Kansas Journal of Medicine最新文献

Introduction: The purpose of this study was to investigate the influence of the Summer Training Option in Rural Medicine (STORM) program and other elective experiences during the summer between the first and second pre-clerkship years of medical school on medical students' career intentions.

Methods: A retrospective voluntary and anonymous cohort study was conducted by distributing an email survey to the 211 second-year medical students at the University of Kansas School of Medicine (KUSM). The survey consisted of a variety of questions regarding their recent summer break elective experiences.

Results: Eighty-nine students (42.2% response rate) completed the survey; 21 respondents participated in the STORM program. Important factors influencing the choice of an elective included, working one-on-one with an educator, hands-on experiences, and receiving academic credit. Sixty-seven respondents (75.3%) concluded that their experience met their expectations, 50 (56.2%) concluded that their experience helped solidify their career goals, while 20 (22.5%) concluded that their experience made them question their career goals. Eleven respondents (12.4%) wished they had participated in a different summer experience, and 16 respondents (18.0%) changed their career plans after their summer experience.

Conclusions: A break between first and second years of medical school allowed students to explore career options; such experiences may ignite a particular passion, solidify an already determined specialty choice, or dissuade a student from pursuing a particular career pathway. Medical school affirmation of the importance of significant, sustained, and student-chosen opportunities to work one-on-one with a mentor and engage in hands-on learning during the pre-clerkship years is crucial. The STORM program was one elective option that delivered on students' expectations.

Introduction: Pregnancy-related mortality in the United States occurs in 32.3 per 100,000 live births. Rural maternal mortality rates were even higher, and these patients were less likely to receive routine care. The purpose of this cross-sectional study was to compare primary and prenatal care and health behaviors among perinatal mothers living in rural and urban Kansas.

Methods: Data were collected from 1,971 pregnant women who participated in Phase 8 Pregnancy Risk Assessment Monitoring System (PRAMS) for Kansas between 2016 and 2018. Respondent location (urban or rural based on NIH classification) was abstracted from birth certificates and frequencies of healthcare visits and secondary healthcare variables were compared.

Results: Most respondents (75.1%, n = 1,481) resided in an urban area. Most (84.4%, n = 1,664) women were Caucasian, and the largest category (31.1%, n = 613) was 25 to 29 years old. More urban women reported visiting an obstetrician/gynecologist within 12 months before pregnancy than rural women (p < 0.0001). Urban women reported attending pre-pregnancy dental visits (p = 0.019) and teeth cleanings (p = 0.004) more than rural women. Of the 35.7% of respondents (n = 516) who reported receiving pre-pregnancy counseling on folic acid, prenatal vitamins, or multivitamins, 78.9% (n = 407) resided in an urban area.

Conclusions: Rural women reported fewer routine primary and prenatal care behaviors compared to their urban counterparts. Efforts are needed to improve access to obstetrician/gynecologist services, especially for women in rural areas.

Introduction: Colon cancer impacts the lives of Kansans and those across the United States. Epidermal growth factor receptor (EGFR) inhibitors, such as panitumumab and cetuximab, have gained popularity as first-line treatment for stage 4 colon cancer despite their toxicities and have been used by clinicians in later lines of therapy. EGFR inhibitors have been proven to be an efficacious first-line treatment for stage 4 colon cancer, but no study has investigated outcomes comparing EGFR inhibitors as first-line treatment to its use as second- or third-line treatment. This study investigated EGFR inhibitor therapy estimated overall survival when used as first-, second-, and third-line treatment for stage 4 colon cancer.

Methods: A retrospective review was done for patients with stage 4 colon cancer who underwent EGFR inhibitor treatment at a large academic center from November 2007 to August 2021. The patients were stratified into five groups by the line in which they received the EGFR inhibitor treatment. A log-rank test was used to analyze the groups, and the median survival for each group was determined.

Results: A total of 68 patients were reviewed; 18 received first-line, 23 received second-line, 18 received third-line, 6 received fourth-line, and 3 received sixth-line treatment with an EGFR inhibitor. Fourth- and sixth-line therapies were excluded due to small patient size. There was no significant difference in estimated survival time between any of the lines. Median survival of the therapies was found.

Conclusions: There was no statistical difference in survival between the first-, second-, or third-line groups, which may provide justification for its use as a second- or third-line therapy.

Introduction: Adequate physical activity is an integral requirement for achieving cardiovascular health. Physical inactivity is the fourth leading cause of death worldwide. Hence, it is important to identify racial/ethnic groups that are less likely to achieve sufficient physical activity levels, and to address barriers to meeting physical activity requirements.

Methods: Cross-sectional data from the 2006-2015 National Health Interview Survey (NHIS) were used to compare self-reported sufficient physical activity among different racial/ethnic groups: non-Hispanic (NH) Whites, NH Blacks, NH Asians, and Hispanics in the United States. Sufficient physical activity was defined as ≥ 150 minutes per week of moderate-intensity physical activity, ≥ 75 minutes per week of vigorous-intensity physical activity, or ≥ 150 minutes per week of moderate and vigorous physical activity.

Results: The study sample consisted of 296,802 individuals, mean age ± standard error age 46.4 ± 0.10 years, 52% women, 70% NH White, 12% NH Black, 5% NH Asian, and 14% Hispanic. The prevalence of sufficient physical activity in the overall population was 46%, while it was 48% among NH Whites, 39% among NH Blacks, 45% among NH Asians, and 40% among Hispanics. In multivariable-adjusted models (odds ratio; 95% confidence interval), NH Blacks (0.79; 0.64,0.97), NH Asians (0.72; 0.62,0.85) and Hispanics (0.71; 0.61,0.82) were significantly less likely to engage in sufficient physical activity compared with NH Whites. Older age, women, and low income were inversely associated with sufficient physical activity, while a college education or higher was associated directly with it.

Conclusions: NH Black and Asian Americans and Hispanic adults were less likely to engage in sufficient physical activity levels compared with Whites. It is important to address barriers to meeting physical activity thresholds to help achieve optimal cardiovascular health.

Introduction: Many medical schools overestimate the percentage of their graduates who enter the primary care workforce based on the "first-certificate" residency their graduates enter. To rectify this problem, Deutchman and colleagues proposed a new method of estimation. The objective of this study was to compare results from the traditional residency match and Deutchman methods to the actual percentage of University of Kansas School of Medicine (KUSM) graduates who practice primary care after completing medical school and all residency and subspeciality fellowship training.

Methods: A retrospective study was conducted using a convenience sample of KUSM graduates from 2003-2014. Percentages of graduates classified as primary care by the traditional Residency Match Primary Care Method (RMPCM) and the percentages of graduates identified as primary care by Deutchman's Intent to Practice Primary Care Method (IPPCM) were compared with the actual percentage of graduates who eventually entered the primary care workforce.

Results: Of the 1,944 KUSM graduates identified during the study period, the RMPCM predicted a 48.1% primary care output rate. The Deutchman's IPPCM predicted a 22.8% primary care output rate. The actual known percentage of graduates practicing primary care was 34.2%.

Conclusions: Neither the RMPCM nor the Deutchman's IPPCM performed well in predicting the percentage or number of KUSM graduates who eventually practiced primary care. Due to predictions for the shortage of primary care physicians, there is a need to identify a method that more accurately predicts the medical schools' contribution to the primary care workforce.

Introduction: No safe detectable level of lead (Pb) exists in the blood of children. Until recently, U.S. Centers for Disease Control and Prevention (CDC) guidelines designated a blood lead level (BLL) ≥ 5 μg/dL as an elevated BLL (EBLL). For the State of Kansas, early childhood blood lead burdens lack reporting in the literature.

Methods: Secondary analysis was conducted of passively reported EBLL rates ≥ 5 μg/dL among children ages 0 - 5 years at the zip code-level in Kansas during 2005 to 2012. Data weights using corresponding population estimates were applied to produce statewide outcomes.

Results: Statewide estimates of annual testing coverage in Kansas among children ages 0 - 5 years were low (9.7%). Approximately 17,000 children ages 0 - 5 years developed an EBLL ≥ 5 μg/dL each year in Kansas with a 6.9% statewide EBLL rate compared to the national rate of 3.2% for the corresponding years. Significant variations in EBLL rates were found between suburban zip codes compared to urban, urban cluster, or rural at 3.1%, 7.2%, 8.8%, and 10.0%, respectively. Among the worst outcomes in EBLL rates was observed for zip codes in southeast Kansas (13.5%) and rural areas with < 500 persons (15.1%).

Conclusions: Young children in Kansas had twice the risk of developing an EBLL ≥ 5 μg/dL compared to the national rate, while higher rates consistently were seen outside of the suburbs and particularly in more rural and less populated areas. At-risk children and troubled areas of toxic lead exposure in the State of Kansas require increased recognition with improved targeting and interventions.

Introduction: Our institution created a review of anatomy relevant to general surgery for third-year medical students. This study was designed to evaluate this review program and determine if participation increased third-year medical students' anatomy knowledge and confidence identifying anatomical structures in the operating room.

Methods: A formalin-embalmed cadaver-based review of anatomy was created and taught in near-peer fashion to third-year medical students. An anonymous survey and anatomy test were administered to participants pre- and post-session. The survey and test were designed to evaluate anatomy knowledge as well as student confidence identifying structures in the operating room. Survey data were compared using the Wilcoxon signed rank test.

Results: Seventy third-year medical students completed the anatomy review. There was a statistically significant improvement in students' confidence levels identifying structures in the operating room (p < 0.001) and in anatomy test scores (p < 0.001). Subjectively, students were thankful for the review session and found it helpful.

Conclusions: This near-peer review session designed at our institution was successful in improving immediate anatomy test scores and confidence levels identifying structures in the operating room. A course similar to this could be included at other medical schools to improve medical student confidence in identifying relevant anatomic structures in the operating room.