Recurrence of Ganglion Cysts Following Re-excision

Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.https://jdc.jefferson.edu/cwicposters/1032/thumbnail.jp

Easing the Pain: An Argument for Prescribing Opiates in Continuity Clinic

Continuity clinic can be painful. The patients are often non-adherent, the no-show rate is high, and the paperelectronic records hybrid system is less than ideal. Added to that is the stress of caring for patients with a variety of medical issues and the burden of being expected to prescribe opiates for them. Given all of the difficulties associated with opiate prescribing, including the potential for abuse, limited continuity with providers, and poor overall adherence to medical advice, it has been proposed that these medications should no longer be prescribed at our resident clinic, and many residents support this plan. However, implementing a blanket moratorium on opiate prescribing would violate several of the fundamental principles of our medical training. According to U.S. Food and Drug Administration data, approximately one hundred million new opiate prescriptions were written in the year 2009. Of these prescriptions, general internists were responsible for writing about fifteen percent of them, including both immediate and extended release formulations.1 So, if opiate use is so fraught with problems, why are physicians prescribing so many of them? This is likely because they are some of our most effective medicines and many of our patients need immediate relief from acute pain

Exercise Beliefs During Pregnancy in a Predominantly Low-Income, Urban Minority Population

In 2002, and reaffirmed in 2009, The American College of Obstetricians and Gynecologists recommended that healthy pregnant women exercise for at least thirty minutes most days of the week. Exercise during a healthy pregnancy is safe and has many maternal and fetal benefits. Identified benefits include management of weight gain, improvement in mood, and preparation for labor. Previous research has evaluated women’s beliefs and practices of exercise in pregnancy, but it has focused on affluent, ethnic majority populations. This survey study was performed to assess beliefs about exercise in pregnancy in a predominantly low-income, urban minority population.https://jdc.jefferson.edu/cwicposters/1031/thumbnail.jp

Hematemesis, a Distended Abdomen, and Pulseless Electrical Activity – An Unusual Presentation of Boerhaave’s Syndrome

Case Presentation An 82-year-old male with a past medical history significant for coronary artery disease with three stents placed over the last 15 months, diastolic heart failure with preserved EF, atrial fibrillation on warfarin, colon cancer status-post sigmoid resection and prostate cancer status-post prostatectomy who presented with three episodes of melena, hematemesis, and weakness. The patient was in his usual state of health prior to these symptoms. He had no history of gastrointestinal (GI) bleeding or other GI pathology and was a non-drinker and non-smoker. He denied frequent use of non-steroidal anti-inflammatory medications

Launching Virtual Care in a Benign Breast Surgery Clinic

The aim of this study is to assess the success of implementation of a telemedicine clinic in a benign breast surgery practice, and the hypothesis was that some women may feel uncomfortable virtually discussing breast complaints and problems. Twelve women seen as new patients in the benign breast surgery clinic and scheduled for surgery were asked if they were interested in having their post-operative visit performed virtually. Demographic information was also collected. Ages ranged from 24 to 77 years, and distance from the hospital ranged from 4.3 miles to 14.3 miles. Of the 12 women surveyed, 8 women were interested in the telemedicine visits. The 4 women that declined were either not active on the patient portal, not active on the computer, or without access to a computer, and their ages ranged from 52-77. The 8 women that were interested in telemedicine ranged in age from 24-67, which was a younger group overall. There was no significant difference in distance from the hospital within the two groups. Of the 8 women who were interested in telemedicine, 2 have completed the post-operative virtual visit without requiring an in-person visit and were satisfied with their virtual visits. There is an opportunity for use of telemedicine in the benign breast clinic for routine post-operative visits. The hypothesis that women would be reluctant to participate due to discomfort with discussing breast problems virtually was not demonstrated. Telemedicine visits can be an important way to personalize care for patients and increase satisfaction

Caring for AML Patients During the COVID-19 Crisis: An American and Italian Experience.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent pandemic have impacted every aspect of oncology care worldwide. Healthcare systems have been forced to rapidly change practices in order to maximize the safety of patients and healthcare providers and preserve scare resources. Patients with acute myeloid leukemia are at increased risk of complications from SARS-CoV-2 not only due to immune compromise related to the malignancy but also due to the acuity of the disease and intensity of treatment. These issues have created unique challenges during this difficult time. In this article, we present the approaches taken by two groups of hematologist/oncologists, one in the United States and one in Italy, who have been caring for acute myeloid leukemia (AML) patients in the face of the pandemic

Small bowel obstruction: a recurrence of melanoma during the second trimester of pregnancy

Background: The incidence of melanoma is on the rise in the United States and is particularly prevalent among women of childbearing age. Obtaining a complete history and understanding the unpredictable behavior of melanoma is essential to make the diagnosis of recurrent disease during pregnancy. Case: A 35-year-old G2P1 at 23 weeks and 1 days’ gestation with a remote history of (treated) cutaneous melanoma underwent an exploratory laparotomy for small bowel obstruction. Pathology was consistent with recurrent metastatic melanoma. Conclusion: Metastatic melanoma diagnosed during pregnancy is rare. There are no guidelines on how or when to proceed with treatment of metastatic disease or delivery of the fetus. Immunotherapy is changing the management of melanoma and is extending life expectancy. The significant survival benefits for mother with immunotherapy may outweigh the risks of preterm delivery for the baby

Adolescent and Young Adult Oncology Patient and Provider Perspectives in Philadelphia (AYA-4P)

Primary Objectives To assess the current perspective of AYA patients regarding medical services and psychosocial support delivered to AYAs in Philadelphia To assess the current knowledge and perspective of healthcare providers at the SKCC about the care and services needed by AYA patient

Climate Variability and Ross River Virus Transmission in Townsville Region, Australia 1985 to 1996

Background How climate variability affects the transmission of infectious diseases at a regional level remains unclear. In this paper, we assessed the impact of climate variation on the Ross River virus (RRv) transmission in the Townsville region, Queensland, north-east Australia. Methods Population-based information was obtained on monthly variations in RRv cases, climatic factors, sea level, and population growth between 1985 and 1996. Cross-correlations were computed for a series of associations between climate variables (rainfall, maximum temperature, minimum temperature, relative humidity and high tide) and the monthly incidence of RRv disease over a range of time lags. The impact of climate variability on RRv transmission was assessed using the seasonal auto-regressive integrated moving average (SARIMA) model. Results There were significant correlations of the monthly incidence of RRv to rainfall, maximum temperature, minimum temperature and relative humidity, all at a lag of 2 months, and high tide in the current month. The results of SARIMA models show that monthly average rainfall (β=0.0012, p=0.04) and high tide (β=0.0262, p=0.01) were significantly associated with RRv transmission, although temperature and relative humidity did not seem to have played an important role in the Townsville region. Conclusions Rainfall, and high tide were likely to be key determinants of RRv transmission in the Townsville region