{"title":"Editor's Letter - One Common and Two Uncommon Medical Conditions in West Virginia","authors":"Linda S. Nield, MD","doi":"10.21885/wvmj.2022.13","DOIUrl":"https://doi.org/10.21885/wvmj.2022.13","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79608883","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}
Courtney A. Hereford, MSPH, MSW, Jacob Lyon, MD, Norman Montalto, DO, James Becker, MD, Todd H. Davies, PhD
INTRODUCTION Increases in opioid use disorder (OUD) and the consequences to communities across the United States have resulted in a call for an increase in buprenorphine-based medication-assisted treatment (MAT) options. As legislative efforts continue to expand, it is important to understand the provider viewpoint of any such expansion. METHODS An anonymous survey was conducted in 2019 among primary care physicians, specialists, and mid-level practitioners, as well as dentists, op-tometrists, veterinarians, and providers currently practicing in West Virginia (WV) and eligible to prescribe opioids and scheduled substances. The survey included both quantitative and qualitative items measuring provider self-reported practices, training, support, experiences, and perceptions on treatment of patients using MAT. RESULTS A significant (p<0.001) majority of providers reported the need for MAT expansion and the belief that patients with OUD benefit from MAT (2.7% response rate). Despite this acknowledged need and established efficacy of MAT, survey findings suggest that fewer providers in WV seem interested or willing to expand their practice by providing MAT without additional resources and support. DISCUSSION Despite a small response rate, the participants responses provide useful information. While recent legislation efforts to encourage expansion of treatment waivers and access have been successful, providers reported significant barriers to expanding or incorporating MAT into their practices. Current MAT practitioners report institutional and staff support as major factors in their willingness to provide MAT. The critical question remains on how best to incentivize and sustain MAT practice and remove barriers for providers to meet the growing need and improve care.
{"title":"Prescriber Attitudes and Medication Assisted Treatment","authors":"Courtney A. Hereford, MSPH, MSW, Jacob Lyon, MD, Norman Montalto, DO, James Becker, MD, Todd H. Davies, PhD","doi":"10.21885/wvmj.2022.16","DOIUrl":"https://doi.org/10.21885/wvmj.2022.16","url":null,"abstract":"INTRODUCTION Increases in opioid use disorder (OUD) and the consequences to communities across the United States have resulted in a call for an increase in buprenorphine-based medication-assisted treatment (MAT) options. As legislative efforts continue to expand, it is important to understand the provider viewpoint of any such expansion. METHODS An anonymous survey was conducted in 2019 among primary care physicians, specialists, and mid-level practitioners, as well as dentists, op-tometrists, veterinarians, and providers currently practicing in West Virginia (WV) and eligible to prescribe opioids and scheduled substances. The survey included both quantitative and qualitative items measuring provider self-reported practices, training, support, experiences, and perceptions on treatment of patients using MAT. RESULTS A significant (p<0.001) majority of providers reported the need for MAT expansion and the belief that patients with OUD benefit from MAT (2.7% response rate). Despite this acknowledged need and established efficacy of MAT, survey findings suggest that fewer providers in WV seem interested or willing to expand their practice by providing MAT without additional resources and support. DISCUSSION Despite a small response rate, the participants responses provide useful information. While recent legislation efforts to encourage expansion of treatment waivers and access have been successful, providers reported significant barriers to expanding or incorporating MAT into their practices. Current MAT practitioners report institutional and staff support as major factors in their willingness to provide MAT. The critical question remains on how best to incentivize and sustain MAT practice and remove barriers for providers to meet the growing need and improve care.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83362638","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}
uberculosis (TB) is relatively uncommon in West Virginia compared to surrounding Appalachia and the rest of the country. Despite the low prevalence, it is essential to diagnose promptly given the high potential for significant disease burden. Miliary TB is a form of disseminated Mycobacterium tuberculosis infection resulting from hematogenous spread of the organism. Known risk factors for developing disseminated TB include immunosup-pressant medications, human immunodeficiency virus infection, and extremes of age. We present a case in which a patient without identifiable risk factors for TB developed intestinal TB that had been misdiagnosed as Crohn's disease. Shortly after being started on immunosuppressant therapy for the presumed inflammatory bowel disease, the patient developed significant miliary TB
{"title":"Tuberculosis Presenting as Intestinal Granulomas in a Patient from West Virginia","authors":"Kristen Catherman, MD, Vishal Deepak, MD, Bathmapriya Balakrishnan, MD, Hatim Al-Jaroushi,MD","doi":"10.21885/wvmj.2022.18","DOIUrl":"https://doi.org/10.21885/wvmj.2022.18","url":null,"abstract":"uberculosis (TB) is relatively uncommon in West Virginia compared to surrounding Appalachia and the rest of the country. Despite the low prevalence, it is essential to diagnose promptly given the high potential for significant disease burden. Miliary TB is a form of disseminated Mycobacterium tuberculosis infection resulting from hematogenous spread of the organism. Known risk factors for developing disseminated TB include immunosup-pressant medications, human immunodeficiency virus infection, and extremes of age. We present a case in which a patient without identifiable risk factors for TB developed intestinal TB that had been misdiagnosed as Crohn's disease. Shortly after being started on immunosuppressant therapy for the presumed inflammatory bowel disease, the patient developed significant miliary TB","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"228 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77002423","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}
Adam M. Franks, MD, Kevin S. McCann, MD, Kimberly Velthouse, MD, MPH, MBA, Rich Sutphin, MPH, Stephen M. Petrany, MD
INTRODUCTION Primary care providers are increasingly called to address the problem of treatment of non-malignant chronic pain with opioids, particularly in low resource areas. An Intentional Structured Opioid Management Protocol (ISOMP) is a primary care-based program shown to significantly decrease opioid burden. The development of sustainable programs that improve opioid-related outcomes is especially important in these low resource areas. METHODS A retrospective electronic health record review was conducted for financial data and billing practices for a cohort engaged in the ISOMP between 2011 and 2014. Data was analyzed for sustainability within macroscopic practice-wide and microscopic daily scopes. Further analysis was conducted on the implications of patients maintained on (Group A) and weaned from (Group B) opioids. Data was analyzed with STATA software. RESULTS ISOMP demonstrated decreased patient encounters numbers (-7.38%), increased total work relative value unit (RVU) (+7.73%), reduced no-show visits (-12.14%), and increased total reimbursement (+13.06%). Group A had fewer encounters (-6.41%) and increased work RVU (+42.95%). Group B had fewer encounters (-24.04%) but decreased work RVU (-17.56%). Significant decreases in encounters (-44.99%) and work RVUs (-47.39%) were seen after discontinuation of opioids. CONCLUSIONS Besides its previously documented opioid discontinuation rate, the ISOMP model was associated with fewer visits and better visit compli-ance. Sustainability was proven as neither global practice nor daily productivity was negatively impacted. Time-based coding for Group A offset losses seen in Group B productivity with savings directly related to speed of opioid wean
{"title":"Intentional Structured Opioid Monitoring Protocol: Responsible and Viable Opioid Deprescribing","authors":"Adam M. Franks, MD, Kevin S. McCann, MD, Kimberly Velthouse, MD, MPH, MBA, Rich Sutphin, MPH, Stephen M. Petrany, MD","doi":"10.21885/wvmj.2022.15","DOIUrl":"https://doi.org/10.21885/wvmj.2022.15","url":null,"abstract":"INTRODUCTION Primary care providers are increasingly called to address the problem of treatment of non-malignant chronic pain with opioids, particularly in low resource areas. An Intentional Structured Opioid Management Protocol (ISOMP) is a primary care-based program shown to significantly decrease opioid burden. The development of sustainable programs that improve opioid-related outcomes is especially important in these low resource areas. METHODS A retrospective electronic health record review was conducted for financial data and billing practices for a cohort engaged in the ISOMP between 2011 and 2014. Data was analyzed for sustainability within macroscopic practice-wide and microscopic daily scopes. Further analysis was conducted on the implications of patients maintained on (Group A) and weaned from (Group B) opioids. Data was analyzed with STATA software. RESULTS ISOMP demonstrated decreased patient encounters numbers (-7.38%), increased total work relative value unit (RVU) (+7.73%), reduced no-show visits (-12.14%), and increased total reimbursement (+13.06%). Group A had fewer encounters (-6.41%) and increased work RVU (+42.95%). Group B had fewer encounters (-24.04%) but decreased work RVU (-17.56%). Significant decreases in encounters (-44.99%) and work RVUs (-47.39%) were seen after discontinuation of opioids. CONCLUSIONS Besides its previously documented opioid discontinuation rate, the ISOMP model was associated with fewer visits and better visit compli-ance. Sustainability was proven as neither global practice nor daily productivity was negatively impacted. Time-based coding for Group A offset losses seen in Group B productivity with savings directly related to speed of opioid wean","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82013893","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}
Complete separation of the amnion and chorion is a rare pregnancy complication. The proposed causes for chorioamniotic separation are failure of fusion,spontaneous separation, and iatrogenically from invasive prenatal pro-cedures. We present the first reported case of delayed complete chorioamniotic separation following a motor vehicle collision. Close fol-low-up with serial fetal ultrasounds resulted in a favorable outcome
{"title":"Delayed Complete Chorioamniotic Membrane Separation in the Third Trimester Following a Motor Vehicle Collision","authors":"Katherine R. Addicott, MD, Jesse N. Cottrell, MD","doi":"10.21885/wvmj.2022.17","DOIUrl":"https://doi.org/10.21885/wvmj.2022.17","url":null,"abstract":"Complete separation of the amnion and chorion is a rare pregnancy complication. The proposed causes for chorioamniotic separation are failure of fusion,spontaneous separation, and iatrogenically from invasive prenatal pro-cedures. We present the first reported case of delayed complete chorioamniotic separation following a motor vehicle collision. Close fol-low-up with serial fetal ultrasounds resulted in a favorable outcome","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88689192","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}
Introduction The Ryan White (RW) program is a cohort of services for underinsured, uninsured, and low-income patients with human immunodeficiency virus (HIV) infection. Although the RW program is known to enhance patient engagement and continuity of care, there are no studies that have investigated the direct impact of a RW clinic on statewide HIV transmission. Methods A retrospective review of 372 patients was undertaken at an HIV clinical site receiving RW funds in West Virginia (WV) in 2009-2019. Demographics, comorbid conditions, and details regarding disease acquisition were noted. In-state transmission was measured as the proportion of patients with newly diagnosed HIV who self-reported HIV acquisition within WV. With high rates of viral suppression and patient retention in our clinic, our hypothesis was that this proportion should decrease over time. Results Despite maintaining a greater than 90% retention of care and viral suppression rate over the study period, our data did not show a significant decline in the ratio of patients newly infected with HIV within WV over time (54.2% at the beginning of the study period vs 58.6% at the end, p-value 0.199). Conclusion Our results show that maintenance of high retention of care and viral suppression rates in one RW clinical site did not significantly reduce in-state transmission of HIV. Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers can reduce spread of in-state HIV infection.
{"title":"Impact of a Ryan White Clinic on Statewide New HIV Infections","authors":"Armaghan-e-Rehman Mansoor, MD, Arif Sarwari, MD","doi":"10.21885/wvmj.2022.11","DOIUrl":"https://doi.org/10.21885/wvmj.2022.11","url":null,"abstract":"Introduction The Ryan White (RW) program is a cohort of services for underinsured, uninsured, and low-income patients with human immunodeficiency virus (HIV) infection. Although the RW program is known to enhance patient engagement and continuity of care, there are no studies that have investigated the direct impact of a RW clinic on statewide HIV transmission. Methods A retrospective review of 372 patients was undertaken at an HIV clinical site receiving RW funds in West Virginia (WV) in 2009-2019. Demographics, comorbid conditions, and details regarding disease acquisition were noted. In-state transmission was measured as the proportion of patients with newly diagnosed HIV who self-reported HIV acquisition within WV. With high rates of viral suppression and patient retention in our clinic, our hypothesis was that this proportion should decrease over time. Results Despite maintaining a greater than 90% retention of care and viral suppression rate over the study period, our data did not show a significant decline in the ratio of patients newly infected with HIV within WV over time (54.2% at the beginning of the study period vs 58.6% at the end, p-value 0.199). Conclusion Our results show that maintenance of high retention of care and viral suppression rates in one RW clinical site did not significantly reduce in-state transmission of HIV. Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers can reduce spread of in-state HIV infection.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80126043","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}
Ganglioneuromas (GNs) are benign neoplasms of the autonomic nervous system. They are typically located in the retroperitoneum, posterior mediastinum, and adrenal gland. Rarely, they can arise in the cervical region and present as an enlarging neck mass. However, there have not been any reported cases, to our knowledge, of a GN presenting as Horner's syndrome. An 11-year-old female presented with a neck mass and a history of left-sided ptosis, miosis, and anhidrosis. The mass was excised, and pathology revealed a GN. In patients with a neck mass and Horner's syndrome, GNs should be considered as well as other nerve sheath tumors.
{"title":"Cervical Ganglioneuroma Presenting as a Neck Mass with Horner's Syndrome","authors":"Erica Haught, BS, Tyler Harper, BS, Pamela Phillips, MD, Marcus Shaffer, MD","doi":"10.21885/wvmj.2022.10","DOIUrl":"https://doi.org/10.21885/wvmj.2022.10","url":null,"abstract":"Ganglioneuromas (GNs) are benign neoplasms of the autonomic nervous system. They are typically located in the retroperitoneum, posterior mediastinum, and adrenal gland. Rarely, they can arise in the cervical region and present as an enlarging neck mass. However, there have not been any reported cases, to our knowledge, of a GN presenting as Horner's syndrome. An 11-year-old female presented with a neck mass and a history of left-sided ptosis, miosis, and anhidrosis. The mass was excised, and pathology revealed a GN. In patients with a neck mass and Horner's syndrome, GNs should be considered as well as other nerve sheath tumors.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74922638","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":"Message from the President: 2021-2022 Presidency in Review: Physician Unity Moves Medicine Through Diversity and Inclusivity","authors":"Shafic Sraj, MD, MBA-c","doi":"10.21885/wvmj.2022.8","DOIUrl":"https://doi.org/10.21885/wvmj.2022.8","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"452 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77715942","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":"Editor's Letter: The Common Cold in the Time of COVID-19","authors":"Linda Nield, MD","doi":"10.21885/wvmj.2022.7","DOIUrl":"https://doi.org/10.21885/wvmj.2022.7","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88000101","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}
Mastoiditis and post-auricular abscesses are exceptionally rare complications of acute otitis media in children less than six months of age. We report the case of a five-week-old boy who presented with protrusion of the right ear accompanied by surrounding erythema and edema. Head computed tomography (CT) revealed right acute otitis media with mastoid opacification and possible post-auricular abscess formation. After one day of intravenous antibiotics and corticosteroids, repeat head CT with contrast revealed right mastoid effusion, breech of the temporal bone cortex overlying the right mastoid air cells, and abscess formation. The disease course and treatment are described.
{"title":"Acute Otitis Media and Mastoiditis with Post-Auricular Abscess in a Five-Week-Old","authors":"Tyler Wanstreet, BS, Marcus Shaffer, MD","doi":"10.21885/wvmj.2022.12","DOIUrl":"https://doi.org/10.21885/wvmj.2022.12","url":null,"abstract":"Mastoiditis and post-auricular abscesses are exceptionally rare complications of acute otitis media in children less than six months of age. We report the case of a five-week-old boy who presented with protrusion of the right ear accompanied by surrounding erythema and edema. Head computed tomography (CT) revealed right acute otitis media with mastoid opacification and possible post-auricular abscess formation. After one day of intravenous antibiotics and corticosteroids, repeat head CT with contrast revealed right mastoid effusion, breech of the temporal bone cortex overlying the right mastoid air cells, and abscess formation. The disease course and treatment are described.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83803298","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}
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