Canoe Trip

Perfect, he said as he carved his knife into the surgical wound, exposing another layer of fascia. We were standing in the operating theatre: he, the surgical chief resident, and I, a third-year medical student. It was the first of many appendectomies I would scrub in for during my surgical rotation. The patient was a I2-year-old boy who had come to the Grand Valley Hospital emergency room that day. He had a low-grade fever, sweats, and periumbilical pain that had migrated to the right lower quadrant of his abdomen. After quizzing me on various anatomical structures, removing the inflamed appendix, and closing the wound, he said, Let\u27s go finish rounds

Surgical site infection and transfusion rates are higher in underweight total knee arthroplasty patients.

BACKGROUND: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion. METHODS: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] \u3c 18.5 kg/m RESULTS: The average BMI was 17.1 kg/m CONCLUSIONS: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken

Medicare at 50: Its Effect on Disparities

This Forum presentation provides an overview of the historical impact of the Medicare with emphasis on key milestones related to reducing health disparities. Recent challenges related to ACA are also discussed. Objectives: Review the history of legislation leading to development of the Medicare program in the U.S Delineate key Medicare milestones Identify recent changes in Medicare Define the impact on disparities and quality of care Presentation: 47:48 Note: PowerPoint slides are at bottom of pag

Principles of Scalp Reconstruction

Outline of Presentation: Case Presentation Background History Anatomy Preoperative Assessment Surgical Technique Algorithm for approach to scalp defects Presentation: 41:47 Note: PowerPoint slides located at bottom of this pag

Medicare at Fifty Years: Impact on Health Care Disparities

Objectives: To review history of legislation to development of Medicare program in the United States To delineate key Medicare milestones To review recent changes in Medicare To define impact on disparities An examination of the history of Medicare and its impact on our ability to deliver patient-centered, interprofessional care. A description of global interprofessional education and practice, highlighting real world examples from the work of Partners In Health in West Africa and Haiti

Behavioral Health Models to Understand High-Risk Prenatal Patient Adherence to Visit Schedule in Camden

ABSTRACT: Introduction: Despite improvement initiatives, patient non-adherence remains an issue in healthcare. Patients with high-risk pregnancies require more frequent monitoring to reduce complications. This study aims to better understand visit non-adherence with high-risk prenatal appointments. We hypothesized that patients’ perceived logistic barriers would be the most prominent determinant of visit non-adherence. Methods: This study included adult, English speaking patients of the high-risk prenatal clinic at Cooper University Hospital that missed at least one appointment. We completed three, one hour focus groups with seven participants. Constant comparison analysis was used to determine common themes discussed by participants. Axial coding and basic unit descriptors were defined by both facilitators to determine common themes discussed during the focus group sessions. Results: We identified two main themes in regards to patient visit non-adherence in our population: logistic issues and perceived relationship issues between the patient and the care team. Logistic issues included issues with rescheduling, seeing different providers, parking, wait time and office hours. In regards to patient-care team relationships, subjects frequently brought up issues with respect, feeling heard by providers, communication and professionalism. All seven patients identified at least one of the five domains of logistic barriers as a concern. Five of the seven participants identified an issue across the four domains of relationship issues. Discussion: The focus group analysis illustrated recurrent themes of logistic barriers and deficiencies in patient-care team relationships that contributed to high-risk prenatal visit non-adherence. A follow-up survey study is necessary to quantitatively assess the most prominent reasons for visit non-adherence based on the themes identified in our study. Keywords: High-Risk Prenatal Clinic, Appointment Adherence, Health Behaviors Model, Theory of Planned Behavior, Focus Group Analysi

Carbamazepine-Associated Hyponatremia

Four cases of CBZ-induced or exacerbated hyponatremia are described in middle-aged to elderly females. Two cases are remarkable in that the pretreatment sodium levels demonstrate hyponatremia. A return to prior sodium levels was observed upon the discontinuation of carbamazepine therapy. No definitive conclusions can be drawn from these case reports; however, similarities in the cases can be examined as follows: (1) all four women have medical problems, in particular two patients had pre-existing hyponatremia; (2) all four patients were using concurrent medications; (3) all four women presented psychotic. A literature review examines risk factors, pharmacological mechanism, and the time course for CBZ-induced hyponatremia