Kimberly S Ward, Brent J Rohling, Brittany L Melton","doi":"10.17161/kjm.vol16.18514","DOIUrl":"10.17161/kjm.vol16.18514","url":null,"abstract":"<p><strong>Introduction: </strong>Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population.</p><p><strong>Methods: </strong>This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found.</p><p><strong>Results: </strong>A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol.</p><p><strong>Conclusions: </strong>Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.</p>","PeriodicalId":17991,"journal":{"name":"Kansas Journal of Medicine","volume":"16 ","pages":"88-93"},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/e7/16-88.PMC10136613.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393696","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}
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