Pub Date : 2022-05-17DOI: 10.17161/kjm.vol15.15913
Kristina M. Bridges, Jennifer Woodward, Megan J. Murray, Emma Mumm, K. Greiner
Introduction Stay-at-home orders during the first wave of the COVID-19 pandemic encouraged individuals, especially the elderly, to stock up on food and supplies and remain home to limit exposure to the SARS-CoV-2 virus. However, individuals with food insecurity may be able only to afford a few days of food at a time, causing frequent outings to obtain food. An emergency food delivery system decreases the need for frequent outings. This study investigated: (1) whether elderly family medicine patients with previously reported food insecurity were making frequent trips to obtain food during the lockdown, and (2) if social determinants of health screening data could be used successfully to identify patients in need of emergency food delivery during the pandemic. Methods Primary care patients 65 years and older with previously reported food insecurity were screened for referral to a community food delivery program. A cross-sectional secondary analysis of screening and referral data were conducted. Results Clinic staff called 52 patients and completed screening of 30. For 23/30 respondents (76.7%), reported monthly outings to obtain food exceeded the recommended stay-at-home guidelines. In our sample, 22/30 (73.3%) reported current food need, 14/30 (46.7%) reported two or fewer days of food, 28/30 (93.3%) reported receiving home food delivery would keep them from going out, 24/30 (80.0%) agreed to food delivery, and 17 patients received a food delivery. Conclusions Targeted screening and referral for food delivery may reduce the need for patients experiencing food insecurity to leave home during a pandemic or other disaster, potentially decreasing community exposure for a high-risk population. Primary care practices can utilize previously collected food insecurity and other social determinants of health data to identify and assist high-risk patients in a pandemic.
{"title":"Pandemic Food Response in Primary Care to Minimize Exposure for Elderly Food Insecure Population","authors":"Kristina M. Bridges, Jennifer Woodward, Megan J. Murray, Emma Mumm, K. Greiner","doi":"10.17161/kjm.vol15.15913","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15913","url":null,"abstract":"Introduction Stay-at-home orders during the first wave of the COVID-19 pandemic encouraged individuals, especially the elderly, to stock up on food and supplies and remain home to limit exposure to the SARS-CoV-2 virus. However, individuals with food insecurity may be able only to afford a few days of food at a time, causing frequent outings to obtain food. An emergency food delivery system decreases the need for frequent outings. This study investigated: (1) whether elderly family medicine patients with previously reported food insecurity were making frequent trips to obtain food during the lockdown, and (2) if social determinants of health screening data could be used successfully to identify patients in need of emergency food delivery during the pandemic. Methods Primary care patients 65 years and older with previously reported food insecurity were screened for referral to a community food delivery program. A cross-sectional secondary analysis of screening and referral data were conducted. Results Clinic staff called 52 patients and completed screening of 30. For 23/30 respondents (76.7%), reported monthly outings to obtain food exceeded the recommended stay-at-home guidelines. In our sample, 22/30 (73.3%) reported current food need, 14/30 (46.7%) reported two or fewer days of food, 28/30 (93.3%) reported receiving home food delivery would keep them from going out, 24/30 (80.0%) agreed to food delivery, and 17 patients received a food delivery. Conclusions Targeted screening and referral for food delivery may reduce the need for patients experiencing food insecurity to leave home during a pandemic or other disaster, potentially decreasing community exposure for a high-risk population. Primary care practices can utilize previously collected food insecurity and other social determinants of health data to identify and assist high-risk patients in a pandemic.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"148 - 154"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41883856","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 : 2022-05-17DOI: 10.17161/kjm.vol15.16525
E. Weesner, Jaya Sri Konakanchi, Roopa Sethi
{"title":"Role of Buprenorphine in an Adolescent with Opioid Abuse","authors":"E. Weesner, Jaya Sri Konakanchi, Roopa Sethi","doi":"10.17161/kjm.vol15.16525","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16525","url":null,"abstract":"","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"197 - 197"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43029172","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 : 2022-04-29DOI: 10.17161/kjm.vol15.16034
Grace Nassim, Freidy Eid
INTRODUCTION Many ischemic strokes are considered cryptogenic as they occur without a well-defined etiology. However, uncovering the pathophysiology affects prognosis, outcome, and management. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) began classifying ischemic strokes as large-artery atherosclerosis, cardioembolic, small-vessel occlusion, stroke of other determined etiology, and stroke of undetermined etiology.1 Twenty-five to forty percent of ischemic strokes are considered cryptogenic strokes, which are diagnosed through exclusion. The Northern Manhattan Study showed that the prevalence of cryptogenic strokes was higher in African Americans and Hispanics than in Caucasians.2 No clear risk association has been found for age and gender.3,4 Multiple mechanisms have been proposed for cryptogenic strokes such as cardiac embolism secondary to atrial fibrillation, paradoxical embolism through a cardiac septal defect, undefined thrombophilia, and sub-stenotic cerebrovascular disease.5 However, there are other important and unidentified mechanisms to uncover. This case study describes a middle-aged woman who presented for an ischemic stroke and was found to have a stenosis of the brachiocephalic vein, likely secondary to chronic pleurisy or congenital malformation.
{"title":"Unusual Cause of Stroke in a Middle-Aged Woman","authors":"Grace Nassim, Freidy Eid","doi":"10.17161/kjm.vol15.16034","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16034","url":null,"abstract":"INTRODUCTION Many ischemic strokes are considered cryptogenic as they occur without a well-defined etiology. However, uncovering the pathophysiology affects prognosis, outcome, and management. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) began classifying ischemic strokes as large-artery atherosclerosis, cardioembolic, small-vessel occlusion, stroke of other determined etiology, and stroke of undetermined etiology.1 Twenty-five to forty percent of ischemic strokes are considered cryptogenic strokes, which are diagnosed through exclusion. The Northern Manhattan Study showed that the prevalence of cryptogenic strokes was higher in African Americans and Hispanics than in Caucasians.2 No clear risk association has been found for age and gender.3,4 Multiple mechanisms have been proposed for cryptogenic strokes such as cardiac embolism secondary to atrial fibrillation, paradoxical embolism through a cardiac septal defect, undefined thrombophilia, and sub-stenotic cerebrovascular disease.5 However, there are other important and unidentified mechanisms to uncover. This case study describes a middle-aged woman who presented for an ischemic stroke and was found to have a stenosis of the brachiocephalic vein, likely secondary to chronic pleurisy or congenital malformation.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"146 - 147"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47810255","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 : 2022-04-29DOI: 10.17161/kjm.vol15.16210
R. Sigler, Kelly Robertson, Megan E. Herrman, Jessica Newman
Introduction Use of tobacco products carries significant long-term health risks, and rates of smoking in persons living with HIV are as high as two to three times that of the general population. This study aimed to increase assessment of readiness to quit smoking and provide cessation counseling to patients receiving HIV care through an infectious disease clinic. Methods This study was a pilot implementation in a single-center teaching hospital. In total, 603 active patients with HIV were followed in clinic at the time of the study start; of these, 79 were active tobacco smokers (13%) and eligible for the intervention. Providers were educated on recommendations for tobacco smoking cessation counseling, intervention strategies, and options for treatment. Patients who smoked tobacco were assessed for readiness to quit. Cessation counseling and tobacco cessation mediations or nicotine replacement were provided at the discretion of the patient and physician based on visit discussions. Primary outcome measures were increase in assessment of readiness to quit and in providing cessation counseling. Secondary measures included tabulation of the number of patients provided with a tobacco smoking cessation treatment and those with a successful quit episode. Results There was a moderate increase in patients assessed for readiness to quit and who received tobacco smoking cessation counseling and treatment medications during the pilot. In total, 11 patients (8.7%) reported quitting smoking for at least two weeks. Conclusions Additional work on streamlined mechanisms to identify tobacco use and provide efficient and effective tobacco smoking cessation counseling are needed in this high-risk population.
{"title":"Implementation of Effective Smoking Cessation Strategies for People Living with HIV: A Pilot Implementation Study","authors":"R. Sigler, Kelly Robertson, Megan E. Herrman, Jessica Newman","doi":"10.17161/kjm.vol15.16210","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16210","url":null,"abstract":"Introduction Use of tobacco products carries significant long-term health risks, and rates of smoking in persons living with HIV are as high as two to three times that of the general population. This study aimed to increase assessment of readiness to quit smoking and provide cessation counseling to patients receiving HIV care through an infectious disease clinic. Methods This study was a pilot implementation in a single-center teaching hospital. In total, 603 active patients with HIV were followed in clinic at the time of the study start; of these, 79 were active tobacco smokers (13%) and eligible for the intervention. Providers were educated on recommendations for tobacco smoking cessation counseling, intervention strategies, and options for treatment. Patients who smoked tobacco were assessed for readiness to quit. Cessation counseling and tobacco cessation mediations or nicotine replacement were provided at the discretion of the patient and physician based on visit discussions. Primary outcome measures were increase in assessment of readiness to quit and in providing cessation counseling. Secondary measures included tabulation of the number of patients provided with a tobacco smoking cessation treatment and those with a successful quit episode. Results There was a moderate increase in patients assessed for readiness to quit and who received tobacco smoking cessation counseling and treatment medications during the pilot. In total, 11 patients (8.7%) reported quitting smoking for at least two weeks. Conclusions Additional work on streamlined mechanisms to identify tobacco use and provide efficient and effective tobacco smoking cessation counseling are needed in this high-risk population.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"131 - 134"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44146086","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 : 2022-04-29DOI: 10.17161/kjm.vol15.16006
Bethany Harpole, S. Helmer, Karson R. Quinn, Howard A. Chang, N. Brown
Introduction Emergency general surgery patients represent a growing segment of general surgical admissions and national healthcare burden. A paucity of literature exists evaluating the work-up of these patients presenting to the Emergency Department (ED), particularly possible evaluation differentials between emergency physicians and physician assistants or advanced practice registered nurses (PA/ APRNs). The purpose of this study was to evaluate differences in ED work-up of general surgical patients between emergency physicians and PA/APRNs. Methods A retrospective review was conducted of patients presenting to the ED with the chief complaint of abdominal pain. Demographic data, evaluating provider, laboratory and imaging tests, diagnostic data, and disposition were obtained. Results Patient median age was 53.5 years, with 49% male and 81.6% Caucasian. Emergency physicians saw the majority (61.2%) of patients. Emergency physicians saw older patients (62.0 vs. 45.5 years; p = 0.017), and more patients that were anemic (28.3% vs. 14.3%) or with elevated creatinine levels (46.7% vs. 25.7%). There was no significant difference between groups for time in the ED (6.1 ± 2.4 vs. 5.7 ± 2.6 hours; p = 0.519), time to surgical consult (3.4 vs. 3.3 hours; p = 0.298), or time to the operating room (29.5 vs. 12.0 hours; p = 0.075). Patients seen by emergency physicians had a longer length of hospital stay (4.5 vs. 2 days; p = 0.002). Conclusions Time in the ED and time to surgical consult did not vary between groups although patients first seen by emergency physicians had potentially higher acuity. Decreased hospital length of stay in patients seen by PA/APRNs may reflect disease-specific differences.
{"title":"The Emergent General Surgical Patient: Evaluation Patterns in the Emergency Department","authors":"Bethany Harpole, S. Helmer, Karson R. Quinn, Howard A. Chang, N. Brown","doi":"10.17161/kjm.vol15.16006","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16006","url":null,"abstract":"Introduction Emergency general surgery patients represent a growing segment of general surgical admissions and national healthcare burden. A paucity of literature exists evaluating the work-up of these patients presenting to the Emergency Department (ED), particularly possible evaluation differentials between emergency physicians and physician assistants or advanced practice registered nurses (PA/ APRNs). The purpose of this study was to evaluate differences in ED work-up of general surgical patients between emergency physicians and PA/APRNs. Methods A retrospective review was conducted of patients presenting to the ED with the chief complaint of abdominal pain. Demographic data, evaluating provider, laboratory and imaging tests, diagnostic data, and disposition were obtained. Results Patient median age was 53.5 years, with 49% male and 81.6% Caucasian. Emergency physicians saw the majority (61.2%) of patients. Emergency physicians saw older patients (62.0 vs. 45.5 years; p = 0.017), and more patients that were anemic (28.3% vs. 14.3%) or with elevated creatinine levels (46.7% vs. 25.7%). There was no significant difference between groups for time in the ED (6.1 ± 2.4 vs. 5.7 ± 2.6 hours; p = 0.519), time to surgical consult (3.4 vs. 3.3 hours; p = 0.298), or time to the operating room (29.5 vs. 12.0 hours; p = 0.075). Patients seen by emergency physicians had a longer length of hospital stay (4.5 vs. 2 days; p = 0.002). Conclusions Time in the ED and time to surgical consult did not vary between groups although patients first seen by emergency physicians had potentially higher acuity. Decreased hospital length of stay in patients seen by PA/APRNs may reflect disease-specific differences.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"112 - 118"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46444051","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 : 2022-04-29DOI: 10.17161/kjm.vol15.16213
Aaron Nilhas, S. Helmer, Rachel M. Drake, J. Reyes, Megan Morriss, James M. Haan
Introduction New recommendations for emergency medical services spinal precautions limit long spinal board use to extrication purposes only and are to be removed immediately. Outcomes for spinal motion restriction against spinal immobilization were studied. Methods A retrospective chart review of trauma patients was conducted over a six-month period at a level I trauma center. Injury severity details and neurologic assessments were collected on 277 patients. Results Upon arrival, 25 (9.0%) patients had a spine board in place. Patients placed on spine boards were more likely to be moderately or severely injured [injury severity score (ISS) > 15: 36.0% vs. 9.9%, p = 0.001] and more likely to have neurological deficits documented by emergency medical services (EMS; 30.4% vs. 8.8%, p = 0.01) and the trauma team (29.2% vs. 10.9%, p = 0.02). Conclusions This study suggested that the long spine board was being used properly for more critically injured patients. Further research is needed to compare neurological outcomes using a larger sample size and more consistent documentation.
{"title":"Pre-Hospital Spinal Immobilization: Neurological Outcomes for Spinal Motion Restriction Versus Spinal Immobilization","authors":"Aaron Nilhas, S. Helmer, Rachel M. Drake, J. Reyes, Megan Morriss, James M. Haan","doi":"10.17161/kjm.vol15.16213","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16213","url":null,"abstract":"Introduction New recommendations for emergency medical services spinal precautions limit long spinal board use to extrication purposes only and are to be removed immediately. Outcomes for spinal motion restriction against spinal immobilization were studied. Methods A retrospective chart review of trauma patients was conducted over a six-month period at a level I trauma center. Injury severity details and neurologic assessments were collected on 277 patients. Results Upon arrival, 25 (9.0%) patients had a spine board in place. Patients placed on spine boards were more likely to be moderately or severely injured [injury severity score (ISS) > 15: 36.0% vs. 9.9%, p = 0.001] and more likely to have neurological deficits documented by emergency medical services (EMS; 30.4% vs. 8.8%, p = 0.01) and the trauma team (29.2% vs. 10.9%, p = 0.02). Conclusions This study suggested that the long spine board was being used properly for more critically injured patients. Further research is needed to compare neurological outcomes using a larger sample size and more consistent documentation.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"119 - 122"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47732680","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 : 2022-04-29DOI: 10.17161/kjm.vol15.16243
Zachary A. Unruh, E. Ablah, Hyarettin Okut, David Chacko
Introduction Tractional retinal detachment remains a leading cause of severe, persistent vision loss in those with diabetic retinopathy. The purpose of this study was to investigate factors in treatment history associated with outcomes of surgical repair for diabetic tractional retinal detachments. Methods A retrospective, cohort study design was used. Data on 64 eyes that underwent surgical correction for diabetic tractional retinal detachment were analyzed. For eyes that received any treatment within three months of surgery, the entire treatment history was recorded and analyzed. Eyes with no recorded treatment or only remote treatment outside of three months prior to surgery were considered treatment naïve. Results Of all eyes, 56% (n = 36) had received treatment for proliferative diabetic retinopathy in the three months prior to surgery. Among those treated, 50% (n = 18) of eyes had both laser and bevacizumab treatments and 44% (n = 16) had only bevacizumab injections. Average best corrected visual acuity (BCVA) for all eyes improved from 1.68 LogMAR (20/1,000) pre-operatively to 1.34 (20/400) post-operatively, p = 0.0017. Average BCVA in eyes with pre-operative treatment history improved from 1.73 (20/1,000) pre-operatively to 1.09 (20/250) post-operatively, p = 0.0006. Average BCVA in treatment-naïve eyes was 1.60 (20/800) pre-operatively and 1.66 (20/1,000) post-operatively, p = 0.638. Eyes treated only with intravitreal injections had an improvement in BCVA from 1.81 (20/1,200) pre-operatively to 0.91 (20/160) post-operatively, p = 0.006. There was no difference between tamponade agents when comparing mean change in BCVA, p = 0.944. Conclusions There was a relationship between intravitreal injection treatment history and a large improvement in BCVA, and a similar association between combined laser and injection treatment history and improvement in BCVA. These relationships, however, were not present when controlling for confounders in multivariate analysis. There were likely other factors in the patient’s treatment history such as timing, quantity, and order of treatments that played a role in the bivariate association observed in this study.
{"title":"Treatment History as a Predictor for Change in Visual Acuity After Surgical Correction of Diabetic Retinal Traction Detachment","authors":"Zachary A. Unruh, E. Ablah, Hyarettin Okut, David Chacko","doi":"10.17161/kjm.vol15.16243","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16243","url":null,"abstract":"Introduction Tractional retinal detachment remains a leading cause of severe, persistent vision loss in those with diabetic retinopathy. The purpose of this study was to investigate factors in treatment history associated with outcomes of surgical repair for diabetic tractional retinal detachments. Methods A retrospective, cohort study design was used. Data on 64 eyes that underwent surgical correction for diabetic tractional retinal detachment were analyzed. For eyes that received any treatment within three months of surgery, the entire treatment history was recorded and analyzed. Eyes with no recorded treatment or only remote treatment outside of three months prior to surgery were considered treatment naïve. Results Of all eyes, 56% (n = 36) had received treatment for proliferative diabetic retinopathy in the three months prior to surgery. Among those treated, 50% (n = 18) of eyes had both laser and bevacizumab treatments and 44% (n = 16) had only bevacizumab injections. Average best corrected visual acuity (BCVA) for all eyes improved from 1.68 LogMAR (20/1,000) pre-operatively to 1.34 (20/400) post-operatively, p = 0.0017. Average BCVA in eyes with pre-operative treatment history improved from 1.73 (20/1,000) pre-operatively to 1.09 (20/250) post-operatively, p = 0.0006. Average BCVA in treatment-naïve eyes was 1.60 (20/800) pre-operatively and 1.66 (20/1,000) post-operatively, p = 0.638. Eyes treated only with intravitreal injections had an improvement in BCVA from 1.81 (20/1,200) pre-operatively to 0.91 (20/160) post-operatively, p = 0.006. There was no difference between tamponade agents when comparing mean change in BCVA, p = 0.944. Conclusions There was a relationship between intravitreal injection treatment history and a large improvement in BCVA, and a similar association between combined laser and injection treatment history and improvement in BCVA. These relationships, however, were not present when controlling for confounders in multivariate analysis. There were likely other factors in the patient’s treatment history such as timing, quantity, and order of treatments that played a role in the bivariate association observed in this study.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"123 - 126"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47517571","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 : 2022-04-29eCollection Date: 2022-01-01DOI: 10.17161/kjm.vol15.15884
Joseph Joslin, Elizabeth Ablah, Hayrettin Okut, Lauren Bricker, Maha Assi
Introduction: Modern laboratory techniques cannot differentiate between Clostridium difficile colonization and infection; therefore, testing must be indicated clinically. To reduce hospital-onset of C. difficile infections (HO-CDI), Ascension Via Christi Hospitals (AVCH) in Wichita intervened in three stages by introducing: 1) a C. diflcile testing algorithm; 2) an electronic medical record (EMR)-based decision support system to enforce said algorithm; and 3) phone calls from the infection prevention department to providers to discontinue tests not collected within 24 hours of the order. The goal of this study was to determine if these interventions improved the HO-CDI rate.
Methods: At AVCH, the three study periods were compared: baseline with algorithm training only, the EMR intervention, and the EMR intervention with additional phone calls (EMR with phone calls). Data were abstracted from the hospital EMR.
Results: A total of 311 charts were reviewed. Adherence to the algorithm increased from 34% at baseline to 52% after the EMR intervention (p = 0.010). During the EMR with phone calls period, more tests were discontinued (87%; n = 39) compared to baseline (54%; n = 15) and EMR (54%; n = 15; p = 0.003). The HO-CDI rate ranged from 8.5 cases per 10,000 patient-days at baseline, to 7.9 during EMR, to 4.0 during EMR with phone calls (p = 0.007).
Conclusions: The EMR and EMR with phone call interventions were associated with a significant decrease in the HO-CDI rate and an increase in provider adherence to the algorithm.
{"title":"Improving Stewardship of <i>Clostridioides difficile</i> Testing with EMR and Provider Phone Calls.","authors":"Joseph Joslin, Elizabeth Ablah, Hayrettin Okut, Lauren Bricker, Maha Assi","doi":"10.17161/kjm.vol15.15884","DOIUrl":"10.17161/kjm.vol15.15884","url":null,"abstract":"<p><strong>Introduction: </strong>Modern laboratory techniques cannot differentiate between <i>Clostridium difficile</i> colonization and infection; therefore, testing must be indicated clinically. To reduce hospital-onset of <i>C. difficile</i> infections (HO-CDI), Ascension Via Christi Hospitals (AVCH) in Wichita intervened in three stages by introducing: 1) a <i>C. diflcile</i> testing algorithm; 2) an electronic medical record (EMR)-based decision support system to enforce said algorithm; and 3) phone calls from the infection prevention department to providers to discontinue tests not collected within 24 hours of the order. The goal of this study was to determine if these interventions improved the HO-CDI rate.</p><p><strong>Methods: </strong>At AVCH, the three study periods were compared: baseline with algorithm training only, the EMR intervention, and the EMR intervention with additional phone calls (EMR with phone calls). Data were abstracted from the hospital EMR.</p><p><strong>Results: </strong>A total of 311 charts were reviewed. Adherence to the algorithm increased from 34% at baseline to 52% after the EMR intervention (p = 0.010). During the EMR with phone calls period, more tests were discontinued (87%; n = 39) compared to baseline (54%; n = 15) and EMR (54%; n = 15; p = 0.003). The HO-CDI rate ranged from 8.5 cases per 10,000 patient-days at baseline, to 7.9 during EMR, to 4.0 during EMR with phone calls (p = 0.007).</p><p><strong>Conclusions: </strong>The EMR and EMR with phone call interventions were associated with a significant decrease in the HO-CDI rate and an increase in provider adherence to the algorithm.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"135-138"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43149284","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 : 2022-04-29DOI: 10.17161/kjm.vol15.15916
R. Hazard, S. Lines, Kelsey Lu, E. Ablah
Introduction In 2019, 25.8% of Kansas high school youth reported using any form of tobacco product. Schools can prevent and reduce youth tobacco use by adopting comprehensive tobacco policies, which include all tobacco products, on school grounds and at school-sponsored, off-campus events, for all individuals at all times, and integrate cessation services for students who violate the tobacco policy. The purpose of this study was to determine the prevalence of comprehensive tobacco policies in unified school districts (USD) across Kansas to determine how many schools have adopted such policies. Methods All 286 USDs in Kansas were eligible to participate in this study including elementary, middle, and high schools. Participating schools were asked to upload their policies to a website developed by the Kansas Department of Health and Environment (KDHE). Frequencies and percentages were computed to identify the type of tobacco products prohibited, the locations where tobacco use is prohibited, who is prohibited from using tobacco, when tobacco is prohibited, and consequences of students’ violation of the tobacco policy. Results Several USD policies met some of these comprehensive recommendations; however, 97.9% (n = 280) did not. In other words, 2.1% of USD policies (n = 6) were comprehensive in Kansas. Most districts (98.3%, n = 281) presented policies prohibiting use of all forms of tobacco for students, but policies often offered more leniency for faculty/staff and visitors. Fewer districts presented policies prohibiting use of all tobacco products for staff/faculty (73.1%, n = 209) and visitors (45.8%, n = 131) of policies. Conclusions Nearly all USDs in Kansas have an opportunity to strengthen their tobacco policies. Relatively simple edits can be made to prohibit all tobacco products, prohibit use on school grounds and at school-sponsored, off-campus events, ensure these policies apply to everyone, at all times, and integrate cessation resources for students who violate the tobacco policy.
{"title":"An Overview of Tobacco Policies in Kansas Unified School Districts","authors":"R. Hazard, S. Lines, Kelsey Lu, E. Ablah","doi":"10.17161/kjm.vol15.15916","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15916","url":null,"abstract":"Introduction In 2019, 25.8% of Kansas high school youth reported using any form of tobacco product. Schools can prevent and reduce youth tobacco use by adopting comprehensive tobacco policies, which include all tobacco products, on school grounds and at school-sponsored, off-campus events, for all individuals at all times, and integrate cessation services for students who violate the tobacco policy. The purpose of this study was to determine the prevalence of comprehensive tobacco policies in unified school districts (USD) across Kansas to determine how many schools have adopted such policies. Methods All 286 USDs in Kansas were eligible to participate in this study including elementary, middle, and high schools. Participating schools were asked to upload their policies to a website developed by the Kansas Department of Health and Environment (KDHE). Frequencies and percentages were computed to identify the type of tobacco products prohibited, the locations where tobacco use is prohibited, who is prohibited from using tobacco, when tobacco is prohibited, and consequences of students’ violation of the tobacco policy. Results Several USD policies met some of these comprehensive recommendations; however, 97.9% (n = 280) did not. In other words, 2.1% of USD policies (n = 6) were comprehensive in Kansas. Most districts (98.3%, n = 281) presented policies prohibiting use of all forms of tobacco for students, but policies often offered more leniency for faculty/staff and visitors. Fewer districts presented policies prohibiting use of all tobacco products for staff/faculty (73.1%, n = 209) and visitors (45.8%, n = 131) of policies. Conclusions Nearly all USDs in Kansas have an opportunity to strengthen their tobacco policies. Relatively simple edits can be made to prohibit all tobacco products, prohibit use on school grounds and at school-sponsored, off-campus events, ensure these policies apply to everyone, at all times, and integrate cessation resources for students who violate the tobacco policy.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"127 - 130"},"PeriodicalIF":0.0,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47052158","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.vol15.15986
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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：