J. Cottrell, MD, William Hayes, MS4, David Jude, MD, David Chaffin, MD
Background Obesity is a significant contributor to adverse maternal and perinatal outcomes, increasing the risk of spontaneous miscarriage, stillbirth, preterm delivery, fetal malformations, gestational diabetes, fetal macrosomia, cesarean section, maternal thromboembolic complications, and hypertensive complications. Historical data indicate that nonpregnant individuals with obesity typically have an elevated cardiac output, increase in total and central blood volume, and low peripheral vascular resistance. Studies measuring hemodynamic parameters in pregnant patients with obesity is lacking. Methods A retrospective study was conducted in 796 pregnant patients referred to the Maternal Hypertension Center at Cabell Huntington Hospital; 335 had a Body Mass Index (BMI) of < 30kg/m2, 171 had a BMI of 30kg/m2 - 34.9kg/m2, 154 had a BMI of 35kg/m2 - 39.9kg/m2, and 136 had a BMI >4 40kg/m2. Results The maternal hemodynamic parameters showed significant differences in systolic blood pressure (p value <.01), mean arterial pressure (p value = 0.01), cardiac output (p value <0.01), and systemic vascular resistance (p value <0.01). There were no significant differences in maternal heart rate (p value = 0.2093) or diastolic blood pressure between groups (p value = 0.1139). Conclusion Non-invasive hemodynamic testing offers the opportunity to further explore pathologic cardiovascular alterations of pregnant patients with obesity. Further research is needed to categorize hemodynamic parameters, with an attempt to explore potential interventions to improve pregnancy outcomes for gravidas with obesity.
{"title":"Cardiodynamic Profiles of Gravidas with Obesity in Early Gestation","authors":"J. Cottrell, MD, William Hayes, MS4, David Jude, MD, David Chaffin, MD","doi":"10.21885/wvmj.2022.9","DOIUrl":"https://doi.org/10.21885/wvmj.2022.9","url":null,"abstract":"Background Obesity is a significant contributor to adverse maternal and perinatal outcomes, increasing the risk of spontaneous miscarriage, stillbirth, preterm delivery, fetal malformations, gestational diabetes, fetal macrosomia, cesarean section, maternal thromboembolic complications, and hypertensive complications. Historical data indicate that nonpregnant individuals with obesity typically have an elevated cardiac output, increase in total and central blood volume, and low peripheral vascular resistance. Studies measuring hemodynamic parameters in pregnant patients with obesity is lacking. Methods A retrospective study was conducted in 796 pregnant patients referred to the Maternal Hypertension Center at Cabell Huntington Hospital; 335 had a Body Mass Index (BMI) of < 30kg/m2, 171 had a BMI of 30kg/m2 - 34.9kg/m2, 154 had a BMI of 35kg/m2 - 39.9kg/m2, and 136 had a BMI >4 40kg/m2. Results The maternal hemodynamic parameters showed significant differences in systolic blood pressure (p value <.01), mean arterial pressure (p value = 0.01), cardiac output (p value <0.01), and systemic vascular resistance (p value <0.01). There were no significant differences in maternal heart rate (p value = 0.2093) or diastolic blood pressure between groups (p value = 0.1139). Conclusion Non-invasive hemodynamic testing offers the opportunity to further explore pathologic cardiovascular alterations of pregnant patients with obesity. Further research is needed to categorize hemodynamic parameters, with an attempt to explore potential interventions to improve pregnancy outcomes for gravidas with obesity.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76651045","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}
A. B. Sheppard, PhD, Courtney Hereford, MSPH, MSW, Cynthia Persily, PhD, April Vestal, MPH, Emily Thomas, DO, Janet Hinton, MS
Introduction The purpose of the study was to identify factors that influence the decision to practice medicine in West Virginia (WV) and to identify state-specific targets to address workforce issues. Methods A cross-sectional study was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians with a e-mail address on file with the state allopathic medical licensing board and the WV Osteopathic Medical Association. Descriptive statistics and inductive analyses were employed. Results Forty-five percent of respondents were from WV, and 17% were from rural WV in the sample size of 428. Quality of life and loan forgiveness/repayment were more important to primary care than specialty care providers. Community attributes were important to native West Virginians. Recruitment and retention themes that emerged were as follows: home and family, the capacity to dually serve as faculty and clinician, to serve where most needed, debt payback, and quality of life. Discussion Quality of life and community attributes were the most influential factors in deciding to practice medicine in WV. Financial incentives were effective recruitment tools. Retention was strongly influenced by social and reimbursement policy in the state, clinical leadership at the local level, and lifestyle factors in the geographic region. Conclusion Enhancing relationships and coordinating programs across sectors to provide targeted recruitment, addressing socioeconomic and public health issues, and periodically evaluating physician satisfaction may be leverage points for physician recruitment and retention in WV.
{"title":"Factors Influencing the Decision to Practice Medicine in West Virginia: Findings from a Statewide Survey of Physicians","authors":"A. B. Sheppard, PhD, Courtney Hereford, MSPH, MSW, Cynthia Persily, PhD, April Vestal, MPH, Emily Thomas, DO, Janet Hinton, MS","doi":"10.21885/wvmj.2022.5","DOIUrl":"https://doi.org/10.21885/wvmj.2022.5","url":null,"abstract":"Introduction The purpose of the study was to identify factors that influence the decision to practice medicine in West Virginia (WV) and to identify state-specific targets to address workforce issues. Methods A cross-sectional study was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians with a e-mail address on file with the state allopathic medical licensing board and the WV Osteopathic Medical Association. Descriptive statistics and inductive analyses were employed. Results Forty-five percent of respondents were from WV, and 17% were from rural WV in the sample size of 428. Quality of life and loan forgiveness/repayment were more important to primary care than specialty care providers. Community attributes were important to native West Virginians. Recruitment and retention themes that emerged were as follows: home and family, the capacity to dually serve as faculty and clinician, to serve where most needed, debt payback, and quality of life. Discussion Quality of life and community attributes were the most influential factors in deciding to practice medicine in WV. Financial incentives were effective recruitment tools. Retention was strongly influenced by social and reimbursement policy in the state, clinical leadership at the local level, and lifestyle factors in the geographic region. Conclusion Enhancing relationships and coordinating programs across sectors to provide targeted recruitment, addressing socioeconomic and public health issues, and periodically evaluating physician satisfaction may be leverage points for physician recruitment and retention in WV.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"219 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73775611","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}
Lisa Calderwood, MPH, James Mears, MD, Scott Fields, PhD
Purpose We studied the psychological impact of the coronavirus disease-2019 (COVID-19) on employees at an urban tertiary care center in the United States' mid-Atlantic region. Methods A Research Electronic Data Capture, or REDCap, survey was completed by 1,116 employees who worked during the COVID-19 pandemic at the tertiary care center. Data included findings from a demographic survery, the Impact of Events Scale-Revised (IES-R), the Patient Health Questionnaire - 9 (PHQ-9), and the Generalized Anxiety Disorder - 7 (GAD-7). A series of Chi- square and, as appropriate, Fisher's Exact tests were performed to compare outcomes among healthcare workers. Results Healthcare employees who had direct contact with patients during the pandemic had significantly higher scores (increased impairment) on the GAD-7 (P<.05), PHQ-9 (P<.001), and IES-R scales (P<.01). Employees with prior psychiatric diagnoses had significantly higher scores on those same corresponding psychological measures (P<.001). Employees who identified with a set of spiritual beliefs had significantly lower scores on the GAD-7 (P<.001) and PHQ-9 (P<.01). Employees reporting five or more years of work experience had lower markers of distress across measures (P<.05). Conclusions The COVID-19 pandemic has had a profound psychological effect on healthcare workers. Our findings point to patient contact and prior psychologic distress as risk factors for impairment, while employee spirituality and prior work experience appear to mitigate risk. Healthcare leaders may use our findings to help employees cope with health crises.
{"title":"Psychological Impact of Coronavirus Disease-2019 on Healthcare Workers","authors":"Lisa Calderwood, MPH, James Mears, MD, Scott Fields, PhD","doi":"10.21885/wvmj.2022.4","DOIUrl":"https://doi.org/10.21885/wvmj.2022.4","url":null,"abstract":"Purpose We studied the psychological impact of the coronavirus disease-2019 (COVID-19) on employees at an urban tertiary care center in the United States' mid-Atlantic region. Methods A Research Electronic Data Capture, or REDCap, survey was completed by 1,116 employees who worked during the COVID-19 pandemic at the tertiary care center. Data included findings from a demographic survery, the Impact of Events Scale-Revised (IES-R), the Patient Health Questionnaire - 9 (PHQ-9), and the Generalized Anxiety Disorder - 7 (GAD-7). A series of Chi- square and, as appropriate, Fisher's Exact tests were performed to compare outcomes among healthcare workers. Results Healthcare employees who had direct contact with patients during the pandemic had significantly higher scores (increased impairment) on the GAD-7 (P<.05), PHQ-9 (P<.001), and IES-R scales (P<.01). Employees with prior psychiatric diagnoses had significantly higher scores on those same corresponding psychological measures (P<.001). Employees who identified with a set of spiritual beliefs had significantly lower scores on the GAD-7 (P<.001) and PHQ-9 (P<.01). Employees reporting five or more years of work experience had lower markers of distress across measures (P<.05). Conclusions The COVID-19 pandemic has had a profound psychological effect on healthcare workers. Our findings point to patient contact and prior psychologic distress as risk factors for impairment, while employee spirituality and prior work experience appear to mitigate risk. Healthcare leaders may use our findings to help employees cope with health crises.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79397251","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: Physician Wellness","authors":"Linda Nield, MD","doi":"10.21885/wvmj.2022.1","DOIUrl":"https://doi.org/10.21885/wvmj.2022.1","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84113900","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}
C. Sedney, Patricia Dekeseredy, Rebecca M. Elmo, Sarah Sofka
Introduction Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff. Methods An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data. Results Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being" included" and feeling part of the team. Conclusion The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.
{"title":"Exploring Resident Physician Wellness at an Allopathic Medical School in West Virginia: A Qualitative Study.","authors":"C. Sedney, Patricia Dekeseredy, Rebecca M. Elmo, Sarah Sofka","doi":"10.21885/wvmj.2022.3","DOIUrl":"https://doi.org/10.21885/wvmj.2022.3","url":null,"abstract":"Introduction\u0000Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff.\u0000\u0000\u0000Methods\u0000An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data.\u0000\u0000\u0000Results\u0000Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being\" included\" and feeling part of the team.\u0000\u0000\u0000Conclusion\u0000The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"66 1","pages":"18-24"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85254038","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: On Healthcare Quality, Patient Safety, and the Guardians of Healthcare","authors":"Shafic Sraj, MD, MBA-c","doi":"10.21885/wvmj.2022.2","DOIUrl":"https://doi.org/10.21885/wvmj.2022.2","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87065973","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 Hereford, MSPH, MSW, A. B. Sheppard, PhD, April Vestal, MPH, Cynthia Persily, PhD, Janet Hinton, MS, Emily Thomas, DO
INTRODUCTION The study describes pipeline, training, and contextual experiences and factors that influence the decision to practice medicine in West Virginia (WV). METHODS The cross-sectional study using descriptive statistics was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians licensed to practice medicine in WV with an e-mail address on file with the WV Board of Medicine or WV Osteopathic Medical Association at the time of the study. RESULTS More WV medical school graduates identifying as a WV native practiced primary care than non-native WV medical graduates in this sample. More native WV medical graduates practiced primary care than non-native peers; however, both groups chose primary care at a greater rate than out-of-state medical school graduates. Returning to home communities and an established network of family and friends were influential factors for WV medical graduates. More WV natives completed residency in-state (n = 127) compared to out-of-state (n = 55). More than half of the sample (69.4%) participated in at least one pipeline program during medical school (n=153), residency (n = 86), undergraduate (n = 50), other graduate training (n = 18), or K-12 (n = 16). Approximately 24% of all respondents' primary practice was in a rural area, and 60% of respondents practiced in a primary health profession shortage area. DISCUSSION More native WV respondents are currently providing primary care and completed residency in-state compared to non-native respondents. The choice of primary care practice was similar across graduates of WV's three medical schools. A majority of respondents participated in pipeline programming though the effect on career and practice location decisions are unclear. CONCLUSIONS Continued recruitment of WV medical school graduates into in-state residency programs, concurrently with expanded primary care training placements and promotion, may increase the number and retention of WV primary care physicians in the coming years. Further study should examine factors that influence physician choice not to return to WV to practice after residency or fellowship training.
{"title":"Factors Influencing the Decision to Practice Medicine in West Virginia: Training Experiences","authors":"Courtney Hereford, MSPH, MSW, A. B. Sheppard, PhD, April Vestal, MPH, Cynthia Persily, PhD, Janet Hinton, MS, Emily Thomas, DO","doi":"10.21885/wvmj.2022.6","DOIUrl":"https://doi.org/10.21885/wvmj.2022.6","url":null,"abstract":"INTRODUCTION The study describes pipeline, training, and contextual experiences and factors that influence the decision to practice medicine in West Virginia (WV). METHODS The cross-sectional study using descriptive statistics was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians licensed to practice medicine in WV with an e-mail address on file with the WV Board of Medicine or WV Osteopathic Medical Association at the time of the study. RESULTS More WV medical school graduates identifying as a WV native practiced primary care than non-native WV medical graduates in this sample. More native WV medical graduates practiced primary care than non-native peers; however, both groups chose primary care at a greater rate than out-of-state medical school graduates. Returning to home communities and an established network of family and friends were influential factors for WV medical graduates. More WV natives completed residency in-state (n = 127) compared to out-of-state (n = 55). More than half of the sample (69.4%) participated in at least one pipeline program during medical school (n=153), residency (n = 86), undergraduate (n = 50), other graduate training (n = 18), or K-12 (n = 16). Approximately 24% of all respondents' primary practice was in a rural area, and 60% of respondents practiced in a primary health profession shortage area. DISCUSSION More native WV respondents are currently providing primary care and completed residency in-state compared to non-native respondents. The choice of primary care practice was similar across graduates of WV's three medical schools. A majority of respondents participated in pipeline programming though the effect on career and practice location decisions are unclear. CONCLUSIONS Continued recruitment of WV medical school graduates into in-state residency programs, concurrently with expanded primary care training placements and promotion, may increase the number and retention of WV primary care physicians in the coming years. Further study should examine factors that influence physician choice not to return to WV to practice after residency or fellowship training.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85940900","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 Since the influenza vaccination rate in West Virginia has been low in comparison to the Healthy People 2020 Goal of 70%, we sought to understand the barriers to vaccination. METHODS A questionnaire was administered to adult patients 18 years and older who sought care between October 1, 2017, and February 28,2018, at a university primary care clinic. The participants were divided into two groups: patients who received or intended to receive the influenza vaccine (vaccinated group) and those who declined it (unvaccinated group). The two groups were compared to assess differences in knowledge, attitudes, and perceptions. RESULTS In total, 178 patients participated. The vaccinated group had increased knowledge of the vaccine's effectiveness (p value < 0.001), vaccine indications (p = 0.044), and reduced disease severity after vaccination (p < 0.001) compared to the unvaccinated group. In addition, the most common reasons for declining vaccination were lack of awareness (34%), fear of side effects (31%), and lack of perceived need or motivation (21%). CONCLUSION A significant knowledge disparity existed between patients who received or planned to receive the influenza vaccine and those who declined, suggesting this knowledge gap may explain the low vaccination rates and emphasizing the importance of counseling patients on the benefits and risks of the vaccine.
{"title":"Knowledge Gap as Barrier to Influenza Vaccination at a University Primary Care Clinic","authors":"Yi-Wen Chen, MD, MS, Ruchi Bhandari, PhD, MPA, MBA, Melanie Fisher, MD, FACP, MSc","doi":"10.21885/wvmj.2021.13","DOIUrl":"https://doi.org/10.21885/wvmj.2021.13","url":null,"abstract":"INTRODUCTION Since the influenza vaccination rate in West Virginia has been low in comparison to the Healthy People 2020 Goal of 70%, we sought to understand the barriers to vaccination. METHODS A questionnaire was administered to adult patients 18 years and older who sought care between October 1, 2017, and February 28,2018, at a university primary care clinic. The participants were divided into two groups: patients who received or intended to receive the influenza vaccine (vaccinated group) and those who declined it (unvaccinated group). The two groups were compared to assess differences in knowledge, attitudes, and perceptions. RESULTS In total, 178 patients participated. The vaccinated group had increased knowledge of the vaccine's effectiveness (p value < 0.001), vaccine indications (p = 0.044), and reduced disease severity after vaccination (p < 0.001) compared to the unvaccinated group. In addition, the most common reasons for declining vaccination were lack of awareness (34%), fear of side effects (31%), and lack of perceived need or motivation (21%). CONCLUSION A significant knowledge disparity existed between patients who received or planned to receive the influenza vaccine and those who declined, suggesting this knowledge gap may explain the low vaccination rates and emphasizing the importance of counseling patients on the benefits and risks of the vaccine.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80477130","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}
Joy J. Juskowich, MD, William L. Hall, MD, Katrin Kiavash, MD, AP/CP, Arif R. Sarwari, MD, MSc, MBA, P. R. LaSala, MD
INTRODUCTION Leprosy, caused by the acid-fast bacillus Mycobacterium leprae, is a chronic infectious disease that primarily affects skin and peripheral nerves. While it is now considered a rare disorder, nine-banded armadillos recently emerged as a source of zoonotic leprosy in the southern United States (US). We present a patient with zoonotic leprosy diagnosed in West Virginia (WV). An immunocompetent 64-year-old woman, living in WV since late childhood, presented with a one-year history of progressively worsening maculopapular rash and peripheral neuropathy. Skin biopsies from her upper back on two separate occasions revealed well-formed, non-caseating epithelioid granulomas and scarce acid-fast bacilli. The patient had traveled to her son's farmhouse in rural Texas multiple times over the past three years and disclosed seeing several armadillos around the yard. She was diagnosed with tuberculoid leprosy and responded well to dapsone and rifampin. Leprosy is an underrecognized and underdiagnosed disease. Within the last decade, two armadillo- related strains of Mycobacterium leprae have been identified, Awareness of zoonotic leprosy is important for prompt diagnosis and treatment to minimize disability.
{"title":"A Case of Zoonotic Leprosy in West Virginia","authors":"Joy J. Juskowich, MD, William L. Hall, MD, Katrin Kiavash, MD, AP/CP, Arif R. Sarwari, MD, MSc, MBA, P. R. LaSala, MD","doi":"10.21885/wvmj.2021.12","DOIUrl":"https://doi.org/10.21885/wvmj.2021.12","url":null,"abstract":"INTRODUCTION Leprosy, caused by the acid-fast bacillus Mycobacterium leprae, is a chronic infectious disease that primarily affects skin and peripheral nerves. While it is now considered a rare disorder, nine-banded armadillos recently emerged as a source of zoonotic leprosy in the southern United States (US). We present a patient with zoonotic leprosy diagnosed in West Virginia (WV). An immunocompetent 64-year-old woman, living in WV since late childhood, presented with a one-year history of progressively worsening maculopapular rash and peripheral neuropathy. Skin biopsies from her upper back on two separate occasions revealed well-formed, non-caseating epithelioid granulomas and scarce acid-fast bacilli. The patient had traveled to her son's farmhouse in rural Texas multiple times over the past three years and disclosed seeing several armadillos around the yard. She was diagnosed with tuberculoid leprosy and responded well to dapsone and rifampin. Leprosy is an underrecognized and underdiagnosed disease. Within the last decade, two armadillo- related strains of Mycobacterium leprae have been identified, Awareness of zoonotic leprosy is important for prompt diagnosis and treatment to minimize disability.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81393534","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}
Afton Wagner, CCRP, Jordan Brewer, MPAS, PA-C, Daniel Grabo, MD, FACS
BACKGROUND Injured patients in rural states like West Virginia (WV) rely on advanced practice providers (APPs) to provide initial care in Level Ill an IV trauma centers prior to transfer to medical centers with additional resources. This is a first attempt to survey trauma centers in WV and report on the roles that APPs perform in trauma care. METHODS Trauma directors and program managers at all 21 accredited trauma centers in WV were queried via an online survey. The number of APPs~-physicians' assistants (PAs) and nurse practitioners (NPs) participating in trauma care were queried from each center. Information was obtained on the location where APPs participated in trauma care, such as: trauma bay, operating room, and intensive care unit. Follow-up surveys inquired about trauma educational opportunities provided to APPs, including: Advanced Trauma Life Support (ATLS), Rural Trauma Team Development Course (RTTDC), and Stop the Bleed (STB). RESULTS Responses were received from 81% of WV's trauma centers. The total number of APPs participating in trauma care were 81 (PAS =48; NPS = 33). The majority of APPs performed patient care roles in the trauma bay (84%). The results of the follow-up survey demonstrated that 100% of trauma centers provide the ALS course for their APPs, 83% provide RTTDC, and 50% provide STB training. CONCLUSIONS The WV trauma system relies on APPs to deliver care from patient arrival through definitive treatment and disposition. Opportunities exist for education and training of the APP community within a rural trauma system.
{"title":"The Role of Advanced Practice Providers in the West Virginia Trauma System","authors":"Afton Wagner, CCRP, Jordan Brewer, MPAS, PA-C, Daniel Grabo, MD, FACS","doi":"10.21885/wvmj.2021.20","DOIUrl":"https://doi.org/10.21885/wvmj.2021.20","url":null,"abstract":"BACKGROUND Injured patients in rural states like West Virginia (WV) rely on advanced practice providers (APPs) to provide initial care in Level Ill an IV trauma centers prior to transfer to medical centers with additional resources. This is a first attempt to survey trauma centers in WV and report on the roles that APPs perform in trauma care. METHODS Trauma directors and program managers at all 21 accredited trauma centers in WV were queried via an online survey. The number of APPs~-physicians' assistants (PAs) and nurse practitioners (NPs) participating in trauma care were queried from each center. Information was obtained on the location where APPs participated in trauma care, such as: trauma bay, operating room, and intensive care unit. Follow-up surveys inquired about trauma educational opportunities provided to APPs, including: Advanced Trauma Life Support (ATLS), Rural Trauma Team Development Course (RTTDC), and Stop the Bleed (STB). RESULTS Responses were received from 81% of WV's trauma centers. The total number of APPs participating in trauma care were 81 (PAS =48; NPS = 33). The majority of APPs performed patient care roles in the trauma bay (84%). The results of the follow-up survey demonstrated that 100% of trauma centers provide the ALS course for their APPs, 83% provide RTTDC, and 50% provide STB training. CONCLUSIONS The WV trauma system relies on APPs to deliver care from patient arrival through definitive treatment and disposition. Opportunities exist for education and training of the APP community within a rural trauma system.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"68 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77442391","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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