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What Providers Know vs. What Providers Do: Barriers to Contraception in Adolescents 提供者知道什么vs.提供者做什么:青少年避孕的障碍
Pub Date : 2021-06-01 DOI: 10.21885/wvmj.2021.9
Andrya J. Durr, BS, Elizabeth A. Critch, MBA, M. P. Fitzgerald, PhD, Kylie A. Fuller, MD, Kelly M. Devlin, MD, Roberta I. Renzelli-Cain, DO, MHS, NCMP, FACOG, IF
INTRODUCTION The teenage birth rate in West Virginia (WV) remains among the highest in the United States. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend long-acting reversible contraception (LARC) as first-line contraception. Because WV teenagers' LARC use is exceptionally low, the objective of this study was to gain insight into the current knowledge, practice, and beliefs of health care providers (HCP) in WV regarding LARC for adolescent patients. METHODS An electronic survey using Qualtrics.com was distributed to WV HCPs. Of the 2,196 HCPs contacted, 132 respondents returned the survey, and 109 completed usable data. RESULTS A majority of HCPs were aware that LARC (i.e., intrauterine devices and implantable devices) is the first line recommendation of the ACOG and AAP for adolescent birth control. However, HCPs most frequently prescribed combination oral contraceptives and injectables, which are not first-line recommendations. Notably, 59% of HCPs prescribing combination oral contraceptives believed they were prescribing according to COG and AAP recommendations. Forty-one percent of HCPs knew that combination oral contraceptives were not a first-line recommendation but prescribed them most often. The most frequently identified most important reason for not prescribing LARC was that the HCP did not know how to place them (16.5% of respondents), followed by litigious or malpractice action if there is a malfunction or complication (4.6% of respondents). DISCUSSION These results indicate a need to provide adequate LARC training to HCPs in WV.
西弗吉尼亚州(WV)的青少年生育率仍然是美国最高的。美国妇产科医师学会(ACOG)和美国儿科学会(AAP)推荐长效可逆避孕(LARC)作为一线避孕措施。由于WV青少年的LARC使用率非常低,本研究的目的是深入了解WV中卫生保健提供者(HCP)对青少年患者LARC的当前知识、实践和信念。方法使用Qualtrics.com进行电子问卷调查。在联系的2196名HCPs中,132名受访者回复了调查,109名完成了可用数据。结果大多数HCPs意识到LARC(即宫内节育器和植入式节育器)是ACOG和AAP对青少年节育的首选推荐。然而,卫生保健专业人员最常开出口服避孕药和注射剂的联合处方,这并不是一线建议。值得注意的是,59%的处方联合口服避孕药的医护人员认为他们是根据COG和AAP的建议开处方的。41%的医护人员知道复方口服避孕药不是一线推荐,但却是最常开的处方。不开LARC的最常见的最重要原因是HCP不知道如何放置它们(16.5%的受访者),其次是如果出现故障或并发症的诉讼或医疗事故诉讼(4.6%的受访者)。这些结果表明需要为WV的HCPs提供足够的LARC培训。
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引用次数: 1
Feasability of Utilizing a Rapid Screening Tool for Suicide and Major Depressive Disorder in Appalachian Acute Care Settings 在阿巴拉契亚急症护理机构中使用自杀和重度抑郁症快速筛查工具的可行性
Pub Date : 2021-06-01 DOI: 10.21885/wvmj.2021.8
Melinda J. Sharon, MPH, Erica Shaver, MD, FACEP, Carmen Burrell, DO, Joseph Minardi, MD, Christopher Kiefer, MD, FACEP, Stephen Davis, PhD, Elyce Biddle, PhD
INTRODUCTION Patients who commit suicide will often visit the emergency department (ED) shortly before death for reasons other than those related to the suicide. These visits may be a prime opportunity to identify patients with symptoms of major depressive disorder (MDD) that contribute to suicidal ideation. This pilot study investigated the feasibility of a recently developed tool, the CAD-MDD-S, a combination of the Computerized Adaptive Diagnostic Screening Tool for Major Depressive Disorder (CAD-MDD) and four screening questions from the Columbia-Suicide Severity Rating Scale (C-SSRS),to identify patients with suicidal thoughts, intent, plans, and behaviors, and/or MDD. METHOD CAD-MDD-S was administered to ambulatory adult patients (18+ years) who presented at an academic ED or student health services clinic for non-mental health concerns. The goal was to study the feasibility and efficiency of the screening tool, assessing the potential impact the tool may have in identifying at risk patients in these clinical settings. RESULTS From August 2015 to November 2016, 345 patients agreed to complete the screening tool (89% agree rate), with 76 screening positive for MDD, 13 for risk of suicide, and 7 for both. The median screening time to completion was six minutes, with 87% of patients taking less than 10 minutes. CONCLUSIONS This pilot study demonstrated that the ad- ministration of the CAD-MDD-S diagnostic screening tool was feasible and efficient in emergency settings, and the time to completion did not present a substantial burden to the patient. Future studies are needed to confirm these findings in other populations with larger samples.
自杀的患者通常会在死亡前不久前往急诊科(ED),原因与自杀无关。这些访问可能是识别导致自杀意念的重度抑郁症(MDD)症状患者的主要机会。这项初步研究调查了最近开发的工具CAD-MDD- s的可行性,CAD-MDD是计算机自适应诊断筛选工具(CAD-MDD)和哥伦比亚自杀严重程度评定量表(C-SSRS)中的四个筛选问题的组合,用于识别有自杀想法、意图、计划和行为和/或MDD的患者。方法CAD-MDD-S被用于在学术ED或学生健康服务诊所就诊的非心理健康问题的非流动成年患者(18岁以上)。目的是研究筛查工具的可行性和效率,评估该工具在这些临床环境中识别高危患者方面的潜在影响。结果2015年8月至2016年11月,345例患者同意完成筛查工具(89%的同意率),其中76例MDD筛查阳性,13例自杀风险筛查阳性,7例两者均阳性。筛查完成的中位时间为6分钟,87%的患者用时不到10分钟。结论:本初步研究表明,CAD-MDD-S诊断筛查工具的使用在急诊环境中是可行和有效的,并且完成时间不会给患者带来实质性负担。未来的研究需要在其他更大样本的人群中证实这些发现。
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引用次数: 0
LGBT Medical Education Assessment in West Virginia 西弗吉尼亚州LGBT医学教育评估
Pub Date : 2021-03-01 DOI: 10.21885/wvmj.2021.5
Elizabeth Duarte, MD, Mahreen Hashmi, MD, Kylie A. Fuller, MD
BACKGROUND Lesbian, gay, bisexual and transgender (LGBT) individuals experience healthcare disparities related to their physical, mental, behavioral, and sexual health. Educating medical students about how to address this public health issue is a priority of the Association of American Medical Colleges and all medical schools across the country. Yet, the training to care for LGBT patients has been inconsistent, and it is unknown how comprehensively these competencies are being addressed at the two allopathic medical schools in West Virginia (WV). METHODS An online questionnaire was distributed to medical students at the two allopathic medical schools in WV to evaluate perceptions of the curricula with respect to care for LGBT patients. RESULTS Medical students (N-91) felt prepared to address 9 of 16 LGBT-specific subject areas. The majority of students felt prepared to discuss sexual orientation (64/91; 70.3%) and human immunodeficiency virus (60/91; 65.9%). Fewer students felt prepared to discuss sex-reassignment surgery (17/91; 18.7%) and transitioning (21/91; 23.1%). Overall, 82.4% of respondents reported feeling "comfortable" or "somewhat comfortable" with LGBT health issues. Medical school education helped 59.3% of respondents feel "more comfortable" and 65,9% of respondents feel "more prepared" to provide medical care to LGBT patients. CONCLUSION Our data suggests that medical school curricula in WV has increased student-rated comfort and preparedness in providing medical care to LGBT patients, but should be further developed and standardized to reduce the perceived knowledge gaps.
背景女同性恋、男同性恋、双性恋和变性人(LGBT)在身体、心理、行为和性健康方面都存在着医疗保健方面的差异。教育医学生如何解决这一公共健康问题是美国医学院协会和全国所有医学院的优先事项。然而,照顾LGBT患者的培训一直不一致,而且尚不清楚西弗吉尼亚州(WV)的两所对抗疗法医学院对这些能力的全面程度。方法通过在线问卷调查的方式对两所对抗疗法医学院的医学生进行问卷调查,以评估他们对LGBT患者护理课程的看法。结果:医学生(N-91)对16个lgbt特定主题领域中的9个做好了准备。大多数学生愿意讨论性取向(64/91;70.3%)和人类免疫缺陷病毒(60/91;65.9%)。很少有学生愿意讨论变性手术(17/91;18.7%)和过渡(21/91;23.1%)。总体而言,82.4%的受访者表示对LGBT健康问题感到“舒服”或“有些舒服”。医学院教育帮助59.3%的受访者感到“更舒服”,65.9%的受访者感到“更准备”为LGBT患者提供医疗服务。结论:我们的数据表明,WV的医学院课程提高了学生对LGBT患者提供医疗服务的舒适度和准备程度,但应进一步发展和标准化,以减少感知到的知识差距。
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引用次数: 0
Appalachian Culture & History, An Important Lesson for Incoming Medical Students 阿巴拉契亚文化与历史:对即将入学的医学生的重要一课
Pub Date : 2021-03-01 DOI: 10.21885/wvmj.2021.3
Jason S. Hedrick, MA, Larry A. Rhodes, MD, Scott Cottrell, EdD, Norman D. Ferrari III, MD
INTRODUCTION There is an expectation that medical students will be exposed to and gain cultural competence prior to graduation. It is prudent to ensure that cultural competence education starts early in the medical school curriculum. METHODS A 90-minute educational session ("Appalachian Culture and History") was created at the West Virginia University School of Medicine as a part of the cultural competency curriculum to better introduce and orient new medical school matriculates to the culture and history of both the state and Appalachia. Students anonymously completed on-line evaluations at the conclusion of the session to rate the quality of the presentation on a five-point scale which ranged from 1 (" very dissatisfied ") to S ("extremely satisfied "). RESULTS Students rated the session at a mean of 4.52, 4.37, and 4,53 in 2018, 2019, and 2020 respectively. Positive comments were generated by in-state and out-of-state students. DISCUSSION Matriculating students have been overwhelmingly satisfied with the Appalachian Culture and History educational session based upon anonymous evaluations. CONCLUSIONS As the majority of medical students have positively appraised the Appalachian Culture and History educational session, there is reason to believe they will be better prepared to learn from and care for patients from Appalachia.
医学生期望在毕业前接触并获得文化能力。确保文化能力教育在医学院课程的早期开始是明智的。方法在西弗吉尼亚大学医学院创建了一个90分钟的教育课程(“阿巴拉契亚文化和历史”),作为文化能力课程的一部分,以便更好地向新的医学院新生介绍和引导他们了解该州和阿巴拉契亚的文化和历史。在课程结束时,学生们匿名完成了在线评估,以5分制对演讲的质量进行评分,从1(非常不满意)到S(非常满意)。结果:2018年、2019年和2020年,学生对课程的平均评分分别为4.52、4.37和4.53。州内和州外的学生都给出了积极的评价。根据匿名评估,入学学生对阿巴拉契亚文化和历史教育课程非常满意。结论大部分医学生对阿巴拉契亚文化和历史教育课程给予了积极评价,我们有理由相信他们会更好地准备学习和照顾阿巴拉契亚病人。
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引用次数: 0
Rural Obesity Medical Education for Primary Care in West Virginia: A Needs Assessment 西弗吉尼亚州农村肥胖医学教育初级保健:需求评估
Pub Date : 2021-03-01 DOI: 10.21885/wvmj.2021.2
Laura Davisson, MD, MPH, FACP, Melissa A. Hernandez-Pachon, BS, Treah S. Haggerty, MD, MS
ABSTRACT INTRODUCTION Obesity is a serious disease associated with adverse health effects and costs, West Virgini(WV) has one of the highest obesity rates in the nation. Addressing obesity largely falls on primary care practitioners, but many feel ill -equipped to counsel patients on weight loss. It is critical for clinicians to be adequately trained to treat obesity, We conducted this study to assess the obesity medical education needs of WV primary care practices. METHODS Data was collected from 17 health systems through W/V Practice-Based Research Network's Collective Outreach and Research Engagement survey. Survey results were analyzed using descriptive statistics to summarize demographics; obesity treatment knowledge and confidence, topics of interest; and preferred educational delivery methods. RESULTS The majority of respondents agreed that medical training in obesity should be strengthened (96.4%). Relatively low confidence levels were reported for prescribing anti-obesity medications (49,4%), optimizing chronic medications for weight (61.0%), and counseling/managing patients before/after bariatric surgery (52,4%). Highest reported interest levels were in strategies for discussing weight with patients (87.2%), food and nutrition (85.7%), physical activity plans (84.4%), motivational interviewing (84.0%), and optimizing chronic medications for weight (79,2%). The highest rated educational delivery method was virtual Continuing Medical Education (91.5%) with lecture format (89.0%). CONCLUSIONS These results can be used to develop obesity medical education for primary care that can ultimately help to reduce health disparities in rural WV. An educational plan should ideally be delivered in virtual lecture format and should address lifestyle modifications, motivational interviewing, bariatric surgery, and obesity pharmacotherapy.
肥胖是一种与不良健康影响和成本相关的严重疾病,西弗吉尼亚州(WV)是全国肥胖率最高的州之一。解决肥胖问题在很大程度上落在了初级保健从业人员身上,但许多人觉得没有能力向患者提供减肥方面的建议。临床医生接受适当的肥胖治疗培训是至关重要的。我们进行了这项研究,以评估WV初级保健实践的肥胖医学教育需求。方法通过W/V基于实践的研究网络的集体外展和研究参与调查从17个卫生系统收集数据。对调查结果进行描述性统计分析,总结人口统计学特征;对肥胖治疗知识有信心,对话题感兴趣;以及首选的教育方式。结果大多数受访者(96.4%)认为应加强肥胖医学培训。处方抗肥胖药物(49.4%)、优化体重慢性药物(61.0%)和减肥手术前后患者咨询/管理(52.4%)的置信度相对较低。报告中最感兴趣的是与患者讨论体重的策略(87.2%)、食物和营养(85.7%)、体育活动计划(84.4%)、动机性访谈(84.0%)和优化慢性药物治疗体重(79.2%)。评价最高的教育交付方式为虚拟继续医学教育(91.5%)和讲座形式(89.0%)。结论这些结果可用于开展肥胖医学教育的初级保健,最终有助于减少农村WV的健康差距。理想情况下,教育计划应该以虚拟讲座的形式进行,并应涉及生活方式的改变、动机访谈、减肥手术和肥胖药物治疗。
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引用次数: 1
Editor's Letter: West Virginian Physicians: Role Models of Optimal Patient Care 编者信:西弗吉尼亚医生:最佳病人护理的榜样
Pub Date : 2021-03-01 DOI: 10.21885/wvmj.2021.1
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引用次数: 0
Raising Awareness about Health Disparities with a Medical and Dental School Web-Based Collaboration 通过医学和牙科学校网络协作提高对健康差异的认识
Pub Date : 2021-03-01 DOI: 10.21885/wvmj.2021.4
Shelia S. Price DDS, EdD, Linda Nield, MD, Christa L. Lilly, PhD, Manuel C. Vallejo MD, DMD
INTRODUCTION A collaborative web-based learning event for beginning medical and dental students was created to raise awareness about health disparities. METHODS Incoming medical and dental students completed an online assignment based upon real patient scenarios which addressed the following six topics: religion, sexual preference, socio-economic status, race, culture, and military veteran status, Students completed identical pre- and post- questionnaires approved by the West Virginia University Institutional Review Board. Questions were ranked on a 6-point Libert scale (1 = strongly disagree to 6 = strongly agree) or 5-point frequency scale (1 = never to 5= always). Data were analyzed using the Mann-Whitney test, with p < 0.05 as significant RESULTS The pre- and post-questionnaires were completed by 45 dental students (94% response rate) and 118 (pre-) and 116 (post-) medical students with 98% and 97% respective response rates. Both dental and medical students had a significant increase in their awareness of health disparities. Dental students had a significant increase in their appreciation of the frequency of health disparities in state and country, while medical students had a significant increase in their agreement that learning events about diversity and inclusion should be threaded throughout the curriculum, and disparities are influenced by the quality of interpersonal health care. CONCLUSIONS Bringing attention to diverse patient populations in a web-based format as part of new student orientation is effective in introducing and enhancing medical and dental students' awareness of health disparities and under essentiality of diversity topics in.
为提高对健康差异的认识,为初学医学和牙科学生创建了一个基于网络的协作学习活动。方法:新入学的医学和牙科学生完成了一份基于真实患者情景的在线作业,涉及以下六个主题:宗教、性取向、社会经济地位、种族、文化和退伍军人身份。学生完成了由西弗吉尼亚大学机构审查委员会批准的相同的前后问卷。问题按6分制(1 =非常不同意到6 =非常同意)或5分制(1 =从不到5=总是)进行排序。结果共有45名牙科专业学生完成问卷前和问卷后的问卷调查,答复率为94%;118名医学生完成问卷前调查,116名医学生完成问卷后的调查,答复率分别为98%和97%。牙科和医科学生对健康差距的认识都有了显著提高。牙科学生对州和国家之间健康差异的认识显著增加,而医科学生对多样性和包容性的学习活动应贯穿整个课程以及差异受人际保健质量的影响这一观点的认同显著增加。结论:作为新生导向的一部分,以网络形式关注不同的患者群体,可以有效地引入和增强医学和牙科学生对健康差异的认识,并在多样性主题的必要性下。
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引用次数: 1
Spinal Flexion Distraction Injuries: Chance Fractures and Posterior Ligamentous Equivalents in Children and Adolescents 脊柱屈曲牵张损伤:儿童和青少年的偶发骨折和后韧带等效损伤
Pub Date : 2020-10-01 DOI: 10.21885/wvmj.2020.8
Tyler Calkin, Emily P. Ernest, J. Lubicky
Flexion-distraction injuries (FDI) are uncommon and often serious due to the mechanism of injury. Although originally described as a bony lesion in the thoracolumbar spine, these injuries can be purely bony, purely ligamentous/soft tissue or a combination at all spinal levels. Because of the forces involved, associated non-spine injuries can occur. Data on patients age 0-18 years with spinal injuries over a ten-year period were retrospectively reviewed and patients were classified into two groups, those with FDI and those with a spinal fracture other than FDI. Cervical and thoracic FDI, Chance fractures and posterior ligamentous equivalents, all considered FDI in this study, occurred in 22/301 spinal injured patients. The highest incidence considering all spinal injured patients was in the under 10 years old group (31.6%; p=0.004). A motor vehicle collision was the most common mechanism of injury. Statistically significant differences between patients with FDI compared to those without were respectively: average age (13.7 vs. 15.6 years), length of stay (10.2 days vs. 4.0 days), follow-up (1.7 years vs. 0.5 years), spinal surgery (78.3% vs. 15.5%), intra-abdominal organ injury (26% vs. 11%) and neurological deficit at presentation (43% vs. 10.4%) and at final follow-up (22% vs. 4%). Five patients without neurologic deficit did not undergo surgery.Seventy-two percent (13/18) of FDI patients having surgery required instrumentation. There was no association between injury level and FDI incidence or neurological deficit. FDI are most common in younger children with high likelihood of associated injuries, including intra-abdominal and neurological. FDI patients most often require surgical treatment, have an increased length of hospital stay and require longer-term follow-up.
屈曲-牵张损伤(FDI)是一种罕见且严重的损伤。虽然最初描述为胸腰椎的骨损伤,但这些损伤可以是纯骨性的,纯韧带/软组织的或所有脊柱水平的组合。由于涉及的力量,相关的非脊柱损伤可能发生。回顾性分析了10年间0-18岁脊柱损伤患者的数据,并将患者分为两组,FDI和非FDI脊柱骨折。在本研究中,颈椎和胸椎FDI、Chance骨折和后韧带等效骨折均被视为FDI,发生在22/301脊柱损伤患者中。所有脊髓损伤患者中发病率最高的是10岁以下年龄组(31.6%;p = 0.004)。机动车碰撞是最常见的伤害机制。与非FDI患者相比,FDI患者的统计学显著差异分别为:平均年龄(13.7岁对15.6岁)、住院时间(10.2天对4.0天)、随访时间(1.7年对0.5年)、脊柱手术(78.3%对15.5%)、腹内器官损伤(26%对11%)、首发时(43%对10.4%)和最终随访时(22%对4%)的神经功能缺损。5例无神经功能缺损患者未行手术。72%(13/18)接受手术的FDI患者需要使用器械。损伤程度与FDI发生率或神经功能缺损之间无关联。FDI最常见于年龄较小的儿童,其相关损伤的可能性很高,包括腹内和神经损伤。FDI患者通常需要手术治疗,住院时间延长,需要长期随访。
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引用次数: 0
Concurrent Development of Septic Arthritis of the Acromioclavicular Joint and Osteomyelitis of the Acromion in a Pediatric Patient 一名儿科患者肩锁关节脓毒性关节炎和肩峰骨髓炎的并发发展
Pub Date : 2020-10-01 DOI: 10.21885/wvmj.2020.6
C. Vijay, Charles B. Chen
The acromioclavicular joint is a rare location for the development of septic arthritis and osteomyelitis. If left untreated, these conditions are rapidly destructive and can cause significant morbidity. Individuals who are immunocompromised, use intravenous drugs, or have a history of shoulder trauma are at higher risk of developing septic arthritis. Having a high degree of suspicion is important in making a timely diagnosis and implementing appropriate therapy. We hereby describe a previously healthy 13-year old patient who presented with concurrent septic arthritis and osteomyelitis of the acromioclavicular joint.
肩锁关节是化脓性关节炎和骨髓炎的罕见发病部位。如果不及时治疗,这些情况会迅速具有破坏性,并可能导致严重的发病率。免疫功能低下、静脉注射药物或有肩关节创伤史的人患感染性关节炎的风险更高。高度怀疑对于及时诊断和实施适当治疗非常重要。我们在此描述一个以前健康的13岁患者谁提出了并发感染性关节炎和肩胛骨骨髓炎。
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引用次数: 0
Preventing a Convergence of COVID-19 Pandemic and Influenza Epidemic on West Virginia’s Residents and Healthcare System 防止COVID-19大流行和流感大流行对西弗吉尼亚州居民和医疗保健系统的融合
Pub Date : 2020-10-01 DOI: 10.21885/wvmj.2020.5
Elaine Darling
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引用次数: 0
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The West Virginia medical journal
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