Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.15986
Kristina L. Koch, S. Powell, Sukruta Pradhan, F. Newton
INTRODUCTION Ludwig’s angina was described first by physician Wilhem Friedrich von Ludwig in 1836 as a rapidly progressive, potentially fatal spread of bilateral cellulitis of the submandibular space associated with elevation and posterior displacement of the tongue.1 The most frequent source of infection are the molars, particularly the second and third mandibular molars.2,3 It is important for medical providers to recognize this condition promptly and initiate proper treatment before the cellulitis progresses to airway obstruction. Before the era of antibiotics, especially penicillin, this disease had a mortality rate greater than 50%. Following the advent of antibiotics, improved dental care, and aggressive surgical treatment, the mortality rate was estimated to be approximately 8%.1,4 Ludwig’s angina is most seen between ages 20 and 60 years, but has been reported in patients as young as 12 days and as old as 84 years.5,6 The incidence in males is three to four times that in females.3 This case study presents a novel report of a centenarian who presented for surgical drainage of Ludwig’s angina. Older patients with peritonsillar and parapharyngeal abscesses present in a subtle fashion with few of the classic symptoms such as fever, in addition to a delayed presentation.7 This tendency made diagnosis challenging. Whether these results can be extrapolated to a patient with Ludwig’s angina remains to be seen. Managing older patients can be difficult due to multiple comorbidities, as seen in our patient, and because of poorer functional status and frailty. A multi-disciplinary team approach was necessary for this complex case, as it presented the dual challenges of an anticipated difficult airway and perioperative considerations of a centenarian.
{"title":"Ludwig's Angina in a Centenarian Patient","authors":"Kristina L. Koch, S. Powell, Sukruta Pradhan, F. Newton","doi":"10.17161/kjm.vol15.15986","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15986","url":null,"abstract":"INTRODUCTION Ludwig’s angina was described first by physician Wilhem Friedrich von Ludwig in 1836 as a rapidly progressive, potentially fatal spread of bilateral cellulitis of the submandibular space associated with elevation and posterior displacement of the tongue.1 The most frequent source of infection are the molars, particularly the second and third mandibular molars.2,3 It is important for medical providers to recognize this condition promptly and initiate proper treatment before the cellulitis progresses to airway obstruction. Before the era of antibiotics, especially penicillin, this disease had a mortality rate greater than 50%. Following the advent of antibiotics, improved dental care, and aggressive surgical treatment, the mortality rate was estimated to be approximately 8%.1,4 Ludwig’s angina is most seen between ages 20 and 60 years, but has been reported in patients as young as 12 days and as old as 84 years.5,6 The incidence in males is three to four times that in females.3 This case study presents a novel report of a centenarian who presented for surgical drainage of Ludwig’s angina. Older patients with peritonsillar and parapharyngeal abscesses present in a subtle fashion with few of the classic symptoms such as fever, in addition to a delayed presentation.7 This tendency made diagnosis challenging. Whether these results can be extrapolated to a patient with Ludwig’s angina remains to be seen. Managing older patients can be difficult due to multiple comorbidities, as seen in our patient, and because of poorer functional status and frailty. A multi-disciplinary team approach was necessary for this complex case, as it presented the dual challenges of an anticipated difficult airway and perioperative considerations of a centenarian.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"106 - 108"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46496070","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}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.15798
Austin Armstrong, Rachna Kalia, M. Troutman
109 Lamotrigine Drug Interactions: Ignorance is not Bliss Austin G. Armstrong, M.D.1, Rachna Kalia, M.D.1, Megan Troutman, Pharm.D.2 1University of Kansas School of Medicine-Wichita, Wichita, KS Department of Psychiatry and Behavioral Sciences 2Ascension Via Christi Hospital, Wichita, KS Received Sept. 16, 2021; Accepted for publication Feb. 23, 2022; Published online March 15, 2022 https://doi.org/10.17161/kjm.vol15.15798
109拉莫三嗪药物相互作用:无知不是幸福Austin G. Armstrong, M.D.1, Rachna Kalia, M.D.1, Megan Troutman，药学博士2 university of Kansas Medicine-Wichita, Wichita, KS精神病学和行为科学系2 ascension Via Christi Hospital, Wichita, KS接收于2021年9月16日;接受于2022年2月23日发表;2022年3月15日在线发布https://doi.org/10.17161/kjm.vol15.15798
{"title":"Lamotrigine Drug Interactions: Ignorance is not Bliss","authors":"Austin Armstrong, Rachna Kalia, M. Troutman","doi":"10.17161/kjm.vol15.15798","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15798","url":null,"abstract":"109 Lamotrigine Drug Interactions: Ignorance is not Bliss Austin G. Armstrong, M.D.1, Rachna Kalia, M.D.1, Megan Troutman, Pharm.D.2 1University of Kansas School of Medicine-Wichita, Wichita, KS Department of Psychiatry and Behavioral Sciences 2Ascension Via Christi Hospital, Wichita, KS Received Sept. 16, 2021; Accepted for publication Feb. 23, 2022; Published online March 15, 2022 https://doi.org/10.17161/kjm.vol15.15798","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"109 - 111"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46572551","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}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.15984
Maxwell C. Braasch, Heather M. Minchew, Justin Riffel, German Berbel
Introduction The efficacy of a surgical skills curriculum was assessed for third-year medical students focused on suturing training on soft embalmed cadavers, which simulate natural tissue more effectively for surgical procedures than traditionally preserved cadavers or surgical practice pads. Methods A retrospective cohort study compared pre- and post-survey results at a premier, accredited, nationally ranked academic medical center. Study participants were third-year medical students completing their required surgical clerkship rotation who participated in suturing sessions on both synthetic suture practice pads and soft-embalmed cadavers prior to beginning their operating room experience. Results A total of 40 participants were included, with slightly more male participants. The majority of participants (52%) were interested in pursuing a non-surgical career. After participating in Clinical Anatomy Mentorship Program (CAMP), participants felt significantly more confident in their ability to suture in the operating room (median 4 [3–4] vs. 2 [1–3], p < 0.001); in their knowledge of basic suturing supplies and instruments (median 4 [4-4] vs. 3 [2–3], p < 0.001); and in their ability to determine when different suture techniques are appropriate in the operating room (median 3 [3–4] vs. 1 [1–2], p < 0.001). Participants felt more confident in their ability to suture in the operating room after their experience suturing on soft-embalmed cadavers compared to suture practice pads (median 5 [4–5] vs. 4 [4-4], p = 0.002). Conclusions Medical students’ confidence in suturing skills and in the knowledge of important characteristics of suturing practice was improved significantly after a suture training session on soft-embalmed cadavers.
{"title":"Suture Education with Soft-Embalmed Cadavers: A Cut Above the Rest","authors":"Maxwell C. Braasch, Heather M. Minchew, Justin Riffel, German Berbel","doi":"10.17161/kjm.vol15.15984","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15984","url":null,"abstract":"Introduction The efficacy of a surgical skills curriculum was assessed for third-year medical students focused on suturing training on soft embalmed cadavers, which simulate natural tissue more effectively for surgical procedures than traditionally preserved cadavers or surgical practice pads. Methods A retrospective cohort study compared pre- and post-survey results at a premier, accredited, nationally ranked academic medical center. Study participants were third-year medical students completing their required surgical clerkship rotation who participated in suturing sessions on both synthetic suture practice pads and soft-embalmed cadavers prior to beginning their operating room experience. Results A total of 40 participants were included, with slightly more male participants. The majority of participants (52%) were interested in pursuing a non-surgical career. After participating in Clinical Anatomy Mentorship Program (CAMP), participants felt significantly more confident in their ability to suture in the operating room (median 4 [3–4] vs. 2 [1–3], p < 0.001); in their knowledge of basic suturing supplies and instruments (median 4 [4-4] vs. 3 [2–3], p < 0.001); and in their ability to determine when different suture techniques are appropriate in the operating room (median 3 [3–4] vs. 1 [1–2], p < 0.001). Participants felt more confident in their ability to suture in the operating room after their experience suturing on soft-embalmed cadavers compared to suture practice pads (median 5 [4–5] vs. 4 [4-4], p = 0.002). Conclusions Medical students’ confidence in suturing skills and in the knowledge of important characteristics of suturing practice was improved significantly after a suture training session on soft-embalmed cadavers.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"78 - 81"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43048484","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}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.15201
P. Subramanian, Lucy Stun, Kellie Wark, N. Bahr, W. El Atrouni, L. Satterwhite, Maharshi Bhakta, F. Plapp, Jessica Newman
Introduction Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19 infection. Early in the pandemic, our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin. Given more available outcomes data, limiting standing order of labs that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes. The purpose of this study was to determine ordering and utilization patterns of inflammatory markers by physicians caring for patients hospitalized with COVID-19 infection. Methods An anonymous 10-question survey was distributed to 125 physicians (Infectious Disease, Hospitalist, Pulmonary and Critical Care faculty). Responses were tallied and values greater than 50% were identified as the majority of the surveyed group. Results Of the 125 physicians surveyed, 77 (62%) responded. A total of 57.1% (44/77) of physicians reported ordering daily inflammatory markers for 3 – 10 days from admission. Another 31.2% (24/77) ordered markers until clinical improvement or hospital discharge. D-dimer was used for care decisions by 83.1% (64/77) of respondents; 93.8% (60/64) of those reported utilizing it in determining anticoagulation dose. CRP was used by 61% (47/77) of physicians to help identify a secondary infection or determine steroid dose or duration. LDH and ferritin were not used for management decisions by the majority of physicians. Inflammatory markers were not used routinely after isolation precautions had been discontinued, even when ongoing care required mechanical ventilation. Conclusions Of the markers studied, both d-dimer and CRP were considered useful by most respondents. LDH and ferritin were used less frequently and were not considered as useful in guiding medical decision making. Discontinuation of standing daily LDH and ferritin orders is believed to have potential to result in cost savings to the health care system with no adverse patient outcomes.
{"title":"Assessing Provider Utilization of COVID-19 Inflammatory Marker Trends in Hospitalized Patients and Implications in Optimizing Value-Based Care During a Pandemic","authors":"P. Subramanian, Lucy Stun, Kellie Wark, N. Bahr, W. El Atrouni, L. Satterwhite, Maharshi Bhakta, F. Plapp, Jessica Newman","doi":"10.17161/kjm.vol15.15201","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15201","url":null,"abstract":"Introduction Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19 infection. Early in the pandemic, our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin. Given more available outcomes data, limiting standing order of labs that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes. The purpose of this study was to determine ordering and utilization patterns of inflammatory markers by physicians caring for patients hospitalized with COVID-19 infection. Methods An anonymous 10-question survey was distributed to 125 physicians (Infectious Disease, Hospitalist, Pulmonary and Critical Care faculty). Responses were tallied and values greater than 50% were identified as the majority of the surveyed group. Results Of the 125 physicians surveyed, 77 (62%) responded. A total of 57.1% (44/77) of physicians reported ordering daily inflammatory markers for 3 – 10 days from admission. Another 31.2% (24/77) ordered markers until clinical improvement or hospital discharge. D-dimer was used for care decisions by 83.1% (64/77) of respondents; 93.8% (60/64) of those reported utilizing it in determining anticoagulation dose. CRP was used by 61% (47/77) of physicians to help identify a secondary infection or determine steroid dose or duration. LDH and ferritin were not used for management decisions by the majority of physicians. Inflammatory markers were not used routinely after isolation precautions had been discontinued, even when ongoing care required mechanical ventilation. Conclusions Of the markers studied, both d-dimer and CRP were considered useful by most respondents. LDH and ferritin were used less frequently and were not considered as useful in guiding medical decision making. Discontinuation of standing daily LDH and ferritin orders is believed to have potential to result in cost savings to the health care system with no adverse patient outcomes.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"91 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43943751","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}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.14846
Stephanie Hassouneh, E. Ablah, H. Okut, M. Harrison
Introduction By 2050, more than 580,000 children in the United States will be diagnosed with type 1 diabetes (T1D). Management of T1D requires careful and continuous intervention, and children with T1D experience unique challenges in disease management compared to their adult counterparts. Diabetes camps are designed to help those with T1D learn diabetes management skills while experiencing summer camp. Psychological aspects are not addressed explicitly in diabetes camps located in Kansas. The purpose of this study was to evaluate the psychological state of past campers and camp counselors from one diabetes camp in Kansas. Methods Campers and counselors, all of whom had T1D, and attended diabetes camp from 2015 to 2019 in Kansas were recruited to complete a survey about diabetes-related stress, diabetes management self-efficacy, and symptoms of depression. A link to the online survey was distributed to previous campers and counselors by email and through Facebook. Results A total of 24 camp counselors and 10 campers were surveyed, 100% of whom reported having T1D and attending camp at least once. One-third of respondents (n = 8) reported having severe diabetes-related stress, and 100% (n = 34) reported high levels of diabetes management self-efficacy. Most participants reported moderate levels of depression, and 9% (n = 3) reported a past suicide attempt. These results suggested a relatively high prevalence in signs of psychological distress from former campers and camp counselors with T1D. Conclusions This study suggested that campers and counselors with T1D have high levels of diabetes-related stress, high diabetes management self-efficacy, and many signs of depression.
{"title":"Psychological State of Camp Counselors with Type 1 Diabetes who Have Attended Diabetes Camp","authors":"Stephanie Hassouneh, E. Ablah, H. Okut, M. Harrison","doi":"10.17161/kjm.vol15.14846","DOIUrl":"https://doi.org/10.17161/kjm.vol15.14846","url":null,"abstract":"Introduction By 2050, more than 580,000 children in the United States will be diagnosed with type 1 diabetes (T1D). Management of T1D requires careful and continuous intervention, and children with T1D experience unique challenges in disease management compared to their adult counterparts. Diabetes camps are designed to help those with T1D learn diabetes management skills while experiencing summer camp. Psychological aspects are not addressed explicitly in diabetes camps located in Kansas. The purpose of this study was to evaluate the psychological state of past campers and camp counselors from one diabetes camp in Kansas. Methods Campers and counselors, all of whom had T1D, and attended diabetes camp from 2015 to 2019 in Kansas were recruited to complete a survey about diabetes-related stress, diabetes management self-efficacy, and symptoms of depression. A link to the online survey was distributed to previous campers and counselors by email and through Facebook. Results A total of 24 camp counselors and 10 campers were surveyed, 100% of whom reported having T1D and attending camp at least once. One-third of respondents (n = 8) reported having severe diabetes-related stress, and 100% (n = 34) reported high levels of diabetes management self-efficacy. Most participants reported moderate levels of depression, and 9% (n = 3) reported a past suicide attempt. These results suggested a relatively high prevalence in signs of psychological distress from former campers and camp counselors with T1D. Conclusions This study suggested that campers and counselors with T1D have high levels of diabetes-related stress, high diabetes management self-efficacy, and many signs of depression.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"86 - 90"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43401137","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}
Pub Date : 2022-03-15eCollection Date: 2022-01-01DOI: 10.17161/kjm.vol15.16327
Jordan C Smith, Robert Klug, Thomas Dagg, Elizabeth Lewis, Paul Cleland, Andrew S T Porter, Samuel Ofei-Dodoo
Introduction: The COVID-19 pandemic caused a pause to nearly all sporting activities in the spring of 2020, and collegiate athletes at the National Collegiate Athletic Association (NCAA)-affiliated universities whose sporting seasons were affected by the pandemic were granted an extra year of athletic eligibility. This study was conducted to determine how collegiate athletes planned to use an additional year of eligibility granted by the NCAA.
Methods: The authors conducted a cross-sectional survey of 632 athletes from two universities in the Midwestern United States, between August and September 2021. The athletes completed an anonymous, nine-item survey to assess the effect of the pandemic on the athletic season, athletic eligibility, and potential change in an academic or professional career. Chi-square tests, generalized linear mixed models, and adjusted odds ratio were used for the analyses.
Results: The participation rate was 74.5% (471 of 632). Nearly 63% (290 of 461) of the athletes received an additional year of eligibility because of the pandemic, with 193 (66.6%) planned to use their extra year for scholastic development. Male athletes (65.3% vs. 34.7%; χ2[1, n = 290] = 11.66, p < 0.001, Φ = 0.20), Division II athletes (59.6% vs. 40.4%; χ2[1, n = 290] = 13.93, p < 0.001, Φ = 0.22), and athletes who had not previously used redshirt (73.1% vs. 26.9%; χ2[1, n = 290] = 4.79, p = 0.029, Φ = 0.32) where more likely to use their extra year of eligibility academically.
Conclusions: Our findings suggested that most of the athletes planned to use their extra year of eligibility to pursue further scholastic or professional development, highlighting the positive part of the COVID-19 pandemic. Future studies should investigate how these findings relate to athletes from universities in different geographical locations and intra-division schools.
2019冠状病毒病大流行导致2020年春季几乎所有体育活动暂停，全国大学体育协会(NCAA)附属大学的大学生运动员的运动季节受到大流行的影响，他们获得了额外一年的运动资格。这项研究是为了确定大学生运动员计划如何利用NCAA授予的额外一年的资格。方法:作者在2021年8月至9月期间对来自美国中西部两所大学的632名运动员进行了横断面调查。运动员们完成了一项包含9个项目的匿名调查，以评估疫情对运动季节、运动资格以及学术或职业生涯的潜在变化的影响。采用卡方检验、广义线性混合模型和校正优势比进行分析。结果632例患者中有471例参加，参评率为74.5%。由于大流行，近63%(461名运动员中的290名)的运动员获得了额外一年的资格，其中193名(66.6%)计划将额外的一年用于学业发展。男运动员(65.3% vs. 34.7%;χ2[1, n = 290] = 11.66, p < 0.001， Φ = 0.20)，乙级运动员(59.6% vs. 40.4%;χ2[1, n = 290] = 13.93, p < 0.001， Φ = 0.22)，未穿过红衫的运动员(73.1% vs. 26.9%;χ2[1, n = 290] = 4.79, p = 0.029， Φ = 0.32)，更有可能在学业上使用他们额外一年的资格。我们的研究结果表明，大多数运动员计划利用他们额外的一年资格来进一步追求学术或专业发展，这突出了COVID-19大流行的积极一面。未来的研究应该调查这些发现与来自不同地理位置的大学和校内学校的运动员之间的关系。
{"title":"Academic Impact of COVID-19 in Collegiate Athletes.","authors":"Jordan C Smith, Robert Klug, Thomas Dagg, Elizabeth Lewis, Paul Cleland, Andrew S T Porter, Samuel Ofei-Dodoo","doi":"10.17161/kjm.vol15.16327","DOIUrl":"10.17161/kjm.vol15.16327","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic caused a pause to nearly all sporting activities in the spring of 2020, and collegiate athletes at the National Collegiate Athletic Association (NCAA)-affiliated universities whose sporting seasons were affected by the pandemic were granted an extra year of athletic eligibility. This study was conducted to determine how collegiate athletes planned to use an additional year of eligibility granted by the NCAA.</p><p><strong>Methods: </strong>The authors conducted a cross-sectional survey of 632 athletes from two universities in the Midwestern United States, between August and September 2021. The athletes completed an anonymous, nine-item survey to assess the effect of the pandemic on the athletic season, athletic eligibility, and potential change in an academic or professional career. Chi-square tests, generalized linear mixed models, and adjusted odds ratio were used for the analyses.</p><p><strong>Results: </strong>The participation rate was 74.5% (471 of 632). Nearly 63% (290 of 461) of the athletes received an additional year of eligibility because of the pandemic, with 193 (66.6%) planned to use their extra year for scholastic development. Male athletes (65.3% vs. 34.7%; χ<sup>2</sup>[1, n = 290] = 11.66, p < 0.001, Φ = 0.20), Division II athletes (59.6% vs. 40.4%; χ<sup>2</sup>[1, n = 290] = 13.93, p < 0.001, Φ = 0.22), and athletes who had not previously used redshirt (73.1% vs. 26.9%; χ<sup>2</sup>[1, n = 290] = 4.79, p = 0.029, Φ = 0.32) where more likely to use their extra year of eligibility academically.</p><p><strong>Conclusions: </strong>Our findings suggested that most of the athletes planned to use their extra year of eligibility to pursue further scholastic or professional development, highlighting the positive part of the COVID-19 pandemic. Future studies should investigate how these findings relate to athletes from universities in different geographical locations and intra-division schools.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"101-105"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48370997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.16036
Benjamin Lancaster, Alexander Wendling, Tanner Poppe, Rosalee Zackula, Wade Massey, R. Cusick, Paul C Pappademos
Introduction Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. Methods This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Results Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). Conclusions The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.
{"title":"Comparative Analysis of Topical Versus Intravenous Administration of Epsilon-Aminocaproic Acid on Blood Management in Total Knee Arthroplasty","authors":"Benjamin Lancaster, Alexander Wendling, Tanner Poppe, Rosalee Zackula, Wade Massey, R. Cusick, Paul C Pappademos","doi":"10.17161/kjm.vol15.16036","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16036","url":null,"abstract":"Introduction Although the use of antifibrinolytics to reduce perioperative blood loss during total knee arthroplasty (TKA) has shown unequivocal benefit in regard to blood conservation, the best route of administration remains in question. This study tested the hypothesis that topical delivery of epsilon-aminocaproic acid (EACA) was superior to intravenous (IV) administration in the setting of primary TKA. Methods This cross-sectional study included a six-year retrospective chart review of TKA patients done by a single surgeon. Post-operative hemoglobin levels and the incidence of blood transfusions were compared among three patient subgroups: no EACA, topical EACA, or IV EACA. Key outcome measures included post-operative hemoglobin, need for post-operative transfusion, and length of hospital stay. Results Of the 668 patients included in this study, 351 (52.5%) received IV EACA, 298 (44.6%) received topical EACA, and 19 (2.8%) received no EACA. For the three-way comparisons, significant differences were observed for post-operative mean hemoglobin on day one (p < 0.001), day two (p < 0.001), and day three (p = 0.004), with consistently higher means for participants in the topical group. Eight patients required transfusions in the IV EACA group, but none were needed in the topical EACA group (p = 0.027). Length of stay was shortest for patients in the topical group, with 66% hospitalized for two days, while 84% of the IV group remained hospitalized for three days (p < 0.001). Conclusions The topical delivery of EACA is superior to IV administration with respect to blood conservation for patients undergoing primary TKA.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"73 - 77"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48382163","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}
Pub Date : 2022-03-15DOI: 10.17161/kjm.vol15.15831
B. Ho, S. Beatty, David Warnky, Kevin Sykes, Jennifer A. Villwock
Introduction Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0 – 10 numeric rating scale (NRS) in post-operative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME), after discharge. Results The function that correlated most to the NRS at discharge was “Out of Bed to Chair”. Indicators of better mental health were correlated inversely with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, such as, “Out of Bed to Chair”, may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship.
{"title":"Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale Used by Surgical Patients","authors":"B. Ho, S. Beatty, David Warnky, Kevin Sykes, Jennifer A. Villwock","doi":"10.17161/kjm.vol15.15831","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15831","url":null,"abstract":"Introduction Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0 – 10 numeric rating scale (NRS) in post-operative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME), after discharge. Results The function that correlated most to the NRS at discharge was “Out of Bed to Chair”. Indicators of better mental health were correlated inversely with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, such as, “Out of Bed to Chair”, may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"82 - 85"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45582539","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}
Pub Date : 2022-02-09DOI: 10.17161/kjm.vol15.15825
K. Mills, Anna Tri, K. Nilsen
Introduction Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has spread rapidly throughout the world since its discovery in 2019. Three vaccines (Pfizer-BioNTech, Moderna/NIAID/BARDA, and Johnson & Johnson’s Janssen) have been developed for use in the U.S. to aid in the fight against this virus, but have been scrutinized intensely for their efficacy and safety. It is important to understand and interpret the adverse events or reactions (AERs) associated with these vaccines in an objective and analytical manner. The goal of this descriptive study was to provide a resource outlining AERs associated with the three available vaccines in Kansas. Methods Reports were obtained from the Vaccine Adverse Event Reporting System (VAERS), representing AERs observed in Kansas from December 11, 2020 to May 13, 2021. All data were screened and coded, and descriptive statistics were used to describe AERs based on vaccine manufacturer, patient age and biological sex, and reported deaths. Results Only 0.00068% of COVID-19 vaccine doses given in Kansas were associated with an AER (1,445/2,120,350). There were 4,297 individual AERs reported, and the most common were fatigue/tiredness (266; 6.2%), tingling/itching (251; 5.9%), fever (226; 5.3%), hives (223; 5.2%), and muscle/joint pain (209; 4.9%). Only 0.002% of COVID-19 vaccine doses in Kansas were associated with a death (38/2,120,350). The majority of VAERS reports were by females (1,139; 78.8%) and those aged 30 to 39 years (297; 20.6%). Conclusions No reported AERs were unexpected compared to national data, and no VAERs report provided a causal relationship between vaccine administration and death. Vaccines are, and will continue to be, essential tools to fight COVID-19 in the quest to reach herd immunity. Providing a resource of potential AERs could aid in individual decisions to receive a vaccine and may help in the control of COVID-19. Future studies may include describing reported AERs for children under age 12 as the vaccines become available for those age groups, as well as reporting AERs for those who have received the vaccine after our study time period.
{"title":"The COVID-19 Vaccines: A Description of Adverse Events of Reactions Reported in Kansas","authors":"K. Mills, Anna Tri, K. Nilsen","doi":"10.17161/kjm.vol15.15825","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15825","url":null,"abstract":"Introduction Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has spread rapidly throughout the world since its discovery in 2019. Three vaccines (Pfizer-BioNTech, Moderna/NIAID/BARDA, and Johnson & Johnson’s Janssen) have been developed for use in the U.S. to aid in the fight against this virus, but have been scrutinized intensely for their efficacy and safety. It is important to understand and interpret the adverse events or reactions (AERs) associated with these vaccines in an objective and analytical manner. The goal of this descriptive study was to provide a resource outlining AERs associated with the three available vaccines in Kansas. Methods Reports were obtained from the Vaccine Adverse Event Reporting System (VAERS), representing AERs observed in Kansas from December 11, 2020 to May 13, 2021. All data were screened and coded, and descriptive statistics were used to describe AERs based on vaccine manufacturer, patient age and biological sex, and reported deaths. Results Only 0.00068% of COVID-19 vaccine doses given in Kansas were associated with an AER (1,445/2,120,350). There were 4,297 individual AERs reported, and the most common were fatigue/tiredness (266; 6.2%), tingling/itching (251; 5.9%), fever (226; 5.3%), hives (223; 5.2%), and muscle/joint pain (209; 4.9%). Only 0.002% of COVID-19 vaccine doses in Kansas were associated with a death (38/2,120,350). The majority of VAERS reports were by females (1,139; 78.8%) and those aged 30 to 39 years (297; 20.6%). Conclusions No reported AERs were unexpected compared to national data, and no VAERs report provided a causal relationship between vaccine administration and death. Vaccines are, and will continue to be, essential tools to fight COVID-19 in the quest to reach herd immunity. Providing a resource of potential AERs could aid in individual decisions to receive a vaccine and may help in the control of COVID-19. Future studies may include describing reported AERs for children under age 12 as the vaccines become available for those age groups, as well as reporting AERs for those who have received the vaccine after our study time period.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"39 - 47"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49386436","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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