Kansas journal of medicine最新文献

Introduction: In the United States, limited English proficiency (LEP) and provider-patient language discordance are associated with poorer medical outcomes compared with English-proficient, language-concordant patients. Asian American and Pacific Islander (AAPI) populations have higher-than-average rates of LEP and may be more vulnerable to adverse outcomes. The authors of this study examined differences in risk factors, medical care, and delivery outcomes between AAPI individuals who gave birth and spoke English at home versus those who spoke an AAPI language at home.

Methods: De-identified birth and death certificate data from January 1, 2005, to December 31, 2018, were obtained from the Kansas Department of Health and Environment (N = 17,067). Risk factors, medical care, and delivery outcomes were compared between AAPI language speakers and English speakers using likelihood chi-square and Fisher exact tests.

Results: Non-English speakers initiated prenatal care later (p <0.0001) and received less adequate prenatal care (p <0.0001). They also had higher rates of forceps- and vacuum-assisted deliveries (p <0.0001), and third- or fourth-degree perineal lacerations (p <0.0001) compared with English speakers. Neonatal outcomes largely were similar between groups.

Conclusions: Within the AAPI community in Kansas, speakers of AAPI languages experienced poorer maternal delivery outcomes, specifically higher rates of assisted deliveries and severe perineal lacerations, compared with English speakers. These disparities may reflect patient-provider language discordance, which can limit patient autonomy and influence decision-making in urgent or emergent situations, as well as broader structural determinants of health.

Introduction: Few studies have examined contraceptive knowledge and counseling confidence among primary care residents and physicians. Authors of this study evaluated education, knowledge, and counseling practices related to contraception among physicians in obstetrics and gynecology (OB-GYN) and family medicine (FM).

Methods: In this prospective, cross-sectional study, current OB-GYN and FM residents, as well as program graduates from the past five years at a single institution, were surveyed. The survey assessed demographics, contraception knowledge, provider confidence, counseling practices, and procedural experience. Responses were included in the analysis if at least one knowledge question was completed.

Results: The final analysis included 45 respondents (8% response rate): 33.3% (n = 15) from FM and 66.7% (n = 30) from OB-GYN. Average knowledge scores did not differ significantly between FM (60%, 12/20) and OB-GYN physicians (70%, 14/20). Attending physicians' average scores were significantly higher (85%, 17/20) than residents (60%, 12/20; p = 0.0014). Most respondents (97.8%, n = 44) reported feeling comfortable counseling patients, and 93.3% (n = 42) felt comfortable performing procedures and prescribing contraceptives. OB-GYN physicians reported greater comfort placing levonorgestrel and Paragard® intrauterine devices (IUDs) than FM physicians (93%, n = 14 vs. 61%, n = 11; p = 0.040). More OB-GYN physicians (6.7%, n = 3) reported performing over 80 Nexplanon® insertions compared to FM physicians (0.0%, n = 0; p <0.0001).

Conclusions: Contraceptive knowledge did not differ significantly between OB-GYN and FM physicians. However, advanced training was associated with greater comfort in both prescribing and performing contraceptive procedures.

Introduction: Suicide is a leading cause of death among youth in the United States. Most youth who attempt suicide have underlying mental health disorders, which account for approximately 10% of pediatric hospitalizations. Researchers hypothesized that children with chronic suicidality (CS) have more suicide-related risk factors, attempt suicide with greater lethality, and have more pre-existing mental health diagnoses compared to those without chronic suicidality (Non-CS).

Methods: The study team reviewed pediatric hospitalizations related to suicide at Wesley Medical Center from 2016 to 2021. CS was defined as a reported history of, or prior hospitalization for, suicide-related behavior. The severity of suicidal ideation/behavior and actual lethality or medical damage was measured using the Columbia-Suicide Severity Rating Scale (C-SSRS).

Results: Of 375 patients, 253 were classified as CS and 122 as Non-CS. Age and race distributions were similar between groups. Females were more likely to have CS (p = 0.0006). Patients with CS were more often admitted for suicide attempts rather than non-suicidal self-injury (p = 0.0171). No significant differences were found in method or lethality of attempts.Patients with CS experienced more peer stress, abuse, legal problems, and job-related issues (all p <0.05). No differences were observed in other stressors. CS patients had more prior mental health treatment (p <0.0001) and were more frequently discharged to inpatient mental health care (p <0.0001).

Conclusions: Female gender and psychosocial stressors were associated with increased risk of chronic suicidality in youth. Early identification of these factors may enable earlier interventions to prevent suicide-related behaviors.

Introduction: Thicker polyethylene inserts in total knee arthroplasty (TKA) may be associated with increased wear rates, a higher risk of implant failure, and the need for revision surgery. The authors of this study aimed to compare polyethylene insert thickness in robotic-assisted TKA versus conventional manual TKA.

Methods: The authors conducted a cross-sectional study on patients with end-stage primary knee osteoarthritis who underwent TKA by a single fellowship-trained orthopedic surgeon over a two-year period. Patients with post-traumatic or inflammatory arthropathy or those undergoing revision arthroplasty were excluded. Demographics, implant manufacturer and type, and polyethylene insert thickness were recorded in an electronic database. Bivariate analyses, including t-tests, Mann-Whitney U tests, and Fisher's exact tests were used to compare robotic-assisted and manual TKA procedures.

Results: Data from 222 patients were analyzed, with 111 in each group. The mean (standard deviation [SD]) age at surgery was similar between groups: 64.3 (8.2) years for robotic-assisted and 62.3 (8.8) years for the manual group (p = 0.398). Polyethylene insert thickness differed significantly: the median was 9 mm (range 9-13 mm) in the robotic-assisted group versus 11 mm (range 9-16 mm) in the manual group (p <0.001). The most frequently used thickness was 9 mm, used in 70.3% (78/111) of robotic-assisted cases compared to 34.2% (38/111) of manual cases (p <0.001).

Conclusions: Robotic-assisted TKA was associated with significantly thinner polyethylene inserts compared to manual TKA, suggesting more precise, bone-sparing femoral and tibial cuts. These findings may support the use of robotic-assisted techniques by orthopedic surgeons seeking to optimize implant positioning and longevity.

Introduction: End-stage renal disease (ESRD) requires renal replacement therapy, either through pre-emptive transplantation (PET) or non-pre-emptive transplantation (non-PET). PET is associated with improved patient and allograft survival compared to non-PET; however, only 2.5% of patients in the United States undergo PET. The authors of this study report on mortality and allograft rejection rates in patients undergoing PET versus non-PET.

Methods: This single-center, retrospective study compared posttransplant complications between PET and non-PET in adults with ESRD. De-identified electronic health record data from 2017 to 2022 were analyzed. Odds ratios (ORs) for one-year post-transplant mortality and allograft rejection were calculated using unadjusted multivariate logistic regression (Model 1), adjusted for age and sex (Model 2), and further adjusted for comorbidities (Model 3).

Results: A total of 787 patients with ESRD underwent kidney transplantation: 14% underwent non-PET and 86% underwent PET. Compared to PET, the ORs for one-year post-transplant mortality with non-PET were:Model 1: OR 1.76 (95% CI, 0.64-4.85; p = 0.27)Model 2: OR 2.02 (95% CI, 0.71-5.71; p = 0.19)Model 3: OR 1.86 (95% CI, 0.64-5.39; p = 0.24)For one-year allograft rejection, the ORs for non-PET versus PET were:Model 1: OR 1.63 (95% CI, 0.85-3.10; p = 0.13)Model 2: OR 1.61 (95% CI, 0.84-3.06; p = 0.15)Model 3: OR 1.60 (95% CI, 0.82-3.10; p = 0.16).

Conclusions: This single-center study found no statistically significant differences in one-year mortality or allograft rejection between patients undergoing PET and non-PET.

Introduction: The Dobbs decision returned the regulation of abortion to individual states. In the Midwest, several legislative efforts have included restrictions on both abortion and gender-affirming care. Clinics that provide abortion services sometimes offer gender-affirming care. Given this intersection, recent laws restricting abortion may have unintended consequences for access to gender-affirming care in the Midwest.

Methods: Authors of this retrospective study analyzed medical records of patients seen at a Midwestern health center. We included patients aged 18 or older who attended a new patient visit at either the gender diversity clinic (GDC) or the general gynecology (GYN) clinic between July 1, 2021 and June 30, 2023. We used generalized estimating equations to assess changes in wait times and distance traveled pre- vs. post-Dobbs. Differences in new patient volume were analyzed using Poisson regression.

Results: We reviewed 5,260 charts, 4,552 from the GYN clinic and 708 from the GDC. Following Dobbs, the GYN clinic experienced a 6% increase in new patients, while the GDC saw a 21% increase (p <0.001). The average wait time for a GYN appointment increased by two days, whereas the wait time for GDC appointments decreased by 21 days. The average distance traveled by new GYN patients decreased by 6.3 miles (p <0.001), while distance for GDC patients increased by 2.5 miles (p = 0.738).

Conclusions: Patients continue to seek gender-affirming care in the post-Dobbs landscape. Despite an increase in patient volume, wait times for gender diversity appointments decreased, likely reflecting expanded appointment availability around the time of the Dobbs decision.

Introduction: To reduce Sudden Unexpected Infant Death (SUID), the Kansas Infant Death and SIDS Network offered a series of two-day Safe Sleep Instructor (SSI) certification trainings. These sessions aimed to educate health care and related professionals on the American Academy of Pediatrics (AAP) evidence-based safe sleep recommendations.

Methods: A secondary analysis of qualitative data was conducted using responses to a single open-ended question on the post-training assessment. Participants were asked to list three specific things they learned during the training. All Fiscal Year 2023 participants (N = 67) responded. Two trained coders independently analyzed responses using a priori codes derived from the 2022 AAP Safe Sleep Recommendations and key concepts from the Safe Sleep Instructor training. Inter-rater reliability was assessed using Cohen's kappa.

Results: A total of 205 comments were collected from 67 participants, who self-identified as nurses, social workers, home visitors, early childhood professionals, parent educators, and others. Cohen's kappa indicated substantial agreement (κ = 0.87; 95% CI, 0.77-0.87; p <0.001). The most frequently cited AAP-related topics were temperature regulation (13%, n = 27) and the recommendation for a separate sleep surface (10%, n = 21). Additionally, 12% (n = 24) of responses aligned with key training concepts, while 11% (n = 23) were categorized as "other." No clear patterns in knowledge acquisition emerged within specific professional groups (e.g., nurses).

Conclusions: The presence of pre-training knowledge gaps related to safe sleep practices highlights the importance of comprehensive, evidence-based educational programs for professionals involved in perinatal and infant care.