Deep venous thrombosis after office vasectomy: a case report

Abstract Introduction Postoperative pulmonary embolism is considered a complication of major surgery. However, thromboembolism can also occur following minor procedures. We report a case of a major embolic event following a straightforward office vasectomy. Case presentation A healthy 35-year-old Asian man underwent an uncomplicated office vasectomy. Soon after, he noticed vague chest pain and dyspnea. Lower extremity Doppler ultrasound revealed acute venous thrombosis. A computer-assisted tomography angiogram revealed extensive bilateral pulmonary emboli. Extensive laboratory work-up failed to identify thrombophilia. He has not had any recurrences in the eight years since the initial presentation. Conclusion This case highlights that major embolic events can follow minor office procedures. Patients with suggestive findings should be investigated aggressively.http://deepblue.lib.umich.edu/bitstream/2027.42/112562/1/13256_2009_Article_1199.pd

Everyone Can Use Ramps, So Don't Forget These "Steps": Disability Accessibility at COVID-19 Vaccination Sites

The COVID-19 pandemic affected everyone around the globe, but for some the impact was drastic and even more life-threatening. People with disabilities historically struggle with health inequities and inaccessible health care, but many of these disparities are now magnified due to the pandemic. Most of the safeguards put in place by health care systems to manage the pandemic were implemented without any input or consideration from individuals with disabilities. With the arrival of COVID vaccines, health care systems and vaccine administrators have the opportunity to ensure a more inclusive and accessible vaccine rollout plan to prevent further marginalization of our largest minority group. We present our story and list simple steps to ensure that the "shots in arms" get into everyone, not just the most "able bodied."http://deepblue.lib.umich.edu/bitstream/2027.42/167171/1/AFM-203-21_PP.pdfDescription of AFM-203-21_PP.pdf : Main ArticleSEL

Guidelines for Accessible COVID-19 Testing & Vaccination Sites

Over 20% of individuals report a disability. These people often struggle with health inequities and poor health care access. Many of these barriers are addressable through simple steps. Providing an avenue for patients to communicate accessibility challenges and request accommodations prior to their appointment will help these individuals obtain their COVID-19 tests and vaccines equitably upon arrival.http://deepblue.lib.umich.edu/bitstream/2027.42/166308/1/COVID-19 Vaccination-Accessibility Guidelines for PWD Final_PP.pdfDescription of COVID-19 Vaccination-Accessibility Guidelines for PWD Final_PP.pdf : Main ArticleSEL

Candida Transmission and Sexual Behaviors as Risks for a Repeat Episode of Candida Vulvovaginitis

Objective: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. Methods: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. Results: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p ≤ 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). Conclusions: Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63382/1/154099903322643901.pd

Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/1/jgs16109-sup-0001-TableS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/2/jgs16109_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/3/jgs16109.pd

The Effect of Simulation based Training on Medical Students’ Perceptions, Knowledge, and Skill at Baseline and 6 month Follow up

The principal goal of most simulation-based learning is enhanced clinical skill, with the desired outcome being skill retention and improved performance over time. While evide nce supports simulation based training at the clerkship, graduate, and post graduate level, the evidence supporting its long term benefit at the pre clerkship level is less well established. Using quantitative methods, this research assessed the effect of skill based clinical simulation training on all second year medical students’ enrolled in two simulation courses at the University of Michigan during the 2013 2014 academic year (n=39). Pre course, post course, and 6 month follow up questionnaires were adm inistered, and analysis of variance was used to assess change in students\u27 knowledge, self reported confidence, and competency. Students in Course 1 (n=12) completed a post course and 6 month follow up skills test, and results were compared to faculty cont rols. Differences between groups were assessed using t tests. Odds ratios were calculated.Knowledge improved from pre course to post course; the gain was retained at follow up only for students in Course 1. Students perceived the courses as improving know ledge, confidence, and skill, though scores were significantly lower at follow up. For the subset of students participating in the skills test, the time to complete central line and thoracentesis at follow up did not significantly differ from post course; however, an increase was observed for lumbar puncture. Compared to faculty, students took significantly more time to complete the central line procedure. Outcomes for needle redirects and correct sequencing were mixed, with most procedures showing no signi ficant difference between measurement periods. Assessing students’ skill and the maintenance of that skill over time using objective and empirically derived measures can be challenging. The evaluation strategy described herein could be adapted to many proc edures commonly practiced within primary care and other medical specialties. Brief exposure to clinical simulation early in medical training and prior to clerkships can have a positive and lasting effecton medical students’ knowledge, confidence, and skil l for selected procedures

Analysis of a Valueâ Based Design Benefit for Rehabilitation Therapies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147227/1/pmr2s313a.pd

Establishing the First Geriatric Medicine Fellowship Program in Ghana

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/1/jgs16014.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151282/2/jgs16014_am.pd

State of research and program development for adults with hearing loss.

Hearing loss is common with a growing body of evidence of its global impact on our patient population. There remains much to learn about the mechanisms and epidemiologic, genetic, and other biobehavioral risk factors associated with hearing loss and its chronic disease sequelae, as well as how hearing healthcare, surveillance, and clinician-based training programs can best reduce the overall health burden among older individuals with hearing loss. This paper provides an update on the state of research for adults with hearing loss. The goal of the paper is to educate the reader on what is known and highlight areas where further work is still needed

Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss.

Importance: Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare. Objective: To determine whether HA use is associated with health care costs and utilization in older adults. Design, Setting, and Participants: This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated. Exposures: Encounter with the US health care system. Main Outcomes and Measures: (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits. Results: Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95$1114 to $1137) and higher out-of-pocket spending by$325 (95% CI, $322 to$326) but lower Medicare spending by $71 (95$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0). Conclusions and Relevance: This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL