Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman
Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.
{"title":"Enhancing the rates of advance directive documentation to improve the quality of patient care","authors":"Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman","doi":"10.33470/2379-9536.1420","DOIUrl":"https://doi.org/10.33470/2379-9536.1420","url":null,"abstract":"Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135928366","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}
Tori R. Miller, Erin Light, C. Spainhower, D. Chaffin, J. Cottrell
I ntroductIon : The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is >10 g/dL and if estimated blood loss during delivery is <500mL. M ethods : A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of >10 g/dL and an estimated blood loss at the time of delivery of <500mL. Comparisons were made with 85 consecutive historical controls in the preceding months. r esults : Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p=<.01) in reducing the number of blood draws (1.67±.12 versus 2.37±.12) when applying the protocol to all eligible patients. c onclusIon : The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced health-care costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies.
{"title":"Discontinuation of Routine Postpartum Complete Blood Count in Uncomplicated Vaginal Deliveries","authors":"Tori R. Miller, Erin Light, C. Spainhower, D. Chaffin, J. Cottrell","doi":"10.33470/2379-9536.1394","DOIUrl":"https://doi.org/10.33470/2379-9536.1394","url":null,"abstract":"I ntroductIon : The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is >10 g/dL and if estimated blood loss during delivery is <500mL. M ethods : A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of >10 g/dL and an estimated blood loss at the time of delivery of <500mL. Comparisons were made with 85 consecutive historical controls in the preceding months. r esults : Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p=<.01) in reducing the number of blood draws (1.67±.12 versus 2.37±.12) when applying the protocol to all eligible patients. c onclusIon : The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced health-care costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42906901","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}
Chad D. Lavender, T. Hewett, John D. Johnson, Richard Peluso, Tyag Patel, S. Taylor
B ackground : The objective of this retrospective study is to evaluate outcomes in patients who underwent the fertilized anterior cruciate ligament (ACL) reconstruction procedure. We aim to investigate the return to previous level of activity, safety, and re-rupture rates of the ACL reconstruction augmented with bone marrow concentrate, demineralized bone matrix, autograft bone, and a suture tape (the fertilized ACL). M ethods : A comprehensive review of medical records was conducted for patients treated with the fertilized ACL (FACL). Medical records of all the patients who underwent reconstruction surgery between July 2018 and January 2021 were evaluated. The inclusion criteria for the study were patients with a defined ACL tear based on clinical examination and magnetic resonance imaging testing who received FACL reconstruction between July 2018 and January 2021. Exclusion criteria included revision ACL reconstruction, non FACL reconstruction, and patients that underwent the FACL reconstruction outside of the defined time period. Thirteen patients underwent reconstruction using a Graftlink allograft (Lifenet Virginia Beach, Va) and 38 using quadriceps autografts. All patients received the FACL reconstruction using bone marrow concentrate, demineralized bone matrix, autograft bone, and suture tape. A phone survey was conducted to obtain patient-reported outcome measures including return to previous level of activity, International Knee Documentation Committee (IKDC), ACL Return to Sport After Injury (ACL RSI), and Visual Analogue Scale (VAS) values. A chart review was conducted for complications and questions were asked during the phone survey regarding return to operating room, infections, and re-ruptures. r esults : Data analysis revealed 94% of the patients returned to their previous level of activity. The average IKDC and ACL RSI scores were 94% (SD, 9.0) and 92% (SD,15.3), respectively. The average VAS score was .9/10 (SD, 1.2). One patient required reoperation for pain at 1 year. No re-ruptures were observed. c onclusion : This retrospective study sheds light on the FACL, which adds biology and an internal brace to an ACL reconstruction, as a reliable and safe option when performing an ACL reconstruction. Very low complication rates were seen in this consecutive series followed for a mean of 2 years. Patients had an extremely high level of return to previous level of sport/activity.
{"title":"Return to activity following ACL Reconstruction with the Fertilized ACL: A retrospective study.","authors":"Chad D. Lavender, T. Hewett, John D. Johnson, Richard Peluso, Tyag Patel, S. Taylor","doi":"10.33470/2379-9536.1410","DOIUrl":"https://doi.org/10.33470/2379-9536.1410","url":null,"abstract":"B ackground : The objective of this retrospective study is to evaluate outcomes in patients who underwent the fertilized anterior cruciate ligament (ACL) reconstruction procedure. We aim to investigate the return to previous level of activity, safety, and re-rupture rates of the ACL reconstruction augmented with bone marrow concentrate, demineralized bone matrix, autograft bone, and a suture tape (the fertilized ACL). M ethods : A comprehensive review of medical records was conducted for patients treated with the fertilized ACL (FACL). Medical records of all the patients who underwent reconstruction surgery between July 2018 and January 2021 were evaluated. The inclusion criteria for the study were patients with a defined ACL tear based on clinical examination and magnetic resonance imaging testing who received FACL reconstruction between July 2018 and January 2021. Exclusion criteria included revision ACL reconstruction, non FACL reconstruction, and patients that underwent the FACL reconstruction outside of the defined time period. Thirteen patients underwent reconstruction using a Graftlink allograft (Lifenet Virginia Beach, Va) and 38 using quadriceps autografts. All patients received the FACL reconstruction using bone marrow concentrate, demineralized bone matrix, autograft bone, and suture tape. A phone survey was conducted to obtain patient-reported outcome measures including return to previous level of activity, International Knee Documentation Committee (IKDC), ACL Return to Sport After Injury (ACL RSI), and Visual Analogue Scale (VAS) values. A chart review was conducted for complications and questions were asked during the phone survey regarding return to operating room, infections, and re-ruptures. r esults : Data analysis revealed 94% of the patients returned to their previous level of activity. The average IKDC and ACL RSI scores were 94% (SD, 9.0) and 92% (SD,15.3), respectively. The average VAS score was .9/10 (SD, 1.2). One patient required reoperation for pain at 1 year. No re-ruptures were observed. c onclusion : This retrospective study sheds light on the FACL, which adds biology and an internal brace to an ACL reconstruction, as a reliable and safe option when performing an ACL reconstruction. Very low complication rates were seen in this consecutive series followed for a mean of 2 years. Patients had an extremely high level of return to previous level of sport/activity.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48003784","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}
Awareness among clinicians about Idiopathic pleuroparenchymal fibroelastosis (PPFE) is lacking. By the time patients are diagnosed, they have been seen by multiple physicians and misdiagnosed multiple times. It is a rare condition that is characterized by fibrosis of the pleura and subpleural lung parenchyma, predominantly affecting the upper lobes. The most common cause of fibrosis in other processes is collagen predominant, but in PPFE fibrosis is usually caused by elastic fibers. A Verhoeff-Van Gieson stain from lung biopsies in patients who present with fibrosis in the upper pleural and parenchymal areas will help in establishing the diagnosis by demonstrating the elastic fibers. We also need to rule out the possibility of other lung parenchymal conditions like usual interstitial pneumonia, nonspecific interstitial pneumonitis, pulmonary apical cap, etc. We have presented a case report on PPFE to bring attention to clinicians and to add to the literature so that patients are diagnosed early.
{"title":"A commonly misdiagnosed rare pulmonary disease: Idiopathic pleuroparenchymal fibroelastosis","authors":"Y. Raru, Amro Al-Astal, S. Sigdel","doi":"10.33470/2379-9536.1407","DOIUrl":"https://doi.org/10.33470/2379-9536.1407","url":null,"abstract":"Awareness among clinicians about Idiopathic pleuroparenchymal fibroelastosis (PPFE) is lacking. By the time patients are diagnosed, they have been seen by multiple physicians and misdiagnosed multiple times. It is a rare condition that is characterized by fibrosis of the pleura and subpleural lung parenchyma, predominantly affecting the upper lobes. The most common cause of fibrosis in other processes is collagen predominant, but in PPFE fibrosis is usually caused by elastic fibers. A Verhoeff-Van Gieson stain from lung biopsies in patients who present with fibrosis in the upper pleural and parenchymal areas will help in establishing the diagnosis by demonstrating the elastic fibers. We also need to rule out the possibility of other lung parenchymal conditions like usual interstitial pneumonia, nonspecific interstitial pneumonitis, pulmonary apical cap, etc. We have presented a case report on PPFE to bring attention to clinicians and to add to the literature so that patients are diagnosed early.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48495220","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. Meadows, Mehiar Elhamdani, Dial Larry, Murad M Kheetan, Khaled Al-Baqain
Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for managing such patients, aggressive blood pressure treatment, including using intravenous antihypertensives, is often undertaken. Although beneficial evidence is lacking, emerging data suggest that treating asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, intensifying a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Combining this common problem with the demonstrable benefit of a less aggressive approach offers considerable opportunity to improve patient care. This review will discuss the existing literature with a clinical scenario and make suggestions for practice improvement.
{"title":"Management of Asymptomatic Hypertension in the Inpatient Setting.","authors":"C. Meadows, Mehiar Elhamdani, Dial Larry, Murad M Kheetan, Khaled Al-Baqain","doi":"10.33470/2379-9536.1406","DOIUrl":"https://doi.org/10.33470/2379-9536.1406","url":null,"abstract":"Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for managing such patients, aggressive blood pressure treatment, including using intravenous antihypertensives, is often undertaken. Although beneficial evidence is lacking, emerging data suggest that treating asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, intensifying a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Combining this common problem with the demonstrable benefit of a less aggressive approach offers considerable opportunity to improve patient care. This review will discuss the existing literature with a clinical scenario and make suggestions for practice improvement.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48872950","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":"A Rare Case of Bilateral Synchronous Phyllodes Tumor and Triple Negative Breast Cancer","authors":"Micah Ray, M. Legenza, Diane Krutzler","doi":"10.33470/2379-9536.1393","DOIUrl":"https://doi.org/10.33470/2379-9536.1393","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":"119 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41266499","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}
Shelby Naegele, S. Bush, Paul Bown, Nadim Bou Zgheib
{"title":"Severe Pelvic Endometriosis Involving the Rectum with Near Complete Bowel Obstruction: A Case Report","authors":"Shelby Naegele, S. Bush, Paul Bown, Nadim Bou Zgheib","doi":"10.33470/2379-9536.1388","DOIUrl":"https://doi.org/10.33470/2379-9536.1388","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47520604","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}
T. Bakhshi, E. Hendricks, E. Mcclanahan, Scott Gibbs, A. Franks, Kathleen O’Hanlon, Vincent Graffeo
{"title":"B-Cell Non-Hodgkin’s Lymphoma: viewing an aggressive neck mass in an older adult from a primary care perspective","authors":"T. Bakhshi, E. Hendricks, E. Mcclanahan, Scott Gibbs, A. Franks, Kathleen O’Hanlon, Vincent Graffeo","doi":"10.33470/2379-9536.1400","DOIUrl":"https://doi.org/10.33470/2379-9536.1400","url":null,"abstract":"","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41673761","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}
Eruptive lentigines related to resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologic agents. Gusel-kumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only 1 case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with the successful treatment of plaque psoriasis with Guselkumab. This case study is significant because as biologic agents become more popular, it is critical to document all side effects of new therapeutic agents when encountered.
{"title":"Eruptive Lentigines Confined to Resolving Psoriatic Plaques Following Treatment with Guselkumab","authors":"J. R. Kilgore, James C Curry, S. Cook","doi":"10.33470/2379-9536.1390","DOIUrl":"https://doi.org/10.33470/2379-9536.1390","url":null,"abstract":"Eruptive lentigines related to resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologic agents. Gusel-kumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only 1 case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with the successful treatment of plaque psoriasis with Guselkumab. This case study is significant because as biologic agents become more popular, it is critical to document all side effects of new therapeutic agents when encountered.","PeriodicalId":93035,"journal":{"name":"Marshall journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46348777","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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