Pub Date : 2022-02-09eCollection Date: 2022-01-01DOI: 10.17161/kjm.vol15.15803
Kelsey J Tenpenny, Adrianne K Griebel-Thompson, Morgan C Weiler, Susan E Carlson, Michael Kennedy
Introduction: The primary purpose of this study was to determine if new recommendations for prenatal supplements of docosahexaenoic acid (DHA) and choline have been implemented into care by physicians who care for pregnant women in rural Kansas communities. Both nutrients are inadequate in the diet of most pregnant women in the U.S., and not all prenatal supplements provide DHA and choline.
Methods: A cross sectional web-based survey was developed and provided by the University of Kansas Medical Center (KUMC) students to 44 rural Kansas clinics believed to have physicians who provide obstetrical care. Questions about DHA and choline were embedded in a larger survey focused on prenatal care. A total of 29 surveys were returned, however, only 21 were completed by physicians who provided obstetrical care.
Results: DHA (3/21) and choline (0/21) rarely were singled out for recommendation in contrast to folic acid (16/21) and iron (14/21). Participants stated that most women sought prenatal care during the first trimester of their pregnancy and indicated that they recommended prenatal vitamins at the first visit. Eleven gave patients a prescription for prenatal vitamins. The remaining patients either chose traditional over the counter prenatal vitamin capsules or less traditional chewable (gummy) vitamins, which provided lower concentrations of nutrients. Common barriers to nutritional counseling were limited resources and time constraints. Clinicians assessed their confidence and ability to provide nutritional counseling as moderate and competent, respectively.
Conclusions: New nutritional recommendations for DHA and choline have not been implemented into standard of care in rural Kansas.
{"title":"A Preliminary Study of Clinical Practice and Prenatal Nutrition in Rural Kansas.","authors":"Kelsey J Tenpenny, Adrianne K Griebel-Thompson, Morgan C Weiler, Susan E Carlson, Michael Kennedy","doi":"10.17161/kjm.vol15.15803","DOIUrl":"10.17161/kjm.vol15.15803","url":null,"abstract":"<p><strong>Introduction: </strong>The primary purpose of this study was to determine if new recommendations for prenatal supplements of docosahexaenoic acid (DHA) and choline have been implemented into care by physicians who care for pregnant women in rural Kansas communities. Both nutrients are inadequate in the diet of most pregnant women in the U.S., and not all prenatal supplements provide DHA and choline.</p><p><strong>Methods: </strong>A cross sectional web-based survey was developed and provided by the University of Kansas Medical Center (KUMC) students to 44 rural Kansas clinics believed to have physicians who provide obstetrical care. Questions about DHA and choline were embedded in a larger survey focused on prenatal care. A total of 29 surveys were returned, however, only 21 were completed by physicians who provided obstetrical care.</p><p><strong>Results: </strong>DHA (3/21) and choline (0/21) rarely were singled out for recommendation in contrast to folic acid (16/21) and iron (14/21). Participants stated that most women sought prenatal care during the first trimester of their pregnancy and indicated that they recommended prenatal vitamins at the first visit. Eleven gave patients a prescription for prenatal vitamins. The remaining patients either chose traditional over the counter prenatal vitamin capsules or less traditional chewable (gummy) vitamins, which provided lower concentrations of nutrients. Common barriers to nutritional counseling were limited resources and time constraints. Clinicians assessed their confidence and ability to provide nutritional counseling as moderate and competent, respectively.</p><p><strong>Conclusions: </strong>New nutritional recommendations for DHA and choline have not been implemented into standard of care in rural Kansas.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49421694","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 : 2022-02-09DOI: 10.17161/kjm.vol15.15921
Ra’ed Jabr, R. Liesman, V. R. Sethapati, D. Shoemaker, A. Spec, W. El Atrouni
{"title":"Disseminated Infection Due to Neocosmospora (Fusarium) falciformis in a Patient with Acute Myelogenous Leukemia","authors":"Ra’ed Jabr, R. Liesman, V. R. Sethapati, D. Shoemaker, A. Spec, W. El Atrouni","doi":"10.17161/kjm.vol15.15921","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15921","url":null,"abstract":" ","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"67 - 69"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41371188","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.vol15.15881
Fabian Delgado, F. Valverde, Richard Vaca
70 Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review Fabian Delgado, M.D., FACP1, Adrian Valverde2, Richard G. Vaca, M.D.3 1Vantage Healthcare, Canton, MA 2Universidad de Guayaquil, School of Medicine, Guayaquil, Ecuador 3Universidad Católica de Santiago de Guayaquil, School of Medicine, Guayaquil, Ecuador Received Sept. 24, 2021; Accepted for publication Nov. 29, 2021; Published online Feb. 9, 2022 https://doi.org/10.17161/kjm.vol15.15881
{"title":"Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review","authors":"Fabian Delgado, F. Valverde, Richard Vaca","doi":"10.17161/kjm.vol15.15881","DOIUrl":"https://doi.org/10.17161/kjm.vol15.15881","url":null,"abstract":"70 Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review Fabian Delgado, M.D., FACP1, Adrian Valverde2, Richard G. Vaca, M.D.3 1Vantage Healthcare, Canton, MA 2Universidad de Guayaquil, School of Medicine, Guayaquil, Ecuador 3Universidad Católica de Santiago de Guayaquil, School of Medicine, Guayaquil, Ecuador Received Sept. 24, 2021; Accepted for publication Nov. 29, 2021; Published online Feb. 9, 2022 https://doi.org/10.17161/kjm.vol15.15881","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"70 - 72"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42225990","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 : 2022-02-09eCollection Date: 2022-01-01DOI: 10.17161/kjm.vol15.15853
Deborah Tyokighir, Ashley M Hervey, Christy Schunn, Daniel Clifford, Carolyn R Ahlers-Schmidt
Introduction: Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period.
Methods: Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework.
Results: Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations.
Conclusions: Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.
{"title":"Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers.","authors":"Deborah Tyokighir, Ashley M Hervey, Christy Schunn, Daniel Clifford, Carolyn R Ahlers-Schmidt","doi":"10.17161/kjm.vol15.15853","DOIUrl":"10.17161/kjm.vol15.15853","url":null,"abstract":"<p><strong>Introduction: </strong>Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period.</p><p><strong>Methods: </strong>Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework.</p><p><strong>Results: </strong>Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations.</p><p><strong>Conclusions: </strong>Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.</p>","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"48-54"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47502067","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 : 2022-02-09DOI: 10.17161/kjm.vol15.16115
Alexander Wendling, J. White, B. Cooper, C. Corrigan, Bradley R. Dart
Introduction During fracture osteosynthesis, traumatologists may remove screws which are too long, cut the excess length from the screw tip, then reinsert the cut screw (CS) to minimize implant waste. The purpose of this study was to determine if this practice influences screw purchase. Methods Using an axial-torsion load device, the maximal insertion torque (MIT) required to insert 3.5 mm stainless steel cortical screws into normal and osteoporotic bone models was measured. MIT was determined in three different test conditions: (1) long screw (LS) insertion; (2) LS insertion, removal, and insertion of a normal-length screw (NS); and, (3) LS insertion, removal, cutting excess length from the screw tip, and reinserting the CS. Results In the normal bone model, mean (± SD) MIT of LS insertion was 546 ± 6 Newton-centimeters (N-cm) compared to 496 ± 61 N-cm for NS reinsertion and 465 ± 69 N-cm for CS reinsertion. In the osteoporotic bone model, MIT of LS insertion was 110 ± 11 N-cm, whereas the values for NS and CS reinsertions were 98 ± 9 N-cm and 101 ± 12 N-cm, respectively. There was no significant difference in MIT between CS and NS reinsertions in the osteoporotic bone analog. Conclusions Cutting excess length from a 3.5 mm stainless steel cortical screw did not decrease its purchase regardless of bone density. During osteosynthesis, orthopaedists may remove screws which are too long, cut the screw tip, and reinsert the shortened screw as a cost-saving measure without compromising fracture fixation.
{"title":"Cut Cortical Screw Purchase in Diaphyseal Bone: A Biomedical Study","authors":"Alexander Wendling, J. White, B. Cooper, C. Corrigan, Bradley R. Dart","doi":"10.17161/kjm.vol15.16115","DOIUrl":"https://doi.org/10.17161/kjm.vol15.16115","url":null,"abstract":"Introduction During fracture osteosynthesis, traumatologists may remove screws which are too long, cut the excess length from the screw tip, then reinsert the cut screw (CS) to minimize implant waste. The purpose of this study was to determine if this practice influences screw purchase. Methods Using an axial-torsion load device, the maximal insertion torque (MIT) required to insert 3.5 mm stainless steel cortical screws into normal and osteoporotic bone models was measured. MIT was determined in three different test conditions: (1) long screw (LS) insertion; (2) LS insertion, removal, and insertion of a normal-length screw (NS); and, (3) LS insertion, removal, cutting excess length from the screw tip, and reinserting the CS. Results In the normal bone model, mean (± SD) MIT of LS insertion was 546 ± 6 Newton-centimeters (N-cm) compared to 496 ± 61 N-cm for NS reinsertion and 465 ± 69 N-cm for CS reinsertion. In the osteoporotic bone model, MIT of LS insertion was 110 ± 11 N-cm, whereas the values for NS and CS reinsertions were 98 ± 9 N-cm and 101 ± 12 N-cm, respectively. There was no significant difference in MIT between CS and NS reinsertions in the osteoporotic bone analog. Conclusions Cutting excess length from a 3.5 mm stainless steel cortical screw did not decrease its purchase regardless of bone density. During osteosynthesis, orthopaedists may remove screws which are too long, cut the screw tip, and reinsert the shortened screw as a cost-saving measure without compromising fracture fixation.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"15 1","pages":"59 - 62"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45823371","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 : 2021-09-01DOI: 10.17161/kjm.vol14.15774
N. Boutrid, H. Rahmoune
We read with deep attention the case report recently published about the peculiar association of morphea, celiac disease, dermatitis herpetiformis and dermatomyositis , and we would discuss the particular genetics that lay behind morphea and related autoimmune disorders, with a focus on HLA genes.
{"title":"Morphea and Autoimmunity: HLA behind the scene?","authors":"N. Boutrid, H. Rahmoune","doi":"10.17161/kjm.vol14.15774","DOIUrl":"https://doi.org/10.17161/kjm.vol14.15774","url":null,"abstract":"We read with deep attention the case report recently published about the peculiar association of morphea, celiac disease, dermatitis herpetiformis and dermatomyositis , and we would discuss the particular genetics that lay behind morphea and related autoimmune disorders, with a focus on HLA genes.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42463302","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 : 2021-09-01DOI: 10.17161/kjm.vol14.15259
R. T. Tung
INTRODUCTION Since its introduction, the electrocardiography (ECG) has become the most commonly performed cardiac diagnostic procedure and a fundamental tool of clinical practice.1,2 It is indispensable for the diagnosis and prompt treatment of patients with acute coronary syndromes and is an accurate, noninvasive tool for diagnosing cardiac conduction disturbances and arrhythmias. Proper, standard ECG leads placement is essential in providing accurate information from the recordings. Modified limb leads placement on the torso has the important advantages of ease and speed of application, particularly in emergent situations and has become commonplace. However, modified limb placement was reported to have unwanted abnormal ECG findings.3 Clinically significant abnormal ECG findings due to this modified, non-standard limb placement are illustrated by two cases.
{"title":"Electrocardiographic Limb Leads Placement and Its Clinical Implication","authors":"R. T. Tung","doi":"10.17161/kjm.vol14.15259","DOIUrl":"https://doi.org/10.17161/kjm.vol14.15259","url":null,"abstract":"INTRODUCTION Since its introduction, the electrocardiography (ECG) has become the most commonly performed cardiac diagnostic procedure and a fundamental tool of clinical practice.1,2 It is indispensable for the diagnosis and prompt treatment of patients with acute coronary syndromes and is an accurate, noninvasive tool for diagnosing cardiac conduction disturbances and arrhythmias. Proper, standard ECG leads placement is essential in providing accurate information from the recordings. Modified limb leads placement on the torso has the important advantages of ease and speed of application, particularly in emergent situations and has become commonplace. However, modified limb placement was reported to have unwanted abnormal ECG findings.3 Clinically significant abnormal ECG findings due to this modified, non-standard limb placement are illustrated by two cases.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41400986","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}
I am an experienced and published researcher using timolol betablocker ophthalmic eyedrops for the successful treatment of acute migraines.1-5 The above referenced paper contains many errors in study design and conduct.6 The statistics, discussion, and conclusion are misleading. Beta blockers are FDA approved and often effective for chronic migraine prevention by taking daily oral doses that maintain therapeutic blood levels. For acute migraine, oral beta blockers have not worked well because they take too long to achieve therapeutic blood levels.1,2 There are three other ways beta blocker solutions can be used to quickly achieve therapeutic blood levels. The first is promptly and properly applied topical beta blocker eyedrops to normal eyes/eyelids/nasolacrimal ducts/nasal mucosa. Faster is sublingual beta blocker drops and the fastest is beta blocker nasal spray.1,2 These last two preferred methods were not discussed in Aggarwal’s paper.6 Ophthalmologists spend their careers listening to patients complain about the difficulties of using eye drops. Sublingual application has been studied and found effective for glaucoma control in a subgroup of dropchallenged patients.7 Most acute migraine patients I have treated with timolol 0.5% eye drops prefer to take them sublingual for ease of application and efficacy rather than topical to the eyes. Absorption of beta blockers and subsequent beta receptor blockade has been studied.1,8 Of these three methods, nasal application has been shown to the be fastest and equivalent to intravenous beta blocker administration in a study of 80 human volunteers.8 Until recently, no beta blocker nasal spray was commercially available. O’Brien Pharmacy (https://obrienrx.com/) now prepares a compounded nasal spray of timolol with MucoluxTM delivering 0.125 mg/0.1 ml spray. The nasal spray is shaken and one spray delivered into each nostril at first onset of migraine symptoms. Patients may also take their other acute migraine medications with the beta blocker nasal spray. If migraine headache persists a second set of one spray per nostril is repeated in 10-15 minutes. A maximum of 4 sprays per 24 hours is specified. An O’Brien pharmacist contacts the patient on receiving a prescription from a licensed physician and inquires about beta blocker contra-indication and instructs on use. The cost of the medication at this writing is $30 for a 10 ml bottle plus postage. All future research on using beta blockers for acute migraine should be done using nasal delivery. I have no financial interest in this product. The Aggarwal study6 has so many other deficiencies that for reasons of space I can only list them without much discussion: patients not beta blocker naïve were included; retrospective exclusion of them taints the already scant data; the patients were not instructed to take the eye drops as quickly as possible with migraine onset; instead they had to fill out a questionnaire about the migraine; the study does not state if
我是一名经验丰富的研究人员，并发表了使用噻莫洛尔β受体阻滞剂眼药水成功治疗急性偏头痛的研究成果。上述引用的论文在研究设计和实施上存在许多错误统计数据、讨论和结论都具有误导性。-受体阻滞剂是美国食品和药物管理局批准的，通过每日口服剂量来维持治疗性血液水平，通常对慢性偏头痛预防有效。对于急性偏头痛，口服受体阻滞剂效果不佳，因为它们需要太长时间才能达到治疗性的血液水平。还有其他三种方法可以使用-受体阻滞剂溶液来快速达到治疗血液水平。首先是及时和适当地将-受体阻滞剂滴眼液涂抹在正常的眼睛/眼睑/鼻泪管/鼻黏膜上。更快的是舌下阻滞剂滴药最快的是阻滞剂鼻喷剂。Aggarwal的论文中没有讨论后两种首选方法眼科医生的整个职业生涯都在倾听病人抱怨使用眼药水的困难。舌下应用已被研究，并发现有效的青光眼控制在一个亚组的drop挑战患者我用0.5%噻莫洛尔滴眼液治疗过的大多数急性偏头痛患者都喜欢舌下服用，因为这样更容易使用，效果也更好，而不是局部使用。β受体阻滞剂的吸收和随后的β受体阻断已被研究。在这三种方法中，经80名志愿者参与的一项研究表明，鼻腔给药是最快的，与静脉注射受体阻滞剂相当直到最近，市面上还没有β受体阻滞剂鼻腔喷雾剂。O 'Brien Pharmacy (https://obrienrx.com/)现在准备了一种含有MucoluxTM的噻莫洛尔复合鼻喷雾剂，剂量为0.125毫克/0.1毫升。在偏头痛症状首次发作时，摇匀鼻喷雾剂，每个鼻孔各喷一剂。患者也可以将其他急性偏头痛药物与受体阻滞剂鼻喷雾剂一起服用。如果偏头痛持续存在，在10-15分钟内重复每鼻孔一次喷雾的第二组。规定每24小时最多喷4次。O 'Brien药剂师在收到执业医师的处方后与患者联系，询问受体阻滞剂的禁忌症并指导使用。在撰写本文时，这种药物的成本是每瓶10毫升外加邮费30美元。未来所有关于使用-受体阻滞剂治疗急性偏头痛的研究都应该使用鼻腔给药。我对这个产品没有经济利益。阿加沃尔的研究还有很多其他不足之处，由于篇幅有限，我只能一一列举，不作过多讨论:没有使用-受体阻滞剂naïve的患者被包括在内;回顾性地排除它们会污染本已不足的数据;没有指示患者在偏头痛发作时尽快服用眼药水;相反，他们必须填写一份关于偏头痛的调查问卷;该研究并没有说明是否或何时需要注射第二组眼药水(如果偏头痛持续，最好是在第一次滴眼药水后10分钟);没有说明患者是否被允许服用他们通常应该服用的急性偏头痛药物;偏头痛患者是从一个三级神经转诊中心招募的，该中心有大量难治性偏头痛患者。最重要的是，根据他们自己的分析，所研究的患者数量不允许任何可靠的统计有效性，而Aggarwal却错误地声称。他们的讨论不包括考虑更有效和更容易使用舌下或鼻腔阻滞剂给药;讨论将发现和结论归因于另一项不准确的研究，并且忽略了那些作者关于进一步研究治疗急性偏头痛的-受体阻滞剂的乐观陈述Cossack et al.9报道，在他们研究的10名患者中，有4名患者发现蒙面β受体阻滞剂滴眼液是急性偏头痛治疗的有效补充，而只有1名患者赞成蒙面安慰剂。他们确实允许使用第二组眼药水，但由于机构审查委员会的考虑，时间不超过30分钟。他们确实讨论过，如果在第一次插入后使用10-15分钟，可能会改善他们的结果。他们没有声称他们的研究具有统计学意义，但确定“未来的交叉研究将需要86名患者来支持α≤0.05和β≤0.2的研究。”9,10哥萨克和格拉顿总结了他们的讨论，“我们相信，我们的工作共同推进了噻莫洛尔滴剂是一种安全有效的概念，并且已经广泛用于某些偏头痛患者的流产治疗。”10哥萨克等人9和阿加瓦尔等人的研究都没有足够大的统计意义，所以阿加瓦尔等人说“我们现在有两个随机对照试验，与安慰剂相比，不会证明药物有明显的效果”是错误的。 “我希望制药行业或资助机构能够尽快开展一项大型的、足够有力的(N≥86)、安慰剂对照的交叉研究，使用最新的鼻喷雾剂作为一种新的、安全的、相对便宜的急性偏头痛治疗方法。
{"title":"Letter to the Editor: A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine","authors":"J. Hagan","doi":"10.17161/kjm.vol1315733","DOIUrl":"https://doi.org/10.17161/kjm.vol1315733","url":null,"abstract":"I am an experienced and published researcher using timolol betablocker ophthalmic eyedrops for the successful treatment of acute migraines.1-5 The above referenced paper contains many errors in study design and conduct.6 The statistics, discussion, and conclusion are misleading. Beta blockers are FDA approved and often effective for chronic migraine prevention by taking daily oral doses that maintain therapeutic blood levels. For acute migraine, oral beta blockers have not worked well because they take too long to achieve therapeutic blood levels.1,2 There are three other ways beta blocker solutions can be used to quickly achieve therapeutic blood levels. The first is promptly and properly applied topical beta blocker eyedrops to normal eyes/eyelids/nasolacrimal ducts/nasal mucosa. Faster is sublingual beta blocker drops and the fastest is beta blocker nasal spray.1,2 These last two preferred methods were not discussed in Aggarwal’s paper.6 Ophthalmologists spend their careers listening to patients complain about the difficulties of using eye drops. Sublingual application has been studied and found effective for glaucoma control in a subgroup of dropchallenged patients.7 Most acute migraine patients I have treated with timolol 0.5% eye drops prefer to take them sublingual for ease of application and efficacy rather than topical to the eyes. Absorption of beta blockers and subsequent beta receptor blockade has been studied.1,8 Of these three methods, nasal application has been shown to the be fastest and equivalent to intravenous beta blocker administration in a study of 80 human volunteers.8 Until recently, no beta blocker nasal spray was commercially available. O’Brien Pharmacy (https://obrienrx.com/) now prepares a compounded nasal spray of timolol with MucoluxTM delivering 0.125 mg/0.1 ml spray. The nasal spray is shaken and one spray delivered into each nostril at first onset of migraine symptoms. Patients may also take their other acute migraine medications with the beta blocker nasal spray. If migraine headache persists a second set of one spray per nostril is repeated in 10-15 minutes. A maximum of 4 sprays per 24 hours is specified. An O’Brien pharmacist contacts the patient on receiving a prescription from a licensed physician and inquires about beta blocker contra-indication and instructs on use. The cost of the medication at this writing is $30 for a 10 ml bottle plus postage. All future research on using beta blockers for acute migraine should be done using nasal delivery. I have no financial interest in this product. The Aggarwal study6 has so many other deficiencies that for reasons of space I can only list them without much discussion: patients not beta blocker naïve were included; retrospective exclusion of them taints the already scant data; the patients were not instructed to take the eye drops as quickly as possible with migraine onset; instead they had to fill out a questionnaire about the migraine; the study does not state if","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42899489","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}
We read with interest the study published by Tung and Heyns.1 It echoes the sentiments we espoused in our findings.2 We, too, support thorough investigation of incidental findings on computed tomography for attenuation correction (CTAC) during myocardial perfusion imaging (MPI). In particular, we share concerns about lung malignancies discovered by this avenue. Interestingly, there were considerable similarities as well as significant differences in the respective patient cohorts. The age group was comparable. In both groups, there was a range of histologic types represented. On the other hand, we noted that the series of patients studied by Tung and Heyns1 was entirely male. Most surprisingly was the occurrence rate of malignancies being discovered incidentally on MPI. The frequency of malignancy of chest in the patients who underwent MPI in this series was 0.73% (8/1,098 patients). By contrast, we identified 10 primary thoracic cancers amongst 3,122 patients. This equates to 0.32%. This is less than half the frequency suggested by Tung and Heyns. We wonder if the CTAC settings (in terms of voltage, current, collimator, rotation time and pitch) were comparable. Other factors which determine spatial resolution on CT scan include field of view, pixel size, focal spot size, magnification, patient motion, kernel, slice thickness, detector size.3 We are at a loss to explain the difference in detection rates otherwise. Perhaps the authors can give suggestions on why our respective cohorts, and prevalences, differed so significantly.
{"title":"Comparative Prevalence of Incidentally Detected Lung Malignancies on CTAC for MPI","authors":"Joseph C. Lee, J. Chong","doi":"10.17161/kjm.vol1415037","DOIUrl":"https://doi.org/10.17161/kjm.vol1415037","url":null,"abstract":"We read with interest the study published by Tung and Heyns.1 It echoes the sentiments we espoused in our findings.2 We, too, support thorough investigation of incidental findings on computed tomography for attenuation correction (CTAC) during myocardial perfusion imaging (MPI). In particular, we share concerns about lung malignancies discovered by this avenue. Interestingly, there were considerable similarities as well as significant differences in the respective patient cohorts. The age group was comparable. In both groups, there was a range of histologic types represented. On the other hand, we noted that the series of patients studied by Tung and Heyns1 was entirely male. Most surprisingly was the occurrence rate of malignancies being discovered incidentally on MPI. The frequency of malignancy of chest in the patients who underwent MPI in this series was 0.73% (8/1,098 patients). By contrast, we identified 10 primary thoracic cancers amongst 3,122 patients. This equates to 0.32%. This is less than half the frequency suggested by Tung and Heyns. We wonder if the CTAC settings (in terms of voltage, current, collimator, rotation time and pitch) were comparable. Other factors which determine spatial resolution on CT scan include field of view, pixel size, focal spot size, magnification, patient motion, kernel, slice thickness, detector size.3 We are at a loss to explain the difference in detection rates otherwise. Perhaps the authors can give suggestions on why our respective cohorts, and prevalences, differed so significantly.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"14 1","pages":"29 - 29"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49357654","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}
Introduction Overweight and obesity during pregnancy are associated with adverse health outcomes leading to increased maternal and neonatal morbidity and mortality. Women with a high body mass index (BMI) also experience low breastfeeding rates. There is limited evidence of effective educational programs that aim to improve length of breastfeeding among this population. The main objective of this pilot educational intervention was to determine knowledge and skills retention at six weeks after completion of a breastfeeding class. Methods A two-hour breastfeeding class was offered during the second and third trimester of pregnancy targeting high BMI women. A longitudinal, survey study design was conducted using two data collection points. No comparator group was employed. Results Baseline mean age of respondents was 26.6 years (SD = 5.7). Respondents who completed post-intervention surveys were largely white (69.2%) followed by Hispanic (15.4%) and non-Hispanic black (15.4%), some college (57.1%), earned less than $50,000/year (64.3%), had employer-provided insurance (53.8%), and did not receive WIC benefits (78.6%). Most respondents had a pre-pregnancy BMI category of overweight (28.6%) or obese (57.1%). The intervention appeared to have some impact on responses. The following were observed: an increased understanding that baby may be fussy in the evening hours and wants to nurse more often (p < 0.002), how to bring baby to the breast (p = 0.004), knowing what to do if breastfeeding hurts (p = 0.031), and knowing what to do when baby has trouble breastfeeding (p = 0.021). Conclusion Consistent with previous findings, all participants in our study reported increased knowledge to breastfeed. Thus, women’s confidence to breastfeed their infant is enhanced through knowledge obtained from breastfeeding education. Additional studies are underway to assess breastfeeding behaviors.
{"title":"Effectiveness of a Pilot Breastfeeding Educational Intervention Targeting High BMI Pregnant Women","authors":"L. Jacobson, Rosalee Zackula, Kelsey Lu","doi":"10.17161/kjm.v13i.14630","DOIUrl":"https://doi.org/10.17161/kjm.v13i.14630","url":null,"abstract":"Introduction Overweight and obesity during pregnancy are associated with adverse health outcomes leading to increased maternal and neonatal morbidity and mortality. Women with a high body mass index (BMI) also experience low breastfeeding rates. There is limited evidence of effective educational programs that aim to improve length of breastfeeding among this population. The main objective of this pilot educational intervention was to determine knowledge and skills retention at six weeks after completion of a breastfeeding class. Methods A two-hour breastfeeding class was offered during the second and third trimester of pregnancy targeting high BMI women. A longitudinal, survey study design was conducted using two data collection points. No comparator group was employed. Results Baseline mean age of respondents was 26.6 years (SD = 5.7). Respondents who completed post-intervention surveys were largely white (69.2%) followed by Hispanic (15.4%) and non-Hispanic black (15.4%), some college (57.1%), earned less than $50,000/year (64.3%), had employer-provided insurance (53.8%), and did not receive WIC benefits (78.6%). Most respondents had a pre-pregnancy BMI category of overweight (28.6%) or obese (57.1%). The intervention appeared to have some impact on responses. The following were observed: an increased understanding that baby may be fussy in the evening hours and wants to nurse more often (p < 0.002), how to bring baby to the breast (p = 0.004), knowing what to do if breastfeeding hurts (p = 0.031), and knowing what to do when baby has trouble breastfeeding (p = 0.021). Conclusion Consistent with previous findings, all participants in our study reported increased knowledge to breastfeed. Thus, women’s confidence to breastfeed their infant is enhanced through knowledge obtained from breastfeeding education. Additional studies are underway to assess breastfeeding behaviors.","PeriodicalId":94121,"journal":{"name":"Kansas journal of medicine","volume":"13 1","pages":"219 - 227"},"PeriodicalIF":0.0,"publicationDate":"2020-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.17161/kjm.v13i.14630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49615056","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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