Rhode Island medical journal (2013)最新文献

Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder associated with somatic mutations in the PIK3CA gene, characterized classically by a triad of capillary malformations, venous malformations, and soft tissue and bone hypertrophy. While KTS commonly involves a single lower extremity, we present an atypical pediatric case featuring extensive venolymphatic malformation of the intergluteal region. This uncommon anatomical localization predisposed the patient to recurrent episodes of cellulitis, significantly complicating clinical management. This case underscores the importance of recognizing atypical presentations of KTS and the heightened susceptibility to recurrent infections, such as cellulitis, which may significantly impact morbidity and patient care.

Introduction: To study obstetric and gynecologic (OBGYN) resident comfort with performing a salpingectomy at cesarean delivery after a simulation workshop utilizing a low-cost, easy-to-construct model.

Methods: OBGYN residents were taught how to counsel a patient on a salpingectomy and perform the steps of the procedure utilizing our simulation model. We performed a pre- and post- survey.

Results: Thirty-two OBGYN residents completed the pre-questionnaire (response rate 100%) and 30 completed the post-questionnaire (response rate 94%). After the simulation, OBGYN residents felt more comfortable completing a bilateral salpingectomy at cesarean delivery (pre: 50.0% vs. post: 84.4%, p=0.001) and counseling a patient on the procedure (pre: 59.4% vs. post: 90.6%, p=0.006). After the simulation, 96.7% of residents felt the simulation workshop was useful to clinical practice.

Conclusion: We developed an easy-to-construct bilateral salpingectomy at cesarean delivery model to practice preoperative counseling and surgical techniques. The direct impact on surgical competency and outcomes requires further study.

Patients in the Emergency Department (ED) have a diverse set of spiritual challenges. As part of a clinical initiative to embed palliative care in the ED, our palliative care department looked to provide timely spiritual care (SC) to this population. We worked with three of our chaplains to identify ED-specific spiritual care challenges and benefits. Several themes arose on nuances of SC consults in the ED: quality of consults (less focused on actively dying patients, more upstream support), challenges (physical environment, staff limitations, distractions), benefits (continuity of care, support to the ED staff, high moral/spiritual distress in the ED setting, provider- rewarding care, taking advantage of long ED stays), and ways to improve (embedding SC in the ED, education on scope of service provided by SC). Addressing spiritual and moral distress is a key component of high-quality palliative care and may be a feasible patient-centered outcome to address in future research.

Introduction: This case report describes the utilization of patient-specific 3D modeling for the care of a 13-year-old patient with a distal radius malunion and partial growth arrest.

Methods: Patient-specific 3D models of the patient's wrist were created using computed tomography scans. Digital modeling software was used to determine the appropriate orientation of the osteotomy, size and shape of bone graft, and final wrist alignment. The 3D models were used to rehearse the osteotomy preoperatively. Intraoperatively, bone graft was harvested to the planned specifications and the osteotomy was successfully performed followed by stabilization.  Results: Radiographs demonstrated appropriate correction of radial length, alignment, and rotation matching the preoperative 3D model. At final follow-up, the patient demonstrated union of the osteotomy and full recovery with excellent function.

Discussion: Patient-specific 3D modeling and printing provide valuable tools for planning complex surgical cases. Further research is warranted to assess the broader applications of this technology in orthopedic surgery.

Ovarian teratomas (OT) are rarely first diagnosed in the emergency department (ED) setting. They are less likely to present with acute symptoms unless associated with more serious pathological conditions, such as ovarian torsion, which is considered a gynecological emergency that patients with OT are at risk of developing. We present a patient who complained of abdominal pain, and was diagnosed with an OT using Point-of-care ultrasound (POCUS).

Background: Iron deficiency is a recognized risk for frequent blood donors, particularly for platelet apheresis donors due to their increased donation frequency. This retrospective study examines ferritin levels in 31,661 blood donors, encompassing whole blood (n=26,129) and platelet apheresis (n=5,532) donors from 2018 to 2021. It aims to understand the impact of donation type, age, and sex on iron depletion, emphasizing the unique needs of platelet donors.

Study design and methods: We analyzed data from a centralized blood donation database, stratifying donors by age, sex, and donation type. Ferritin levels, measured using a chemiluminescent immunoassay, served as a marker of iron stores. Statistical analyses included t-tests and ANOVA to compare ferritin levels across donation types and demographics, with a significance threshold of p <0.05.

Results: Platelet donors showed consistently lower mean ferritin levels than whole blood donors, with significant differences observed in males and older female donors across most age groups. This trend suggests cumulative iron depletion in platelet donors due to frequent donation, with marked sex and age-based variations in iron reserves.

Discussion: This study highlights that platelet donors are at a considerable risk of iron depletion, with lower ferritin levels observed across most age and sex categories compared to whole blood donors. Despite the known risks associated with frequent apheresis, interventions have primarily focused on whole blood donors, leaving platelet donors without targeted strategies to mitigate iron deficiency. Our findings underscore the need for targeted interventions for platelet donors.

Introduction: Society guidelines recommend caregivers of neonates, including both co-parents, be up to date on Tdap, COVID-19, and influenza vaccines before delivery to prevent primary transmission of vaccine-preventable diseases to the infant. However, only one third of reproductive-age individuals are up to date on recommended vaccinations. Pregnant individuals often receive recommended vaccines during prenatal care, but limited research has investigated if prenatal care can also provide opportunities to increase vaccination rates among non-birthing partners/co-parents.

Methods: We administered an anonymous survey to outpatient prenatal care providers, including Obstetricians, Family Medicine physicians, Certified Nurse Midwives, and Nurse Practitioners, to assess practice patterns and opinions regarding vaccine counseling and in-office vaccination for the non-birthing partners of pregnant patients.

Results: Of the 200 obstetric providers surveyed, 112 responded (56%). Of these, 42% (n=77) reported counseling non-birthing partners on vaccine recommendations less than half the time. Only 4% (n=4) of respondents report vaccinating non-birthing partners who are not already patients in their practice. Nearly half of providers who do not offer non-birthing partner vaccination had never considered the practice (46%, n=44). The majority of respondents desired more education on non-birthing partner vaccination (58%, n=55). Respondents identified multiple implementation barriers to vaccinating non-birthing partners, including difficulties with registration, staffing, and time constraints. If barriers were addressed, 68% (n=65) of providers expressed willingness to incorporate non-birthing partner vaccination into their practice.

Conclusions: This study demonstrates willingness of key stakeholders to incorporate non-birthing partner vaccination into prenatal care, a unique mechanism to increase parental vaccination rates and protect neonates from vaccine-preventable illness.