Kansas journal of medicine最新文献

Introduction: Suicide rates in the U.S. are higher than the global average, with rural areas experiencing even greater rates. This study investigated whether a single suicide prevention training could improve knowledge, awareness, and intention to act among various gatekeeper populations in Kansas, a rural state with elevated suicide rates.

Methods: Licensed clinical psychologists at a public university in Kansas developed an evidence-based suicide prevention training program, offered online to multiple subgroups: university faculty, staff, and students, health care workers, and community members (voluntarily), as well as high school staff and students (compulsorily). The study employed a reliable, validated instrument to assess participants' knowledge, awareness, and intention to act using a Likert-type scale. Participants also reported whether they had completed prior suicide prevention training. A total of 865 participants provided retrospective pre/post responses, and the data were analyzed using paired samples t-tests and one-way ANOVA/Kruskal-Wallis tests.

Results: Overall, participants in all subgroups, regardless of prior training, showed statistically significant pre/post increases across all measures. While no significant differences were found in learning between recruitment subgroups, variations were identified based on the number of previous trainings completed.

Conclusions: The findings support the effectiveness of a single suicide prevention training across diverse populations, suggesting important implications for targeting training efforts and optimizing resource allocation in high-need environments.

Introduction: An annual fasting lipid panel (FLP) is recommended for patients with diabetes, with more frequent testing advised during the escalation of cholesterol-lowering therapy. However, the calculated low-density lipoprotein cholesterol (LDL-C) using the Friedewald equation becomes unreliable when triglycerides are ≥400 mg/dL. In such cases, providers must order a separate direct LDL-C assay to obtain accurate results. Failing to do so may lead to missed opportunities for therapy intensification. This study examined an institution's current practices for following up on invalid LDL-C results, especially considering the stringent LDL-C targets outlined in recent guidelines and consensus statements.

Methods: The authors conducted a retrospective chart review across 13 outpatient clinics within a single health system over five years. The study included patients aged 40-75 with diabetes who had at least one invalid LDL-C result. They assessed the frequency of ordering a direct LDL-C assay within seven days of an invalid LDL-C result.

Results: Out of 1,364 unique invalid FLPs, 97 (7.1%) met the criteria for the primary outcome. The rate of therapy escalation was not numerically affected by whether a direct LDL-C was ordered or the provider type. However, patients without a direct LDL-C ordered within seven days showed a trend towards more frequent therapy escalation (16.2%, n = 25/154) compared to those with a direct LDL-C (14.9%, n = 23/154).

Conclusions: The current practice at this institution of manually ordering a direct LDL-C assay to verify invalid LDL-C results poses a risk of missing necessary guideline-directed therapeutic intensification. This process may be improved by implementing a reflex direct LDL-C assay.

Introduction: While there is some data on the bone health of transgender individuals, less is known about their fracture patterns. The authors of this study aimed to describe the anatomic locations of fractures and the prevalence of select comorbidities among transgender patients who presented with fractures at a single institution.

Methods: The authors conducted a retrospective chart review of patients with fractures at a single institution between January 2020 and January 2021. The study examined demographics, fracture locations, and comorbidities for all transgender individuals who sustained fractures.

Results: The average age of patients was 35.7 ± 13.2 years. The shoulder and upper arm were the most common fracture sites, accounting for 38% of injuries. Twenty-seven percent of transgender patients presented with multiple fractures. Notably, no lumbar spine fractures were observed in this group. The prevalence of depression was 54%, and hypertension was 19% among transgender patients. Although 85% of fractures were not due to high-energy trauma, none of the patients had a documented history of bone health disorders.

Conclusions: This study provides insights into the fracture patterns among transgender individuals at a single institution, highlighting a tendency toward low-energy fractures in a relatively young population. Further research, including age-matched comparative studies, is needed to better understand bone health and fracture risk in transgender patients.

Introduction: The aim of this study was to assess the percentage of trauma patients admitted and receiving intervention, and to identify which of these interventions were performed by non-trauma specialists.

Methods: The authors conducted a retrospective chart review of all adult patients who presented to the trauma service between January 2019 and June 2019. Collected data included demographics, trauma activation level, total interventions performed, interventions performed by the trauma team, interventions performed by subspecialty teams, and isolated injuries requiring orthopedic, neurosurgical, or other specialized care. Descriptive analyses were used to evaluate the data.

Results: The authors reviewed a total of 287 patient charts. Of these, 111 patients (38.7%) underwent operative intervention. Seventy-five patients (26.1%) received operative intervention from the orthopedic surgery team, 16 patients (5.6%) from the neurosurgery team, and 14 patients (4.9%) from other subspecialty teams. Only six patients (2.1%) underwent operative intervention by the trauma team.

Conclusions: The data suggest that many trauma admissions do not require trauma team interventions. This highlights the potential need to reassess the criteria for admitting trauma patients.

Introduction: Iliopsoas bursitis and tendinopathy are common causes of hip pain and major contributors to snapping hip syndrome, which affects 5-10% of the general population. These conditions often are treated with conservative measures, including corticosteroid injections into the iliopsoas bursa. However, the clinical effectiveness of such injections has not been well studied. Through this study, the authors evaluated the efficacy of ultrasound-guided corticosteroid injections into the iliopsoas bursa.

Methods: The study included 68 patients diagnosed with iliopsoas tendinopathy, iliopsoas bursitis, or snapping hip syndrome (coxa saltans), all of whom received corticosteroid injections into the iliopsoas bursa as a standard treatment. A single-sample, non-experimental design was employed, with participants completing assessments of pain, mechanical symptoms, physical function, activity level, and total hip score at baseline, and again at three- and six-month post-injection. Data were collected from January 1, 2023, to April 1, 2024, and changes in the outcome measures were analyzed using repeated measures ANOVA.

Results: Participants showed significant improvements in pain, mechanical symptoms, physical function, and activity level at both three-month and six-month follow-ups. Additionally, overall hip scores improved statistically by the end of the study.

Conclusions: Our data suggest that ultrasound-guided corticosteroid injections into the iliopsoas bursa can effectively improve physical function, enhance the ability to perform daily activities and physical tasks, and reduce disability associated with iliopsoas tendinopathy. Further research with a longer follow-up period and more rigorous controls is warranted to confirm these findings and assess the long-term benefits and potential risks of the procedure.

Introduction: Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases with childhood onset. Cinematic films and movies can reach populations worldwide and affect their concept of this disease. Through this research, the authors examined the accuracy of movies depicting T1D from childhood into adulthood.

Methods: We conducted an internet search of several databases, which resulted in a list of 39 movies from 2000 to 2022 with characters who had diabetes. We ultimately assessed 13 fictional movies. We calculated the percentages of movies that addressed vital aspects of T1D such as disease management, access to care, character development, and complications. We also applied a qualitative approach to assess the depth and accuracy of the portrayal of T1D.

Results: Movies portrayed severe but rare diabetes manifestations such as coma. They emphasized access to essential diabetes supplies and the cost of care. It was not until 2020 that movies featured a continuous glucose monitor (CGM) and insulin pumps. They presented female characters as resilient and unaffected by the struggles of their T1D.

Conclusions: This sample of fictional movies portrays extreme T1D symptoms and mostly outdated monitoring and treatment technology. It would be beneficial if future movies reflected the advances in closed-loop CGM/insulin pumps. Clinicians should know how the movie industry presents the disease to their patients. Clinicians can use popular movies to start difficult discussions with patients about topics pertinent to the comprehensive care of T1D.