Kansas journal of medicine最新文献

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Kounis Syndrome as a Cause of Myocardial Infarction with Nonobstructive Coronary Arteries. 库尼斯综合征是非阻塞性冠状动脉心肌梗死的病因之一。

Kansas journal of medicine

Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.17161/kjm.vol17.21486

Justin Helberg, Eric Acosta

引用次数: 0

Case Report of Serpiginous Rash on Foot in a Patient after Recent Travel to Brazil. 近期赴巴西旅行后患者足部出现蛇皮状皮疹的病例报告。

Kansas journal of medicine

Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.17161/kjm.vol17.21609

Jadesola V Akinwuntan, Ariana J Cecil, David L Kaplan

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Airway Management in a Pediatric Patient Presenting with Pierre-Robin Sequence. 对一名出现皮埃尔-罗宾序列的儿科患者进行气道管理。

Kansas journal of medicine

Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.17161/kjm.vol17.21529

Logan Foster, Declan Foster, Harsh Nathani, William Krogman

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Biomechanical Comparison of Impaction Techniques and Cross-Sectional Femoral Stem Shapes for Cementless Total Hip Arthroplasty. 无骨全髋关节置换术中植入技术和股骨柄截面形状的生物力学比较

Kansas journal of medicine

Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.17161/kjm.vol17.21522

Vanessa R Richardson, Alexander C M Chong, Anthony N Brown

Introduction: Traditional mallet broaching and stem seating in cementless total hip arthroplasty (THA) can result in femoral stem misalignment, potentially reducing implant longevity. This study aimed to compare the pullout strength of cementless THA femoral stems with different cross-sectional designs achieved through the powered impactor method versus the traditional mallet method.

Methods: The authors utilized 24 polyurethane foam femurs and two femoral bone preservation stems with different proximal cross-sectional shapes (double taper: ACTIS^®, size 5; flat taper: TRI-LOCK^®, size 5). A single orthopedic surgeon broached each femur from size 0 to size 5 using either the powered impactor or mallet impaction methods. Broaching time and component implantation times were recorded. A load-to-failure pullout strength test was conducted, and the ultimate pullout load was recorded.

Results: The broaching time for the TRI-LOCK^® stem showed a statistically significant difference between the two impaction methods (powered: 37±7 seconds, mallet: 75±29 seconds, F[3, 20] = 4.56, p = 0.002), but no statistically significant difference was detected for the ACTIS^® stem between the two impaction methods (powered: 47±22 seconds, mallet: 59±9 seconds, F[3, 20] = 4.56, p = 0.304). There was a statistically significant difference in pullout strength between the two impaction groups, and this strength was influenced by the implant cross-sectional shape (ACTIS^®: 774±75N versus 679±22N, F(3,20) = 16.38, p = 0.018; TRI-LOCK^®: 616±57N versus 859±85N, F(3, 20) = 16.38, p <0.001).

Conclusions: The technique used for femoral bone preparation (powered impactor versus mallet) and the cross-sectional design of the cementless femoral stem are crucial factors that affect initial stem stability and operation time.

简介：在无骨水泥全髋关节置换术（THA）中，传统的槌式拉床和股骨柄就位会导致股骨柄错位，从而可能缩短植入物的使用寿命。本研究旨在比较不同截面设计的无骨水泥全髋关节置换术股骨柄通过动力冲击器法与传统木槌法获得的拔出强度：作者使用了 24 个聚氨酯泡沫股骨和两个具有不同近端横截面形状的股骨头保留柄（双锥度：ACTIS®，5 号；平锥度：TRI-LOCK®，5 号）。一名骨科医生使用动力冲击器或锤击法对每根股骨从 0 号到 5 号进行拉削。记录拉削时间和组件植入时间。进行了加载至破坏拉拔强度测试，并记录了极限拉拔载荷：TRI-LOCK®骨干的拉削时间在两种植入方法之间有显著统计学差异（动力法：37±7秒，槌法：75±29秒，F[3，20] = 4.56，P = 0.002），但ACTIS®骨干的拉削时间在两种植入方法之间无显著统计学差异（动力法：47±22秒，槌法：59±9秒，F[3，20] = 4.56，P = 0.304）。两组种植体的拔出强度有显著的统计学差异，拔出强度受种植体横截面形状的影响（ACTIS®：774±75N 对 679±22N，F[3,20] = 16.38，p = 0.018；TRI-LOCK®：616±57N 对 859±85N，F[3,20] = 16.38，p）：股骨头制备技术（动力冲击器与木槌）和无骨水泥股骨柄横截面设计是影响柄初始稳定性和手术时间的关键因素。

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引用次数: 0

Tumor Stage Mycosis Fungoides with Lymph Node Involvement. 淋巴结受累的肿瘤分期真菌病

Kansas journal of medicine

Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.17161/kjm.vol17.21453

Kale Mills, Edith Sigler, Mikaela Snell, Jared Regehr, Dennis Moore, Elizabeth Ablah, Lisa Gilbert

引用次数: 0

Physician Workforce in Kansas: Where are the Orthopedic Surgeons? 堪萨斯州的医生队伍：骨科医生在哪里？

Kansas journal of medicine

Pub Date : 2024-03-15 DOI: 10.17161/kjm.vol17.21124

Dorothy Hughes, Derek Reese, Kim Templeton

Introduction. Rural patients have greater need but less access to orthopedic surgical care than their urban counterparts. Previous studies have investigated rural surgical care, but this is the first to assess the Kansas orthopedic surgery workforce to identify changes over time and rurality and inform thinking about future workforce composition. Methods. The authors analyzed 2009 and 2019 AMA MasterFile and Area Health Resource File (AHRF) data. Using frequencies, percentages, and calculations of orthopedic surgeons per capita, we assessed workforce changes by rurality (Rural Urban Continuum Codes). Results. The dataset included 307 orthopedic surgeons; 197 were in both 2009 and 2019. Of these, 165 were in active practice in 2009 and 244 in 2019, an increase of 79 (47.9%). Kansas had smaller proportions of surgeons in rural (non-metro) versus urban (metro) counties in both years. Orthopedic surgeons per capita grew throughout the state, but the increase was smaller in rural counties. There were 11 women orthopedic surgeons in both years, 3.6% of the total 307. Among the 197 surgeons in both years, four (2.0%) were women. No women orthopedic surgeons were in non-metro counties either year. Conclusions. Although the Kansas orthopedic surgery workforce grew from 2009 to 2019, rural Kansas remains a surgery desert based on orthopedic surgeons per capita. Further studies could determine whether this trend is similar to that in other rural states and how to attract orthopedic surgeons to rural practice.

导言。与城市患者相比，农村患者对骨科手术护理的需求更大，但获得的机会更少。以前的研究曾对农村外科护理进行过调查，但这是首次对堪萨斯州的骨科手术队伍进行评估，以确定随着时间和农村地区的变化，并为未来的队伍组成提供参考。方法。作者分析了 2009 年和 2019 年 AMA MasterFile 和地区卫生资源档案 (AHRF) 数据。我们使用频率、百分比和人均矫形外科医生的计算方法，评估了乡村劳动力的变化（乡村-城市连续编码）。结果。数据集包括 307 名骨科医生；2009 年和 2019 年均有 197 名。其中，2009 年有 165 人在积极执业，2019 年有 244 人，增加了 79 人（47.9%）。在这两年中，堪萨斯州农村（非都会区）与城市（都会区）县的外科医生比例都较小。全州人均骨科医生人数有所增加，但农村县的增幅较小。这两年共有 11 名女性骨科医生，占总人数 307 的 3.6%。在这两年的 197 名外科医生中，有 4 名女性（占 2.0%）。这两年都没有女性骨科医生在非中心县工作。结论。虽然堪萨斯州的骨科外科医生队伍在 2009 年至 2019 年期间有所增长，但从人均骨科外科医生数量来看，堪萨斯州的农村地区仍然是一个外科医生荒漠。进一步的研究可以确定这一趋势是否与其他农村州相似，以及如何吸引骨科医生到农村执业。

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引用次数: 0

Lemierre's Syndrome Caused by Streptococcus pneumoniae in a Patient with Carbimazole-Induced Severe Neutropenia 卡比马唑致重度中性粒细胞减少症患者肺炎链球菌引发的勒米埃尔综合征

Kansas journal of medicine

Pub Date : 2024-03-15 DOI: 10.17161/kjm.vol17.21217

Naman Lodha, Nakka Vihari, N. Midha, Tashmeen Kaur Sethi, Pawan Garg, Vibhor Tak

引用次数: 0

Gallbladder Torsion: A Rare but Critical Diagnosis 胆囊扭转：罕见但关键的诊断

Kansas journal of medicine

Pub Date : 2024-03-15 DOI: 10.17161/kjm.vol17.21594

Jessica Keller, Shaun Best, Christine Boatright

引用次数: 0

Is it Worsening ADHD or Graves' Disease? A Case Report of Undiagnosed Graves' Disease in a Patient with ADHD 是多动症恶化还是巴塞杜氏病？多动症患者未确诊巴塞杜氏病的病例报告

Kansas journal of medicine

Pub Date : 2024-03-15 DOI: 10.17161/kjm.vol17.21368

Htet Htet Lin, Nazeen Morelli, Susanna Ciccolari Micaldi

引用次数: 0

The Role of Telemedicine in Rural Specialty Care: Priorities and Recommendations from Rural Primary Care Physicians 远程医疗在农村专科医疗中的作用：农村初级保健医生的优先事项和建议

Kansas journal of medicine

Pub Date : 2024-03-15 DOI: 10.17161/kjm.vol17.21290

Faith Hampton, Jeremy Larson, Alyssa Hobson, Ph.D Dorothy Hughes

Introduction. The study goal was to understand telemedicine’s role in improving access to rural specialty care. Other outcomes included assessing specialty availability and frequency of referrals at rural sites. Methods. This mixed methods study included surveys and semi-structured interviews of rural primary care physicians (PCPs). Survey data were analyzed with summary statistics and cross-tabulations. Interview transcripts were inductively thematically analyzed. Results. Of the 19 PCPs who completed the survey, 37% agreed/strongly agreed current telemedicine practices connected patients to better specialty care; 90% agreed/strongly agreed it had such potential. Interviews revealed telemedicine could improve care when local specialists were unavailable and provided the most benefit in acute care settings or specialist follow-ups. Most survey respondents reported outreach specialists were highly effective in addressing rural specialty care needs. Respondents reported cardiology, general surgery, orthopedic surgery, ENT/otolaryngology, and dermatology as the most frequently referred-to specialties. In-person neurology, gastroenterology, and dermatology were unavailable in many communities. Respondents identified psychiatry as a high priority for telemedicine and discussed clinic-to-clinic visits to optimize telemedicine use. Conclusions. The perceived discrepancy between the current and potential roles of telemedicine in rural specialty care suggests that telemedicine may not fully align with the needs of rural patients and could be optimized for rural practice settings. While local, in-person access to specialists remains a priority, telemedicine can reduce patient burdens and improve care when in-person specialists are unavailable.

介绍。研究目标是了解远程医疗在改善农村地区专科医疗服务方面的作用。其他成果包括评估农村地区的专科可用性和转诊频率。研究方法。这项混合方法研究包括对农村初级保健医生（PCP）进行调查和半结构化访谈。调查数据通过汇总统计和交叉表进行分析。对访谈记录进行归纳主题分析。结果。在完成调查的 19 名初级保健医生中，37% 的人同意/非常同意目前的远程医疗实践将病人与更好的专科医疗联系起来；90% 的人同意/非常同意远程医疗有这样的潜力。访谈显示，远程医疗可以在当地没有专科医生的情况下改善护理，并在急症护理或专科医生随访时提供最大的益处。大多数调查对象表示，外联专家在满足农村专科医疗需求方面非常有效。受访者表示，心脏病学、普通外科、整形外科、耳鼻喉科和皮肤科是最常转诊的专科。许多社区都无法提供神经内科、消化内科和皮肤科的上门服务。受访者认为精神科是远程医疗的重中之重，并讨论了诊所到诊所的访问，以优化远程医疗的使用。结论。远程医疗在农村专科医疗中的现有作用和潜在作用之间的差异表明，远程医疗可能并不完全符合农村患者的需求，可以针对农村的实践环境进行优化。虽然当地的专科医生仍然是优先考虑的对象，但在没有专科医生的情况下，远程医疗可以减轻患者的负担并改善医疗服务。

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