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1.
S D Med ; 72(10): 438-441, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31816202

RESUMO

Human papillomavirus (HPV) is a sexually transmitted virus that is the leading cause of cervical cancer world- wide. It is vaccine-preventable. According to the Centers for Disease Control, only 60 percent of girls have started the HPV vaccination series countrywide and only 50 percent of boys have started. South Dakota is below this national average. In an effort to assess - and improve - HPV vaccination rates in our practice a quality improvement effort was undertaken. Two interventions were implemented a month apart: the first was a mailing to the parent(s) of all patients 11-12 years of age during the time period of the intervention; the second was an in-office reminder system for both patients and physicians at the time of an office encounter. After each of the interventions, the immunization rate for one injection was significantly greater than baseline; while slightly higher than baseline, that for those receiving both injections was not statistically different for either intervention.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Vacinação/estatística & dados numéricos , Adolescente , Criança , Medicina de Família e Comunidade , Feminino , Humanos , Imunização , Masculino , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , South Dakota , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia
2.
S D Med ; 72(4): 164-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436929

RESUMO

BACKGROUND: The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS: The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS: Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION: This quality improvement project demonstrated meaningful change with minimal financial and logistical investment and should be sustainable in the long-term.


Assuntos
Programas de Imunização/organização & administração , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Pneumonia/prevenção & controle , Idoso , Medicina de Família e Comunidade , Humanos , Vacinas contra Influenza/administração & dosagem , South Dakota , Vacinação
3.
S D Med ; 72(7): 306-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31461585

RESUMO

PURPOSE: Physician burnout is prevalent in family physicians. Burnout has been associated with an intent to leave practice location. This is especially concerning in many rural areas, which already have physician shortages. While other demographic characteristics of burnout have been assessed, no previously published studies were found that have specifically compared family physician burnout rates in rural versus metropolitan areas. We hypothesized that rural family physicians have higher burnout rates due to increased practice demands and lack of resources. METHODS: Three hundred and two graduates of a Midwest family medicine residency program were surveyed to assess burnout rates in rural (practicing in towns less than 10,000 people) versus medium-sized towns (10,000- 50,000 people) and metropolitan areas (greater than 50,000 people). Burnout was determined by a one question assessment tool that has been validated with the Maslach Burnout Inventory Emotional Exhaustion Index. FINDINGS: Ninety-nine surveys were completed. Twenty-five percent of rural respondents reported burnout, compared to 37.5 percent of respondents in medium-sized towns, and 51.4 percent of respondents practicing in metropolitan areas. These results were statistically significant (p value=0.0183). CONCLUSION: These results were unexpected and may indicate that a rural practice location has a positive effect on physician well-being, which could encourage physicians to pursue rural practice. A larger study of this issue would be beneficial.


Assuntos
Esgotamento Profissional , Médicos de Família , Esgotamento Psicológico , Humanos , Médicos de Família/psicologia , Projetos Piloto , Saúde da População Rural , População Rural
4.
S D Med ; 72(7): 322-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31461588

RESUMO

An elderly female presented to the emergency department with a two-month history of dyspnea on exertion and productive cough. Imaging revealed miliary nodular pattern involving both lungs. She underwent extensive work up evaluating different possible pathological processes. The condition was ultimately lethal. In this educational case report, we review the common - and not-so-common - etiologies that might present with this constellation of signs and symptoms, along with the diagnostic strategies and thought processes used to identify the final diagnosis.


Assuntos
Tosse , Dispneia , Idoso , Tosse/diagnóstico , Dispneia/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos
5.
S D Med ; 72(5): 214-216, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31454474

RESUMO

Cirrhosis resulting from autoimmune hepatitis is associated with an increased risk of hepatocellular carcinoma. A common treatment for autoimmune hepatitis, azathioprine, is also associated with the development of many other cancers, predominantly lymphomas. The strongest association is seen for post-transplant lymphoma and hepatosplenic T-cell lymphoma in Crohn's disease and ulcerative colitis patients; there is also an association with a variety of cutaneous malignancies. A relationship between azathioprine and sarcoma has not been demonstrated, though there have been sporadic case reports. We report here the development of leiomyosarcoma in a patient who was treated with azathioprine for autoimmune hepatitis without cirrhosis.


Assuntos
Azatioprina/efeitos adversos , Colite Ulcerativa , Doença de Crohn , Imunossupressores/efeitos adversos , Leiomiossarcoma , Azatioprina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Leiomiossarcoma/induzido quimicamente
7.
Am J Trop Med Hyg ; 101(1): 8-11, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31094312

RESUMO

The American Society for Tropical Medicine and Hygiene recently inaugurated an award for the best clinical research article published in the society's journal in the previous year. This article summarizes both the process of selecting the winner and several themes that stood out in those articles which rose to the top for consideration. Themes of note included the importance of doing clinical research outside of referral centers, the complexity that must be considered when implementing interventions, incorporation of both ends of the age spectrum into studies, and considering cost-effectiveness and opportunity cost of interventions.


Assuntos
Distinções e Prêmios , Sociedades Médicas , Medicina Tropical/tendências , Ensaios Clínicos como Assunto , Humanos , Publicações Periódicas como Assunto , Estados Unidos
8.
FP Essent ; 476: 11-17, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615405

RESUMO

Due to rapid globalization and ease of travel, mosquito-borne viral infections are now a concern for family physicians throughout the United States. Zika virus infection is one such concern. It is spread via mosquito bites or by sexual contact with an infected individual. Most patients are asymptomatic, and when symptoms occur, they are mild and nonspecific. The main concern is the potential of the infection to cause fetal anomalies. Dengue is another mosquito-borne viral infection. Symptoms of initial infection are mild, and may include arthralgias. Subsequent infection with a different serotype can cause life-threatening hemorrhagic fever or shock. Chikungunya virus infection is widespread in the Americas and symptoms are similar to those of dengue. However, it can cause a postviral chronic inflammatory rheumatism in up to half of patients. Yellow fever occurs mostly in sub-Saharan Africa and can cause hepatic failure. Encephalitis viruses, most commonly West Nile in the United States and others such as Japanese encephalitis virus, can cause neuroinvasive disease, most often in older adults. Vaccines are available for yellow fever and Japanese encephalitis viruses but the keys to prevention are insect avoidance, mosquito eradication, and use of mosquito repellants.


Assuntos
Culicidae , Dengue , Febre Amarela , Infecção por Zika virus , Animais , Dengue/diagnóstico , Dengue/terapia , Dengue/transmissão , Humanos , Estados Unidos , Febre Amarela/diagnóstico , Febre Amarela/terapia , Febre Amarela/transmissão , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/terapia , Infecção por Zika virus/transmissão
9.
FP Essent ; 476: 18-24, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615406

RESUMO

Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species) were once rare in the United States but are now common. They cause intensely pruritic lesions on areas of exposed skin. The bites are highly allergenic and can cause asthma exacerbations or anaphylaxis. Management of bedbug bites involves symptomatic relief of itching and dealing with patient anxiety. Identification and elimination of infestation are most important. Another ectoparasite of concern is lice (Pediculus and Pthirus species), which causes head, body, and pubic infestations. Patients can experience hypersensitivity to the saliva of lice, but such symptoms often do not develop until several weeks after infestation. Diagnosis involves identification of nits (ie, eggs) or lice on the skin or hair. Several pediculicides are used for management but wet combing without use of pediculicides may be more effective. A third common ectoparasitic infestation, scabies (ie, infestation with the mite Sarcoptes scabiei), affects 5% of the world's population. Patients present with pruritic lesions in skin folds, finger webs, and areas in which clothing is tight. The diagnosis can be confirmed with dermatoscopy or microscopy. Management involves use of permethrin cream, oral ivermectin, or benzyl benzoate.


Assuntos
Percevejos-de-Cama , Ectoparasitoses , Infestações por Piolhos , Ácaros , Ftirápteros , Animais , Ectoparasitoses/transmissão , Humanos
10.
FP Essent ; 476: 25-29, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615407

RESUMO

Emerging infectious diseases are those that are newly discovered, recently have increased in prevalence, or are expected to increase in prevalence in the future. Family physicians play an important role in leading community response to emerging infectious diseases. As with other types of disasters, the general approach to outbreaks has four stages: preparedness, response, recovery, and mitigation. Preparedness includes promotion of community health, maintenance of high vaccination rates, development of protocols for hospitals and family medicine practices, preparation of patients for international travel, and consideration of volunteering in case of disasters. Response includes treatment of infected patients, minimization of the risk of transmission to other individuals, education of the public, and disease reporting to local health departments. Recovery can be physical and emotional. Mitigation efforts attempt to minimize long-term effects of the outbreak and apply lessons learned to prevent or minimize the effects of similar events in the future.


Assuntos
Doenças Transmissíveis Emergentes , Doenças Transmissíveis , Surtos de Doenças , Humanos
11.
FP Essent ; 476: 30-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615408

RESUMO

Health care-associated infections (HAIs) are a major cause of morbidity and mortality, with 2 million US patients per year developing HAIs. This results in 90,000 deaths and billions of dollars in preventable expenses annually. Common HAIs include central line-associated bloodstream infection, catheter-related urinary tract infection, surgical site infection, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), methicillin-resistant Staphylococcus aureus (MRSA) infection, Clostridium difficile infection (CDI), and others. Many factors contribute to HAIs, including inadequate hand hygiene by health care workers, inappropriate antibiotic use, increasing prevalence of multidrug-resistant organisms (MDROs), suboptimal disinfection and cleaning of hospital rooms and equipment, and use of invasive medical devices. HAP and VAP together represent the most common HAIs. Control of HAIs involves high- and low-tech solutions, including pulsed xenon light as a room disinfection adjunct, improving health care worker adherence to hand hygiene and standard precautions, as well as regular cleaning of cell phones and stethoscopes. Antibiotic stewardship programs have been shown to reduce inappropriate prescribing of antibiotics, a significant contributor to MDROs and CDI. Bundled interventions to control MRSA and CDI have been effective. Artificial intelligence applications likely will be involved in identification of patients at risk of HAIs in the future.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Staphylococcus aureus Resistente à Meticilina , Pneumonia Associada à Ventilação Mecânica , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/terapia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/terapia , Humanos , Controle de Infecções , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Pneumonia Associada à Ventilação Mecânica/terapia
12.
S D Med ; 72(11): 509-512, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31985901

RESUMO

Varieties of different methods for managing the symptoms of teething are available, and are of variable efficacy and safety. This study surveyed family physicians and pediatricians in the state of South Dakota to find out what they are recommending in their current clinical practices for the relief of symptoms associated with tooth eruption. The most common recommendation given by primary care physicians was acetaminophen or ibuprofen (80 percent). The next most common recommendation was the use of teething rings, both rubber (59 percent) and cold or frozen rings (67 percent). Nearly 20 percent recommended modalities that professional organizations and governmental agencies advise against using due to the potential for significant harm.


Assuntos
Manejo da Dor , Pediatras , Erupção Dentária , Criança , Pré-Escolar , Humanos , Lactente , Dor , South Dakota , Inquéritos e Questionários
13.
S D Med ; 71(3): 112-115, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29991097

RESUMO

Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. Systemic amyloidosis usually involves multiple organs, with kidneys being the most common organ involved, followed by the heart. In general, the presentation of hepatic amyloidosis varies with minimal or no symptoms commonly seen. Hepatic amyloidosis is rarely associated with multiple myeloma. We report here a case of portal hypertension, ascites, and severe intrahepatic cholestasis as the initial presentation of hepatic amyloidosis and multiple myeloma, which followed a rapidly progressive clinical course.


Assuntos
Colestase Intra-Hepática/etiologia , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Falência Hepática/etiologia , Mieloma Múltiplo/complicações , Evolução Fatal , Humanos , Hipertensão Portal/etiologia , Hepatopatias/complicações
14.
S D Med ; 71(5): 222-223, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29999609

RESUMO

BACKGROUND: Kpa (KEL3, Penney) is a red blood cell antigen within the Kell system, first described in 1957, that occurs in less than 2 percent of the population. Although anti-Kpa antibodies were identified in 2-5 percent of those with alloantibodies among patients requiring chronic transfusion, only five previously published case reports of anti-Kpa reactions were identified. CASE REPORT: Reported here is a case of an elderly female who experienced an acute hemolytic transfusion reaction due to this antigen. Following initiation of blood transfusion, she experienced a sudden onset of rigorous chills, accompanied by elevated temperature, tachycardia, and hypertension. Laboratory studies showed uremia, elevated creatinine, positive direct Coomb's, and low haptoglobin. Serology revealed anti-Kpa antibody. CONCLUSION: This report is only the sixth, to our knowledge, of a significant reaction attributable to anti-Kpa and only the second of an acute hemolytic reaction associated with it. It serves as a reminder of the potential of low incidence antigens causing severe reactions; this potential should be considered when evaluating acute hemolytic reaction.


Assuntos
Incompatibilidade de Grupos Sanguíneos , Hemólise/imunologia , Reação Transfusional/imunologia , Idoso , Feminino , Humanos , Isoanticorpos
15.
S D Med ; 70(11): 514-516, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29088524

RESUMO

The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência/organização & administração , Desenvolvimento de Programas , Saúde da População Rural , Acreditação , Medicina de Família e Comunidade/organização & administração , Humanos , South Dakota
16.
S D Med ; 70(9): 410-414, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28863253

RESUMO

In addition to being a nuisance, ticks can carry disease. This article presents a brief review of ticks and associated tick-borne disease relevant to South Dakota and surrounding regions. Tick-borne diseases of special relevance in South Dakota include tularemia, Rocky Mountain spotted fever, and Lyme disease. A number of others may also be encountered in the state as well. Prompt treatment of suspected cases is important to ensure a successful recovery, and tick-avoidance measures can reduce the risks of acquiring them. Most of these conditions are nationally reportable infectious diseases.


Assuntos
Doenças Transmitidas por Carrapatos , Carrapatos , Animais , Doença de Lyme/etiologia , Febre Maculosa das Montanhas Rochosas/etiologia , South Dakota , Tularemia/etiologia
17.
S D Med ; 70(4): 173-175, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28813734

RESUMO

An estimated 5.3 million Americans had Alzheimer's disease in 2015. With the aging population and rapid rise in those with dementia, it is vital to not only care for the dementia patient, but also his or her primary caregiver. Caregivers often suffer from depression and neglect their own health in order to care for their loved one. In this regard, included is a review of the role of the primary care physician including the importance of discussing the diagnosis of dementia with the patient and family, providing supportive services and resources, as well as the challenges that many physicians face in tackling the care of a dementia caregiver.


Assuntos
Cuidadores/psicologia , Demência/psicologia , Atenção Primária à Saúde , Apoio Social , Estresse Psicológico/prevenção & controle , Humanos , Papel do Médico , Relações Profissional-Família , Estresse Psicológico/etiologia
18.
S D Med ; 70(6): 253-261, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28813761

RESUMO

BACKGROUND: Although the burden of infectious diseases has decreased dramatically due to advances in health care, disease prevention and numerous public health efforts and innovations, zoonotic diseases continue to pose a problem in terms of both existing and emerging diseases. These risks are of particular concern in rural areas, in which there is more contact with animals for occupational and recreational purposes. As a rural and agricultural state, South Dakota has a large percentage of its population at risk of exposure to zoonotic diseases through their substantial contact time with animals. METHODS: De-identified data from the South Dakota Department of Health containing the variables and diseases of interest from the time period of 2010-2014 was obtained. From this data were calculated the incidence rates by county, and seasonal and demographic patterns of the diseases were plotted. RESULTS: The incidence of disease in South Dakota were higher than the national rates for campylobacteriosis (threefold), cryptosporidiosis (sixfold), enterohemorrhagic E. coli (fourfold), Q fever (tenfold), salmonellosis (1.2-fold), and tularemia (14-fold). Only listeriosis had a lower incidence than the national rate among zoonoses included in this study. Seasonality of campylobacteriosis in the state was earlier in the year than is reported for the disease nationally. CONCLUSION: Zoonotic infections are a substantial threat to health in South Dakota. There is a need to develop collaboration between healthcare providers, public health professionals, livestock producers, veterinarians, and sportsmen to develop a strategy to address this issue.


Assuntos
Infecções Bacterianas/epidemiologia , Zoonoses/epidemiologia , Animais , Estudos Epidemiológicos , Escherichia coli , Humanos , Saúde Pública , South Dakota/epidemiologia , Zoonoses/microbiologia
19.
S D Med ; Spec No: 37-41, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28817861

RESUMO

Population health management (PHM) is a new health care model being implemented. It has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." This includes health outcomes and patterns of health determinants, and policies and interventions that link these two. Moving from a fee-for-service payment system to a quality- or value-based system, this model places on the clinician more responsibility for the costs of health care and its reimbursements. Screening for disease is an area that could benefit from PHM. Electronic health records (EHRs) employ algorithms to capture PHMrelated data such as diagnostic codes, clinical quality indicators, and other parameters useful in identifying those for whom screening is appropriate and in monitoring the efficacy at implementing the screening in the clinic's population. Registries of patients at risk for a variety of diseases are created in the EHR, and these patients can be notified to visit with their clinician for a shared decision-making conversation about the screening. PHM requires a team approach to input, analyze, and implement this data. The physicians must be the driving force behind population health, but advanced practice clinicians, nurses, case managers, quality coordinators, information technology support, and many others collaborate to make this successful.


Assuntos
Detecção Precoce de Câncer , Disparidades em Assistência à Saúde/organização & administração , Administração dos Cuidados ao Paciente , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Registros Eletrônicos de Saúde , Humanos , Modelos Organizacionais , Inovação Organizacional , Administração dos Cuidados ao Paciente/economia , Administração dos Cuidados ao Paciente/métodos , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
20.
S D Med ; Spec No: 47-53, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28817863

RESUMO

Diabetes mellitus (DM) is increasing in prevalence nationwide and in South Dakota, with an especially high prevalence in its American Indian population. Screening is not recommended for type 1 DM, but is for type 2 DM and pre-diabetes in certain populations. Fasting glucose, two-hour glucose tolerance test, or hemoglobin A1c are appropriate screening options. Treatment can include diabetic self-management education programs and medications. In addition to glycemic control, other cardiovascular risk factors must be reduced in these patients and specific testing and consultations should be performed to detect complications such as nephropathy or retinopathy. Along with routine age-appropriate immunizations, most diabetic patients should receive the pneumococcal polysaccharide vaccine (PPSV-23), influenza, and the hepatitis B series. Progression from pre-diabetes to type 2 DM can be prevented or delayed in some patients through lifestyle interventions and/or metformin. The South Dakota Diabetes Coalition (www.sddiabetescoalition.org) is an excellent resource for clinicians and patients.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Teste de Tolerância a Glucose/métodos , Hemoglobina A Glicada/análise , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Programas de Rastreamento/métodos , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/terapia , Prevalência , Serviços Preventivos de Saúde/organização & administração , Fatores de Risco , Autogestão/métodos , South Dakota/epidemiologia
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