bluuebunny/crossref_metadata_2025 huggingface dataset:
Pelaksanaan Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) di Wilayah Kerja Puskesmas Bualemo Kabupaten Banggai
Authors: Sauli Bani , Lanyumba Fitrianty Sutadi , Sattu Marselina , Balebu Dwi Wahyu , Syahrir Muhammad , Tongko Mirawati
Published: February 2021

Tujuan penelitian ini yaitu mengetahui gambaran pelaksanaan P4K di wilayah kerja Puskesmas Bualemo Kabupaten Banggai Tahun 2014. Jenis penelitian ini adalah penelitian deskriptif, pada 13 bidan, 47 ibu hamil, dan 25 responden tokoh masyarakat yang dipilih secara Purposive Sampling. Waktu penelitian pada bulan Juni Tahun 2014. Pengambilan data dilakukan dengan wawancara secara langsung terhadap responden berdasarkan daftar pertanyaan yang telah disediakan. Hasil penelitian menunjukkan bahwa pelaksanaan P4K pada bidan dengan kriteria baik 4 responden (30,8%), dan kriteria kurang baik 9 responden (69,2%). Pelaksanaan P4K pada ibu hamil dengan kriteria baik sebanyak 6 responden (12,8%), dan kriteria kurang baik 41 responden (87,2%). Pelaksanaan P4K pada tokoh masyarakat dengan kriteria baik 5 responden (20%), dan kriteria kurang baik 20 responden (80%). Secara keseluruan dari 3 variabel yang di teliti pelaksanaan program perencanaan persalinan dan pencegahan komplikasi di wilayah kerja Puskesmas Bualemo tidak terlaksana dengan baik. Saran dari penelitian ini diharapkan kerja sama semua sektor terkait dalam mendukung terlaksananya program perencanaan persalinan dan pencegahan komplikasi (P4K) di Kabupaten Banggai secara umum dan di wilayah kerja Puskesmas Bualemo Khususnya.
The purpose of this study was to find out the description of the implementation of P4K in the Bualemo Community Health Center in Banggai District in 2014. This type of research is a descriptive study, on 13 midwives, 47 pregnant women, and 25 respondents community leaders who were selected by Purposive Sampling. The time of the study was in June 2014. Data was collected by direct interview with respondents based on a list of questions provided. The results showed that the implementation of P4K on midwives with good criteria 4 respondents (30.8%), and 9 respondents (69.2%) unfavorable criteria. The implementation of P4K in pregnant women with good criteria was 6 respondents (12.8%), and unfavorable criteria were 41 respondents (87.2%). The implementation of P4K on community leaders with good criteria is 5 respondents (20%), and criteria are less good for 20 respondents (80%). Overall, the 3 variables examined in the implementation of the birth planning and complications prevention program in the work area of ​​the Bualemo Community Health Center were not implemented properly. Suggestions from this research are expected to cooperate with all related sectors in supporting the implementation of the birth planning and complications prevention (P4K) program in Banggai Regency in general and in the work area of ​​the Bualemo Community Health Center in particular.
Perilaku Seksual Tenaga Kerja Bongkar Muat Pelabuhan dengan Riwayat Penyakit Menular Seksual di Kabupaten Banggai
Authors: Sombeng Supardi , Herawati Herawati , Sakati Sandi Novryanto , Dwicahya Bambang , Kanan Maria , Ramli Ramli
Published: February 2021

Perilaku seksual dapat beresiko terjadinya Penyakit menular seksual (PMS) bila melakukan hubungan seksual dengan berganti-ganti pasangan baik melalui vagina, oral, maupun anal. Kasus Penyakit Menular Seksual yang ditemukan pada Tenaga Kerja Bongkar Muat Pelabuhan yang pernah menderita yaitu sebanyak 24 orang.Tujuan penelitian ini untuk mengetahui perilaku seksual Tenaga Kerja Bongkar Muat Pelabuhan yang pernah menderita penyakit menular seksual di Kabupaten Banggai. Lokasi penelitian dilakukan di kabupaten Banggai pada tahun 2016. Waktu penelitian dilaksanakan pada bulan Oktober-November tahun 2016. Penelitian ini menggunakan metode kualitatif dengan pendekatan wawancara mendalam dan direkam. Jumlah informan 17 orang, yang tidak bersedia diwawancara sebanyak 6 orang dan 1 orang telah meninggal dunia informan kunci sebanyak 2 orang. Hasil penelitian menunjukkan bahwa informan sudah melakukan perilaku seksual yang beresiko yaitu perilaku seksual yang dilakukan secara berganti-gantian pasangan serta tidak menggunakan alat kontrasepsi dan terakhir kali informan melakukan hubungan seksual dengan wanita yang beresiko yaitu wanita pekerja seksual. Masyarakat diperlukan mendapatkan infomasi tentang perilaku-perilaku seksual yang beresiko pada kesehatan terutama tentang kesehatan reproduksi, sehingga kedepanyya mereka tidak akan mendapatkan penyakit yang dapat merugikan diri mereka sendiri.
Sexual behavior can be at risk of sexually transmitted diseases (STDs) when having sexual intercourse by changing partners via vaginal, oral, or anal. Cases of sexually transmitted diseases were found in Port Loading and Unloading Workers who had suffered as many as 24 people. The purpose of this study was to determine the sexual behavior of Port Load Unloading Workers who had suffered from sexually transmitted diseases in Banggai District. The research location was conducted in Banggai district in 2016. The research was conducted in October-November 2016. This study used a qualitative method with in-depth interviews and recorded approaches. There were 17 informants, 6 of whom were unwilling to be interviewed and 2 of them had died as key informants. The results showed that the informants had carried out at risk sexual behavior that is sexual behavior that was carried out alternately-changing partners and did not use contraception and the last time the informant had sexual relations with women who were at risk namely women who were sex workers. Communities are required to get information about sexual behaviors that pose a risk to health, especially about reproductive health, so that in the future they will not get diseases that can harm themselves.
KELOR (Kelas Entrepreneurship Pemanfaatan Daun Kelor) Sebagai Upaya Pemberdayaan untuk Meningkatkan Produktivitas Ibu Rumah Tangga
Authors: Lestari Ayu Fitri , Sari Intan Puspita
Published: February 2021

Data BPS tahun 2016 menyatakan, pada kuartal I-2016, jumlah angkatan kerja Indonesia turun menjadi 127,67 juta orang, dari 128,3 juta orang di kuartal I-2015. Penurunan angkatan kerja ini dikarenakan banyak penduduk perempuan yang beralih menjadi ibu rumah tangga. Penulis membuat program pemberdayaan KELOR (Kelas Entrepreneurship Berbasis Pemanfaatan Daun Kelor) sebagai upaya pemberdayaan untuk meningkatkan produktivitas ibu rumah tangga di Pulo Kelor, Banyuwangi. Kegiatan ini merupakan pemberdayaan masyarakat dengan model social planning dan locality development model. Sasaran pemberdayaan ini adalah Ibu-Ibu PKK dengan jumlah 17 orang, yang dipilih dengan metode purposive sampling. Pelaksanaan kegiatan KELOR sebagai sarana untuk membuat sentra usaha daun kelor dilaksanakan selama lima bulan, yaitu Januari sampai dengan Mei 2018. Proses pemberdayaan yang dilakukan dengan menerapkan tujuh langkah pemberdayaan meliputi tahap persiapan, pengkajian, perencanaan alternatif program, pemformulasian rencana aksi, pelaksanaan program, evaluasi, dan terminasi. Pemberdayaan KELOR berhasil mencapai target terbentuknya kader KELOR, dan 3 kelompok unit usaha produk olahan dari daun kelor. Kelompok unit usaha tersebut terdiri dari kelompok produksi brownies kelor, kerupuk kelor, dan pia kelor. Melalui sosialisasi terkait dengan manfaat kelor, terjadi peningkatan pengetahuan sebesar 68,75% pada ibu-ibu. Pelatihan pemasaran produk, manajemen keuangan, dan desain produk juga dapat meningkatan pengetahuan ibu-ibu tentang materi tersebut sebesar 13,26%. Kegiatan pemberdayaan ini terbukti dapat memberdayakan ibu-ibu PKK Pulo Kelor dalam meningkatkan pengetahuan, keterampilan, serta menambah pendapatan keluarga mereka.
Data from BPS in 2016 stated, in the first quarter of 2016, the number of the Indonesian workforce fell to 127.67 million, from 128.3 million in the first quarter of 2015. The decline of workforce is due to the large number of women who become housewives. Therefore, the author created a KELOR empowerment program as an effort to increase the productivity of housewives in Pulo Kelor, Banyuwangi. This activity is a community empowerment based on social planning and locality development model. Targets are 17 people of the PKK members, who were selected by the purposive sampling method. The implementation is about five months, starting from January to May 2018. The empowerment process is done by implementing seven steps of empowerment includes preparation, assessment, alternative program planning, action plan formulation, implementation, evaluation, and termination. Empowerment of KELOR successfully achieved the target of forming KELOR cadres, and 3 business units. The business units consists of groups of Moringa brownies, Moringa crackers, and Moringa pia production groups. This empowerment activity proved to be able to empower Pulo Kelor PKK women in increasing their knowledge, skills, and increasing their family income.
Consultation Intervention Rates for the Otolaryngology Service: A Large Metropolitan Hospital Experience
Authors: Mors Matt , Bohr Colin , Fozo Michael , Shermetaro Carl
Published: February 2021

CONTEXT

The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital.

METHODS

The authors performed a retrospective review of the specific types of consultations received during calendar year 2016.

RESULTS

A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen (“earwax”) removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available.

CONCLUSIONS

These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.
Osteopathic Orthopaedic Residency Selection Criteria: Program Directors’ Survey and Analysis
Authors: McDonald Michael , Khan Saad , Cabatu Clarence , Scott Fremont
Published: February 2021

CONTEXT

Orthopaedic Surgery has become one of the most competitive specialties. Each year the number of applicants is far greater than the number of available Orthopaedic residency training spots [1,2,3]. With medical schools expanding their class sizes and new medical schools opening out of proportion to the number of residency spots, the competition is becoming even more fierce [12]. There are several published articles on resident selection in allopathic orthopaedic programs [5-7]. However, there are currently no such published studies on osteopathic orthopaedic programs to our knowledge. With the AOA and ACGME merger, this topic is critical to both allopathic and osteopathic applicants alike. The goal of our study was to evaluate the resident selection criteria for osteopathic orthopaedic residency programs.

METHODS

A twenty-five-question survey was sent to all of the osteopathic orthopaedic programs in December of 2017. The most important selection factors were then calculated as a mean of all the responses and were ranked accordingly.

RESULTS

The survey was completed by 29 out of 41 program directors (71%). The most important factors in resident selection were performance during the student’s rotation at the program, formality/politeness and performance in the interview, and medical school board exam scores.

CONCLUSIONS

This study is the most comprehensive study to date on the osteopathic orthopaedic resident selection process. The results from this study will help future applicants, both MD and DO, to focus on the factors in resident selection. The results may also help programs evaluate their own selection process and make improvements.
An Evaluation of a Community Hospital’s Emergency Department Ultrasonography Processes for the Diagnosis of Acute Pediatric Appendicitis
Authors: Davis Tanner , Wisniewski Samuel J. , Suidinski Heidi , Betcher Joe
Published: February 2021

CONTEXT

Since the 1980s, the use of ultrasonography for suspected acute pediatric appendicitis has become increasingly common. Multiple studies have suggested that ultrasound of the appendix has consistently high sensitivity and specificity when the appendix can be clearly visualized. The authors’ primary objective for this study was to retrospectively evaluate their community-based healthcare system’s processes for detecting acute pediatric appendicitis using ultrasonography.

METHODS

This was a retrospective medical chart review study of data over a five-year 2014-2018 period at Mercy Health Muskegon in Muskegon, Michigan. All patients aged 3-18 years who had received an appendix ultrasound during this period were identified using the McKesson Radiology (MS) PACS-Lite computer program. Pediatric appendix ultrasound cases were collected and analyzed for sensitivity, specificity, positive predictive value, negative predictive value with 95% confidence intervals. Acute appendicitis cases had been confirmed based on pathology reports. Secondary measures including white blood cell, body mass index, and body temperature were also included in analyses.

RESULTS

In this sample, the overall sensitivity at detecting acute pediatric appendicitis using ultrasonography was relatively low at approximately 42% (95% CI: 21.1 - 66.0%). On the other hand, sample specificity was quite high at 97% (95% CI: 89.9 – 99.5%). The overall positive predictive value (PPV) was 80% (95% CI: 44.2-96.5%) and the negative predictive Value (NPV) was 86% (95% CI: 75.7-92.4%). The occurrence for false positives was 20% (95% CI: 3.5-55.8%). False negatives were 14% (95% CI: 7.6-24.3%).

CONCLUSIONS

The use of ultrasonography at the authors’ institution less often accurately identified cases of later-confirmed pediatric appendicitis compared to some earlier published studies. The authors concluded that this could be due to seeing a lower number of more complex/ambiguous cases of pediatric appendicitis or lack of hospital personnel’s pediatric-specific training and/or experience compared to specialty children’s hospitals. It is possible that imaging improvements could be achieved by either or a combination of: offering training sessions for general ultrasound technicians, offering training session for radiologists, and visiting pediatric physicians and ultrasound technicians. A valuable follow-up study would be to track anticipated improvements and lead to formulation of an acute pediatric appendicitis care protocol within the authors’ healthcare system.
A Novel ‘Train the Trainer’ Emergency Medicine Resident Point-of-Care Ultrasound Course: A Feasibility Study
Authors: Butki Nikolai , Long Jereme , Butki Andrew , Corser William
Published: February 2021

CONTEXT

A novel multi-site ‘train the trainer’ point-of-care ultrasound (POCUS) training course was designed to better meet the graduate medical education learning needs of a geographically dispersed consortium of 16 community-based Michigan emergency medicine (EM) residency programs. The specific aim of this study was to explore the feasibility of using volunteer EM physicians who were novices with ultrasound techniques as instructors for a POCUS course. Additionally, the authors evaluated the effectiveness and consistency of a POCUS course delivered over multiple sites to enhance EM residents’ ultrasound knowledge and skill acquisition.

METHODS

For the initial session, the lead instructor conducted a focused two-hour course with the novice instructors. A subsequent four-hour session was then repeated for EM residents whereby the aforementioned novice instructors provided the hands-on instruction. The residents were given 10-item pre- and 20-item post-course knowledge tests to gauge the effectiveness of the instruction model. After the course, a satisfaction survey was administered to the resident participants and a qualitative open-ended survey to the volunteer EM physicians who served as instructors.

RESULTS

Forty-two EM residents from 11 different residency programs attended at one of the three courses that were offered. After adjustments for size differences in the pre- and post-training tests, 35 (87.5%) of total sample resident learners’ scores proportionately increased from pre- to post-test scores, with five (11.9%) other residents maintaining their pre-course score levels and only two (4.8%) residents experienced a post-score decline. In addition, resident participants responded favorably to a post-course summary evaluation with an average response of 4.8 (0-5 Likert scale) demonstrating overall satisfaction with the course. In the separate qualitative survey given to instructors, comments consistently conveyed a perceived benefit for the volunteer EM physicians.

CONCLUSIONS

The evaluation of this novel model supports the feasibility of the ‘train the trainer’ program. It provides a proof of principle that train the trainer model can be implemented for POCUS training courses. Despite the small sample size, our results show an increase in the pre- to post-test scores among most participating residents. This model provides an additional option for EM residency program educators to consider when developing their POCUS training courses across multiple GME settings.
The Face of Clostriodes Difficile Infections in the Outpatient Setting
Authors: Wang Michael S , Faheem Samad , Mangio Joanna , Pham Kevin , Lloyd Daniel , Hatch-Vallier Brianna , Johnson Ewanah
Published: February 2021

BACKGROUND

It has long been well-established that Clostridiodes difficile infections (CDI) can cause severe morbidity and mortality. However, most of the literature to date has focused on hospital-diagnosed infections with less emphasis on clinic-based CDI cases. Guidelines from the 2010 IDSA/SHEA for CDI advocate for metronidazole as first-line therapy for mild to moderate CDI cases. However, the 2017 guidelines recommend oral vancomycin or fidaxomicin as first-line therapy due to their superior efficacy. Objective: The purpose of this study was to compare Clostriodes difficile infections in convenience samples of clinic vs. hospital patients.

METHODS

In 2019, a retrospective, case-controlled study was performed by the first six authors between 2015-2017 (i.e., prior to the 2017 IDSA/SHEA CDI guidelines) to compare ambulatory and hospital CDI treatment prescriptions. Analytic data included frequency of White blood cells (WBC) and creatinine collection, frequency of severe CDI cases, compliance with the 2010 guidelines, CDI recurrence, and mortality.

RESULTS

An eligible subgroup of N = 92 hospital patients at Spectrum Health Lakeland were more likely to have WBC (98.4% vs 32.6%, p<0.001) and creatinine (97.8 vs. 39.4, P < 0.001) drawn than 184 patients receiving clinic-based care. Hospital sampled patients were more likely to have severe CDI (46.7% vs 6.7%, p < 0.001). Mortality was less common in hospital patients (1.1% vs. 7.6%, p = 0.017) and the recurrence rates were similar. (21.2% inpatient vs. 28.3% outpatient, (p = 0.224).

CONCLUSIONS

Based on these results, assessment of CDI severity remains limited in the ambulatory population due to the lack of severity markers. It is unclear if this is due to lack of available laboratory resources or difference in clinical presentation. Of those sample patients who have available markers of severity, patients receiving clinic-based diagnoses were less likely assessed to have severe CDI. Keywords: Cloistriodes difficile infection, ambulatory, severity markers
Wilkie’s Weight Loss Wonder: A Case Series
Authors: Haidar Akhlema , Davies Alexandra , Hussain Afzal , Gregerson Samuel , Thammineni Dheeraj , Markus Johnathon
Published: February 2021

INTRODUCTION

Wilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described.

CASE PRESENTATION

In the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management.

DISCUSSION

Common presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary.

CONCLUSION

Therefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.
Does Peritraumatic Ketamine Reduce Symptoms of Post-Traumatic Stress Disorder?
Authors: Brodeur Jack , Mancine Ryley , Ley Alyse , Magen Jed
Published: February 2021

INTRODUCTION

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are chronic diseases which can affect patients following a severe trauma. As these patients typically first present to the emergency department, it is critical for emergency physicians to remain updated on the use of ketamine or other anesthetic agents which may impede development or reduce symptoms which may impair normal functioning. The purpose of this clinical review was is to review the literature regarding how the use of peritraumatic ketamine could decrease the incidence of ASD and PTSD. In 2019, the authors completed a MEDLINE search was performed yielding 25 articles which were initially evaluated by the first and second authors. Four articles which met inclusion criteria are discussed in this manuscript.

SUMMARY of EVIDENCE

Although two earlier research groups have found that peritraumatic ketamine administration contributed to increased symptoms of PTSD (e g., reexperiencing, dissociation, avoidance, and hyperarousal), two later studies have indicated that ketamine had no effect on PTSD development. Additionally, one 2012 study group has suggested propofol use may alleviate PTSD symptoms at six months post-trauma. Another 2017 study team found that the number of surgical procedures was directly correlated with increased PTSD development.

CONCLUSIONS

Based on the literature to date, peritraumatic ketamine does not appear to influence the prevention nor development of ASD and subsequent PTSD. More research is needed to clarify the psychopharmacologic effects of ketamine when used in the management of reactions to acute trauma experiences. Based on the results of the two later works, future research is indicated considering whether propofol may contribute to PTSD development.
Billing Implications of Emergency Medicine Resident Physicians’ Laceration Length Estimates
Authors: Sherer Joseph , Caloia Roya , Corser William D. , Tishkowski Kevin
Published: February 2021

CONTEXT

Lacerations are a common occurrence in urgent care and emergency room settings. The types of lacerations repaired in these settings range from superficial and linear to deep and stellate. Healthcare professionals are required to describe these wounds in documentation and part of that description is length. In a busy clinical setting, many providers use a visual estimation of wound length for documentation. The purpose of this exploratory pilot study was to systematically examine the factors (e.g., sex, residency year, prior laceration training) associated with overall accuracy of five laceration length estimates made on a series of five identically-marked linear dummy torso sutured lacerations by a convenience sample of Emergency Medicine (EM) resident physicians. Before the study, the authors hypothesized that laceration estimates from later-year residents and/or those with more prior laceration training would be more accurate.

METHODS

The EM residents who attended a statewide educational session were encouraged to participate in the study by independently entering information concerning their a) personal characteristics, and b) five laceration length estimates from five dummy torso sutured lacerations onto hard copy forms during break and lunch periods of the daylong conference. The use of any types of measurement devices was prohibited.

RESULTS

A total non-probability convenience sample of 107 participants (93 EM resident physicians and 14 medical student attendees) from 14 different Michigan-based EM residency programs completed a 10-item survey during the educational conference. Results for both composite and individual actual-to-estimated (AE) laceration differences varied widely within the sample, with up to 58.9% of laceration over estimates hypothetically having resulted in overbilling of payers for the laceration repair.

CONCLUSIONS

The considerable range in laceration estimates obtained from these EM clinicians indicate the complexity of attempting to estimate lacerations without measuring devices, as well as the potential for over-billing under such conditions. Larger resident samples recording laceration length estimates, with testing of potential interaction effects on AE patterns, are needed in the future to provide additional evidence concerning this aspect of EM billing.
Use of a Defibrillator Magnet to Extract Multiple Ingested Sharp Iron Objects from the Stomach at Laparotomy
Authors: Jones Mark W.
Published: February 2021

This paper describes a technique for safely removing sharp ingested ferrous-based objects from the stomach at the time of laparotomy. It consists of a case report of a patient with psychiatric issues. He presented to our emergency department on several occasions after eating multiple foreign objects. Due to the large amount of ingested items, they could not be removed via the endoscope, therefore requiring laparotomy. A serious issue presenting to the surgeon and surgical team is puncture of surgical gloves and possible injury to the operating staff’s hands during extraction of sharp objects. This technique describes using a defibrillator magnet placed into a sterile specimen bag that is then inserted into a gastrotomy incision to remove any iron-based ingested sharps. As many ingested sharps such as needles, tacks, nails, screws and pins are ferrous-based, this technique is very useful and efficient.
Examination of Resident Physician Quality Improvement/Patient Safety Project Confidence Levels from Multiple Programs
Authors: McGrail Carolyn , Urban Josie , Church Brandy , Corser William D.
Published: February 2021

CONTEXT

It is now increasingly recognized that physicians should be engaged in quality improvement/patient safety (QIPS) activities to make their patient care systems perform more reliably and safely. In order to ensure that our nation’s physicians embed this aspect of practice into their work, there also is a growing expectation for effective integration of QIPS training into graduate medical education. This exploratory pilot study was conducted to identify how residents’ personal and residency program characteristics might be related to their perceived confidence to develop and conduct prospective QIPS projects.

METHODS

A total non-probability convenience sample of 43 DO resident physicians from five residency programs (Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Psychiatry) at Authority Health were surveyed from 09/28/2015 to 01/06/2016 using online Survey Monkey software. A 38-item survey asked residents about their personal and residency program characteristics, as well as their current overall perceived confidence to develop and conduct QIPS projects.

RESULTS

Two model terms that proved non-significant during analyses were residents’ age category and year in residency training. In the final stepwise multinomial regression model, however, three covariates including: a) sex (p=0.045), b) being in a primary care residency program (p=0.038) and c) having had prior QIPS project experience (p=0.049) were each found to be statistically significant predictors of respondents’ perceived comfort level categories. Male residents and those who were in a primary care residency program (i.e., Family Medicine, Internal Medicine or Pediatrics), and/or reported having had prior QIPS project experience, reported significantly higher confidence levels.

CONCLUSIONS

Somewhat similar to earlier studies, these results suggest the need to incorporate QIPS education for resident trainees across the nation. Ideally, the findings from larger resident studies will enable GME leaders to develop and deliver evidence-based QIPS curricula that are better oriented to resident physicians’ personal characteristics and preferences.
Developmental Consequences of Restrictive Eating Disorders after Childhood Obesity: Two Case Reports
Authors: Kennedy Samantha Fugate , Krive Katherine
Published: February 2021

Although childhood overweight has been associated with an increased risk for later development of eating disorders, there has been little research indicating whether previously overweight children and adolescents have an increased risk for restrictive eating disorders such as anorexia nervosa or atypical anorexia nervosa. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines anorexia nervosa as the restriction of energy intake relative to requirements, leading to a significantly low body weight, an intense fear of gaining weight or becoming fat, and disturbance in the way in which one’s body weight or shape is experienced. In atypical anorexia nervosa, the DSM-5 specifies that all criteria for anorexia nervosa can be met for this disorder, except that after despite significant weight loss the individual’s weight is currently within or above the normal range. In treatment of these disorders, the intense fear of weight gain may be further intensified in previously obese children because they have earlier experienced the significant consequences of obesity. The purpose of this report is to present two cases of previously obese children who later developed restrictive eating disorders. These cases demonstrate how previously obese children may be at risk for restrictive eating disorders with treatment further complicated by an intensified fear of recurrent weight gain. In these cases, treatment was complicated by an intensified fear of weight gain due to the patients’ prior obesity. The mortality rate of restrictive eating disorders may be increased in previously obese children and adolescents due to delay in diagnosis and more complicated treatment, making clinician screening imperative.
A Novel Technique for the Removal of an Intramedullary Femoral Guidewire Lodged in the Femoral Canal
Authors: Kasik Conor , Rosen Michael , Sauchak John
Published: February 2021

Intramedullary nails are currently the most commonly used device for the fixation of intertrochanteric hip fractures. An initial threaded guidewire is used for localizing the site of entry and determining the final position of the fixation device. Hardware failure with guidewire breakage can complicate the procedure and lead to unplanned challenges for the surgeon. Predisposing mechanical properties of the hardware, along with technical surgical errors may lead to inadvertent breakage or migration of guidewires. The authors report a case of initial threaded starting guidewire migration into the femoral intramedullary canal with subsequent impaction into the distal femoral subchondral bone after advancement of the proximal femoral canal reamer. A method for antegrade removal of a lodged intramedullary guidewire through the distal femoral condyles is described. A set of key technical points to avoid this complication are also provided. Although guidewire migration during hip fracture surgery is a rare occurrence, it is important to recognize the technical measures that can be used to prevent this potentially devastating complication. Surgeons should be familiar with several different techniques for extraction of such hardware surrounding the hip, as there is no universally successful method.
First reported case of Lyme carditis in Southwest Michigan
Authors: Frazier Nicholas M. , Douce Richard W.
Published: February 2021

Lyme disease is the most common tick-borne infection found in the eastern United States. In recent years, it has become an emergent Michigan public health concern. Lyme carditis is a recognized rare complication which is classically characterized by rapidly fluctuating degrees of heart block. In severe cases, or if inappropriately treated, Lyme carditis can also result in profound bradycardia, perimyocarditis, and sudden cardiac death. This report describes the first documented case of third degree heart block associated with Lyme carditis to occur in Michigan. This is a retrospective case report of a patient evaluated and treated for Lyme carditis in Southwest Michigan in July, 2016. All information was obtained from either the patient or his electronic medical record. Despite initial misdiagnosis and inappropriate management, this patient ultimately received more appropriate medical therapy within 24 hours of first presentation. After eight days of high dose intravenous Ceftriaxone and supportive care, and more than two weeks of oral Doxycycline, the patient’s symptoms resolved and the disease was treated to resolution. Neither permanent nor temporary pacing was needed during/after the course of treatment. When correctly identified, Lyme disease and Lyme carditis can be easily treated. Although this patient’s history was without reported tick bite or exposure to a known host for Lyme disease, the authors believe that the patient’s history and physical exam was definitive enough to warrant the start of IV therapy with telemetry monitoring upon first presentation. The fact that the condition was not first diagnosed by providers indicates a potential gap in medical knowledge and awareness that should be addressed in clinical practice. The authors consider this case a harbinger of the emerging disease of Lyme carditis. Physical exam and EKG findings should guide clinicians’ therapeutic approaches. Although treatment with appropriate antibiotics is typically curative, therapeutic delays can lead to deadly results.
Accuracy of Patient Height, Weight and Ideal Body Weight Estimates in the Emergency Department
Authors: Boehm Kevin , Welt Cassie , Grimaldi Jeanette
Published: February 2021

CONTEXT

The purpose of this study was to establish the accuracy of emergency medicine professionals’ estimates of a sample of patients’ heights, weights and ideal body weights (IBW).

METHODS

This was a cross-sectional survey study with 69 emergency medicine professionals concerning estimates of five standardized patients. Board-certified emergency physicians, emergency medicine residents and emergency department nurses were asked to estimate patient height, weight and (IBW) by looking at a series of photographs of five standardized patients with varied body types. Repeated measure analysis of variance procedures were used to examine for estimates-to-actual measurement differences.

RESULTS

Overall height, weight and IBW estimate differences did vary significantly for the majority of the five standardized patients. Respondents’ clinical position (i.e., attending physician, resident, or nurse) and years of clinical experience did show a significant level of influence on estimate-to-actual differences for some proportion of patient estimates.

CONCLUSION

Our results support the common belief that the accuracy of overall weight and height estimates in emergency department settings is unacceptably low, and that a patient’s stated weight and height is likely to be more accurate. Further work is required in this area of emergency medicine practice since these types of inaccuracies could potentially compromise the effectiveness of therapies and treatments during emergent situations.
The Influence of Social Isolation and Medical Comorbidities on Geriatric Congestive Heart Failure Hospital Readmissions
Authors: Keyes Daniel , Sheremeta Greg , Yang Jerrit , Davis Naomi , Zhang Shiling , Boehm Kevin
Published: February 2021

CONTEXT

Social isolation and comorbidities are likely to have a significant level of influence on the healthcare use patterns of geriatric patients with ongoing congestive heart failure (CHF)-related needs.

METHODS

A retrospective study was conducted in a specialized emergency department (ED) with a sample of 286 geriatric CHF patients who initially received CHF-related care over a six-month period. Social isolation levels were assessed using a pre-existing four-point screening tool used in the study setting and composite comorbidity was gauged using the Charlson Comorbidity Index method. Subjects were categorized into either “less than 30-day readmission” or “greater than 30-day readmission/non-readmitted” sample subgroups. The setting was a single 304-bed community hospital with approximately 45,000 annual ED visits. The analytic sample was comprised of geriatric patients 65+ years of age with an ICD-9 code corresponding to CHF.

RESULTS

There were no statistically significant differences between earlier hospital readmission versus later/non-readmitted sample patients when grouped by age, race, gender or level of measured social isolation. However, composite comorbidity scores were significantly lower for patients in the >30-day/non-readmitted subgroup compared to earlier readmission patients.

CONCLUSIONS

These initial study results suggest that a larger proportion of CHF hospital readmissions may be more heavily influenced by clinical factors than social living arrangements. Future studies with larger samples and validated measures of social isolation are needed to inform the development and testing of programs for geriatric CHF patients striving to avoid unnecessary hospital readmissions and adverse health outcomes.
Robot Assisted Repair of Acquired Abdominal Intercostal Hernias (AIH)
Authors: Smith Daniel , Kulkarni Mohan , Obi Shawn
Published: February 2021

Abdominal intercostal hernia (AIH) is a rare clinical entity in which intra-abdominal visceral contents protrude through a defect between adjacent ribs. Most AIH are repaired via (an open or a laparoscopic) transabdominal approach or a thoracotomy. In this paper, the authors present two cases of AIH. Both cases of AIH developed in male patients after severe coughing episodes and demonstrated on computed tomography (CT) to include multiple abdominal viscera. In both cases, a robot-assisted laparoscopic hernia repair was performed utilizing Sepramesh and V-Lock suturing. To our knowledge, these are the first case reports of a robotic approach to repair of AIH. Both cases demonstrate the safety of this approach and expand on novel robotic approaches to ventral hernia repairs. Studies of longer term outcomes from this surgical approach are limited in the literature due to small number of cases and even fewer associated case reports.
Carbon Monoxide Poisoning: The Great Imitator
Authors: Velasquez Christopher , Patchana Tye , McParland Brian , Lovy Jonathan , Maarouf Ahmad , Whitty Christopher
Published: February 2021

Carbon Monoxide (CO) is one of the leading causes of poison deaths in the United States. Signs and symptoms are clinically variable secondary to inconsistent targeting of highly metabolic tissues by the gas. We report a case of a man in his early to mid-30’s presenting to the emergency department with mental status changes, fatigue, headache, and flu-like symptoms for three days. The patient had been working on his motor vehicles in the garage during this time, using a portable diesel powered space heater to keep warm. Subsequent neurology and cardiology workup demonstrated bilateral globus pallidus (GP) lesions on brain imaging, increased non-myocardial infarction troponin levels, carboxyhemoglobin (COHb) level of 3.8%, elevated liver enzymes, and acute kidney failure. In this setting of his delayed presentation as a smoker with carbon monoxide poisoning, carboxyhemoglobin levels alone become less reliable. This report investigates the use of bilateral GP lesions, the most frequently affected structure, as well as damage preference to highly metabolic tissues to assist in diagnosis and prognosis for CO poisoning. Our observations can be used for further study of the relationship between bilateral GP necrosis and initial presentation and outcome of patients experiencing CO poisoning leading to earlier recognition, treatment, and decreased morbidity/mortality.
Thermal Energy Produced by Medium Velocity Pistol Projectiles and the Effects on Peripheral Nerve Tissue
Authors: Colen Alexander J. , Hanson Logan F. , Frits Germaine R. , Hanson Cameron G.
Published: February 2021

CONTEXT

Sidearm pistols are more frequently involved in violent crimes due to their relatively small size and ability to be concealed. The extent to which the thermal energy released from such medium velocity pistol projectiles contributes to peripheral nerve injury requires further testing. The purpose of this paper is to describe a method to quantify how much thermal energy is released during impact of medium velocity pistol projectiles and report how thermal energy contributes to peripheral nerve injury.

METHODS

Eleven seven-centimeter segments of radial, median, and ulnar nerves were dissected from a thawed fresh frozen cadaver. The nerve segments were placed in a 10% ballistics gel block, one centimeter from the end of the block nearest the shooter. A series of 115-grain 9 mm. NATO-classified ammunitions were fired through the nerve and ballistics gel construct with a pistol. The impacts were recorded with a high-speed infrared camera and nerve samples were sent for histologic analysis by two board-certified pathologists.

RESULTS

The average velocity of the projectiles were 391m/s, 95% CI [387-395 m/s], with an average kinetic energy of 572.0 J, 95% CI [560.0-583.0J]. The average observable temperature of the ballistics gel/nerve prior to impact was 28.8°C±0.6ºC, 95% CI [26.4-30.3°C]. Average observable temperature of the surrounding ballistics gel/nerve during projectile impact was 55.1°C±2.4ºC, 95% CI [51.3- 62.1°C], yielding an average observable increase of 26.4°C±3.2ºC, 95% CI [20.2- 35.4°C]. An adjusted temperature increase was also surprisingly high 63.4°C ± 3.2, 95% CI [57.2 – 72.4ºC]. Histology reports of the impacted nerve tissue failed to show any sign of thermal or even crush injury.

CONCLUSIONS

Medium velocity handgun projectiles release a significant amount of heat energy when impacting a substance similar to human tissue. The authors’ temperature data points were greater than those previously reported to cause thermal injury to peripheral nerves. The authors’ findings suggest that nerve injury after collision with pistol projectiles may be secondary to thermal injury in addition to the classic model of concussion and penetration given our documented levels of heat generated during impact.
Endoscopic Combined Snare-Forceps Technique for Removing Flat Sessile Polyps
Authors: Jones Mark W. , Henning Werner
Published: February 2021

CONTEXT

Current endoscopes have limitations during use in polypectomies. Specifically, polyps that are flat, broad-based and sessile are more difficult to resect. Routine polypectomy procedures allow one endoscopic device to be used at a time limiting the endoscopist. More advanced scopes are not readily available at smaller community hospitals, limiting the endoscopist to using the resources available to them.

METHODS

The modification of the standard polypectomy method described here employs both an endoscopic forceps and an endoscopic snare to be used simultaneously during colonoscopy with a single lumen colonoscope. The forceps is introduced into the endoscope so the head is just projecting from the distal end of the scope. The snare is then placed just proximal to the head of the forceps outside of the endoscope. The endoscope is reinserted into the colon until the polyp is reached. Using the snare the polyp is elevated and then the snare secured around the base.

RESULTS

This resulted in easier, faster, and more complete removal of flat sessile and poorly located pedunculated polyps on the first try. This technique has been employed successfully in over 20 patients at our institution.

CONCLUSIONS

This new method adds another technique for endoscopists when presented with difficult polypectomies.
Rare Case of Olmesartan Induced Enteropathy
Authors: Handa Richa , Rahman Akhil , Kak Vivek
Published: February 2021

Olmesartan (brand name Benicar) is an antihypertensive drug clinicians commonly use to treat high blood pressure. Olmesartan induced enteropathy (OSE) is a rare entity that authors first identified in 2012. The etiological basis of OSE remains unclear, although authors have suggested that this condition could be due to alternations in cell mediated immune responses induced by the drug. The objective of the case report is to describe a patient who presented with diarrhea and was eventually diagnosed with OSE. A female patient in her later 60s presented to an emergency room after two recent hospitalizations with profound diarrhea, generalized weakness and weight loss. She underwent a diagnostic workup including endoscopy and colonoscopy. The patient’s endoscopy with duodenal biopsy revealed villous atrophy with attenuated and blunted villi with intraepithelial CD3 positive T lymphocytes, suggestive of gluten-induced enteropathy. When the patient’s symptoms did not improve after the authors placed her on a gluten free diet for a few days, they further investigated her for secretory diarrhea, including Gastrin, Somatostatin and Vasoactive Intestinal Peptide lab values that they found to be within normal limits. Due to the patient’s lack of improvement with initial treatment, the authors suspected OSE and stopped her olmesartan and the patients’ symptoms gradually improved in three weeks.