DigitalCommons@KCU (Kansas City Univ.)
Not a member yet
2803 research outputs found
Sort by
The Perfect Storm: Takotsubo Cardiomyopathy and Electrical Storm in Patient With AIDS
No full textBackground: Patients with HIV have an increased risk of sudden cardiac death, with the highest risk in patients with a CD4 count \u3c 200. Arrhythmias are thought to be the cause of cardiac arrest in 20-47% of HIV+ patients, but the data on ventricular storm and HIV infection remains unclear.
Case: A 45 year old female with a history of HIV not on treatment presented with vomiting, diarrhea, and dizziness. Initial EKG showed diffuse ST segment elevation prompting cardiac catheterization which showed non-obstructive coronary artery disease. Echocardiogram revealed mid-to-apical severe hypokinesis of the left ventricle and basal sparing, consistent with Takotsubo cardiomyopathy (TCM). Workup was positive for enteropathogenic E. coli (EPEC). The patient developed electrical storm with numerous episodes of pulseless ventricular tachycardia requiring defibrillation. She was unresponsive to amiodarone and placed on a lidocaine drip, intubated, and sedated. Her CD4 count resulted at 25. She required inotropic and vasopressor support for cardiogenic shock. Her family later decided to pursue comfort measures and she expired six days after admission.
Decision-making: After adjusting for confounding variables, there is no difference in mortality from TCM in HIV+ patients. However, this is not true for ventricular arrhythmias. Patients with HIV are at increased risk for sudden cardiac death, and 20-47% of HIV patients who died of sudden cardiac death had pre-existing history of arrhythmias. Ventricular storm is more likely to occur in patients with underlying structural heart disease, including acute heart failure. Our patient presented with TCM secondary to fulminant EPEC infection in the setting of AIDS. The acute change in her cardiac structure with the increased risk of arrhythmias in the setting of AIDS likely precipitated electric storm and ultimately death.
Conclusion: Sudden cardiac death remains a leading cause of mortality in patients with HIV, with the highest risk with CD4 counts \u3c 200. However, this difference disappears when the CD4 count is above 500. All patients with HIV infection should be strongly encouraged to participate in HAART therapy to reduce their risk of sudden cardiac death
Inadequate Harms Reporting Among Randomized Controlled Trials Cited as Supporting Evidence in the AAOS Management of Hip Fractures in Older Adults Clinical Practice Guideline Recommendations
No full textBackground: Recommendations within clinical practice guidelines (CPGs) are heavily influenced by results from randomized controlled trials (RCTs). Therefore, it is imperative that all RCT outcomes are reported thoroughly to ensure CPGs are created using accurate information. Here, we evaluate the quality of harms reporting using the CONSORT Extension for Harms in RCTs underpinning recommendations in the American Academy of Orthopedic Surgeons (AAOS) Management of Hip Fractures in Older Adults CPG.
Methods: Each RCT cited as evidence for recommendations in the AAOS Management of Hip Fractures in Older Adults CPG was evaluated using the CONSORT Extension for Harms to determine the quality of harms reporting. Descriptive statistics (frequencies, percentages, 95 % confidence intervals) were used to summarize adherence to CONSORT Harms items. A linear regression model was used to evaluate the CONSORT Harms influence on the quality of reporting over time.
Results: Among the 156 RCTs identified, there were a total of 31,848 participants. Most RCTs were conducted at a single center (137; 87.8 %) and in a single-blind manner (130; 83.3 %). Fifty-four (34.6 %) RCTs did not provide funding statements. Trials adequately reported an average of 6.65 out of 18 CONSORT Extension for Harms items (37.0 %). One RCT adequately reported all items, while five reported zero items. Forty-seven RCTs (30.1 %) reported ≥ 50 % of items and 73 (46.8 %) reported ≤ 33.3 % of items. The linear regression model demonstrated no significant increase in mean adherence over time (adjusted R2 = -0.006; p = 0.563).
Conclusion: Our results highlight inadequate harms reporting among RCTs in the AAOS Management of Hip Fractures in Older Patients CPG. While the CONSORT Harms Extension was intended to enhance reporting, the linear regression model did not demonstrate significant improvements over time
Using Diaphragmatic Breathing to Reduce Anxiety and Improve Shooting Accuracy in the Law Enforcement Population
No full textUpholding efficient performance under stress is difficult, especially for first responders such as police officers when encountering dangerous and anxiety-provoking situations. The current research aimed to study the effects of anxiety on shooting accuracy scores. Law enforcement agencies affiliated with the Kansas City Regional Academy were recruited. They volunteered to either be in the experimental or control group, where the control group did not participate in the intervention but had their shooting scores collected. Both groups were provided and encouraged to complete a demographic questionnaire with items that ask for the number of years the participant has been on the police force, as well as the department in which they are assigned. Additionally, each participant received the State-Trait Anxiety Inventory Short-5 (STAIS-5) (Zsido et al., 2020), which measured their anxiety before the shooting examination. It was hypothesized that (1) higher scores on the STAIS-5 would be associated with lower shooting accuracy scores, (2) officers who work in the law enforcement divisions which require them to use their firearms more frequently will have higher shooting accuracy scores, and (3) lower number of years on the police force will be associated with higher shooting accuracy scores. The results of the current study indicated that shooting accuracy, within the police officer population, is greatly impacted by perceived anxiety. It was also found that experience and assigned bureau did not impact shooting accuracy scores
The Effects of a Diaphragmatic Breathing Intervention on Shooting Accuracy within a Law Enforcement Population
No full textLaw enforcement officers are held to a high standard of performance in shooting accuracy and tactical operations to ensure public safety and appropriate decision-making. In situations where acute stressors present potential danger to an individual, stress can cause maladaptive reactions due to physiological side effects. Stress can be managed effectively through stress regulation techniques such as diaphragmatic breathing. Creating additional opportunities for officers to use breathing techniques could promote adaptive cognitive functions, resulting in safer, more accurate outcomes in the field. The current research studied the effectiveness of diaphragmatic breathing on shooting accuracy within a law enforcement population. Participants engaged in a diaphragmatic breathing intervention before going onto the range to shoot for their qualifying examination. The diaphragmatic breathing intervention utilized an audio recording of simulated shooting range instructions and verbal reminders of when to use diaphragmatic breathing. It was hypothesized that (1) officers participating in the diaphragmatic breathing intervention would have higher shooting accuracy scores than the control group, (2) officers in the breathing group would have a lower frequency of failures compared to the non-breathing group, and (3) the longer officers have been on the force, the lower their shooting accuracy scores would be on their firearms qualifying examination. The results indicated that diaphragmatic breathing greatly impacts shooting accuracy among law enforcement officers. It was also found that the number of years on the force did not significantly impact shooting accuracy scores. This research aimed to enhance and contribute to training methods for shooting accuracy within the law enforcement population
A Rare Case Report of Paratesticular Leiomyosarcoma
Get PDFA leiomyosarcoma (LMS) is a malignant mesenchymal tumor of soft tissue that rarely presents in the scrotal region. This case report describes a primary paratesticular LMS originating in the dartos layer of the scrotum in a symptomatic 37-year-old male with a history of hypertension, generalized seizure disorder post-excision of meningioma, and an extensive family history of cancer. Primary paratesticular LMSs in the superficial dartos layer are exceedingly rare. Given the rarity of this particular type of LMS, this case report includes a discussion on its prevalence and incidence. The rarity of this tumor also warrants a review of the literature and related cases to inform the treatment plan and enhance understanding of these oncologic conditions
Unilateral Choanal Atresia in a Child With Prolonged Nasal Congestion
Get PDFChoanal atresia obstructs the nasal passage due to abnormal bony or soft tissue remnants owing to the faulty canalization of the nasal passages during fetal development. The clinical manifestations are more pronounced in bilateral cases, often presenting immediately after birth with cyanosis turning pink when crying, as newborns are obligatory nasal breathers. This contrasts in unilateral cases, where the condition may present with mild symptoms and be diagnosed later in life. We present a case of a five-year-old male who initially presented with a concern for nasal polyps due to nasal congestion with absent airflow out of the right nostril. On examination of the pharynx and nose, the patient was diagnosed with nasal turbinate hypertrophy, the right more than the left, and was subsequently scheduled for bilateral inferior turbinate reduction, possible adenoidectomy, and nasal endoscopy. Intraoperatively, inspection with nasal endoscopy along with the inability to pass a catheter through the nasopharynx to reach the oropharynx was our indicator of a more severe diagnosis. Here, we report an incidental finding of the right choanal atresia and seek to highlight its importance given this incidental finding
The Efficacy of Different Tenotomies in the Treatment of Lateral Epicondylitis: A Systematic Review
Get PDFBackground: Lateral epicondylitis impacts 1-3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4-11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking.
Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction.
Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications.
Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection
Pulmonary Crohn\u27s Disease Masquerading as Lymphoma
Get PDFAlthough extraintestinal manifestations of inflammatory bowel disease (IBD) are common, pulmonary IBD is extremely rare. Owing to its nonspecific clinical, radiologic, and pathologic features, pulmonary IBD is difficult to diagnose and may mimic more concerning disease processes. We present a rare case of a patient with known Crohn\u27s disease whose initial presentation was highly suspicious for malignancy before further investigation revealed pulmonary IBD
Enhancing Patient Education and Engagement Through Digital Intelligence Tools in Dermatology
Get PDFThis comprehensive digital health review examines the expanding landscape of digital intelligence tools within dermatology, specifically examining the innovative role of AI-powered applications aimed at educating and engaging patients in managing their skin health. Drawing upon a wide array of existing research, this review scrutinizes the evolution and impact of various digital tools. These include interactive apps that leverage AI algorithms to deliver tailored skincare guidance, considering factors such as skin type, concerns, and environmental factors. Additionally, the review explores the emerging use of immersive virtual reality experiences to deepen patients’ understanding of skin conditions, offering vivid simulations and educational content. These innovative approaches showcase significant promise in not only improving patient outcomes but also fostering greater treatment adherence and overall satisfaction with dermatological care. Looking ahead, future research should prioritize fine-tuning AI algorithms to further personalize patient recommendations, exploring the integration of wearable technology for real-time monitoring, and conducting longitudinal studies to evaluate the sustained effectiveness and scalability of digital intelligence tools in promoting patient education and engagement. Moreover, innovative strategies such as gamification techniques and social support platforms hold considerable potential for enhancing patient empowerment and involvement in managing their skin health. Leveraging digital intelligence tools will eventually redefine the landscape of dermatological care, empowering patients and optimizing treatment outcomes through enhanced education and engagement