Medicine and Health Sciences Commons^™

Multicultural Gerotranscendence: A Theoretical Approach To Working With Older Adults, Whitney George, Danielle Schlittler

Adultspan Journal

With the growing number of the aging population, the call for counselors to understand the developmental processes of all clients is essential. The theories of gerotranscendence and multicultural counseling and therapy are central to the understanding of adult development in later life. The use of these two theories together provides a theoretical basis for counselors wishing to provide services to diverse older adults.

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Overcoming Communication Challenges: Training Family Medicine Interns Amidst Covid-19, Ny'nika T. Mcfadden, Connie C. Leeper, Catanya G. Stager, Amanda H. Wilkerson

Marshall Journal of Medicine

Introduction

Assessing and addressing possible deficiencies in medical school training is important for residency programs. Due to virtual rotations and low patient volumes, the COVID-19 pandemic disrupted medical students’ opportunities to practice patient communication. Communication skills are essential for medical students and residents. Continuous participation in communication training can increase the self-efficacy of healthcare professionals. Due to the likely impact of COVID-19, we designed and implemented a tailored workshop that focused on increasing 16 incoming family medicine interns’ level of comfort communicating with patients and their families.

Methods

Sixteen incoming family medicine interns participated in the workshop during orientation in …

A Case Of Occlusive Myocardial Infarction Caused By Nephrotic Syndrome In A 26-Year-Old Type 1 Diabetic, Kyle Admire, Charlotta Jornlid, Chelsea Ryan, Rebecca Pauly

Marshall Journal of Medicine

Nephrotic syndrome is a rare condition distinguished by proteinuria exceeding 3g per day. Other associated characteristics include hematuria, hypoalbuminemia, edema, and hyperlipidemia. There is an array of complications of this syndrome, which are primarily due to the profound losses of protein in the urine. One such complication is thromboembolism, with most documented cases in the form of venous thromboembolism of the extremities which is in part due to urinary loss of antithrombin III and increased synthesis of prothrombotic factors. There are limited available data regarding arterial thrombi and especially few reports about coronary thromboses, which can be life-threatening. In this …

Management Of Cryptogenic Stroke Secondary To Large Asd With Percutaneous Occluder Device And Antiplatelet Drugs., Riya Gupta, Naveed Iqbal

Marshall Journal of Medicine

Atrial septal defects (ASD) represent the most common congenital heart disease diagnosed in adult population and can present with variable clinical findings. Recent literature emphasizes the importance of management of ASD especially if it is associated with structural right heart changes such as RV dysfunction, right ventricular enlargement, arrythmias or paradoxical embolism.

The decision between medical therapy versus surgical closure of ASD is a common clinical conundrum especially in the setting of cryptogenic stroke.

More Physicians Alone Won’T Solve Rural America’S Health Care Problems, Atul Grover

Marshall Journal of Medicine

Policymakers have voiced their hope that locating family doctors and other primary care physicians within rural communities would, by itself, improve the health status of rural residents. However, access does not necessarily translate to better health. Rural populations face disproportionately worse health outcomes and inequities compared to urban populations. To improve the health care of rural America, it is critical to define—and periodically reassess—the problem and identify varying targeted policies.

On The Brink: Unveiling The Crisis Of Burnout Among Va Clinic Physicians, Aaron Clarke

Theses, Dissertations and Capstones

Introduction: This study investigates the significant challenge of burnout among physicians at Veterans Affairs (VA) clinics. Characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, physician burnout is a growing concern that compromises the well-being of the doctors and the quality of healthcare they provide. Recent studies have shown an alarming increase in burnout symptoms among healthcare providers, reflecting systemic issues that adversely affect patient care and the operational efficacy of healthcare institutions.

Purpose of the Study: The research aimed to dissect the intricate effects of physician burnout on medical outcomes within the VA healthcare system’s outpatient settings. …

Impact Of The Methamphetamine Epidemic On Healthcare, Amanda Brumfield

Theses, Dissertations and Capstones

Introduction: The surge in methamphetamine use in the U.S. has presented various challenges for individuals and healthcare systems. Research has shown high relapse rates, oral health issues, and increased susceptibility to blood-borne viruses among users, underscoring the gravity of the situation. Furthermore, the absence of approved pharmacological treatments and systemic barriers to effective treatment highlighted the pressing need for holistic approaches to address this epidemic successfully.

Purpose of the Study: The purpose of this research was to identify the challenges faced by treatment providers specializing in substance use disorder treatment amid rising instances of methamphetamine abuse, including managing heightened relapse …

Bridging The Gap: Evaluating The Impact Of Buprenorphine-Based Prenatal Care On Neonatal Abstinence Syndrome And Maternal Health, Whitney-Lanae Crofcheck-Glenn, Jennifer Nethercutt

Theses, Dissertations and Capstones

Introduction: Neonatal Abstinence Syndrome (NAS), now known as Neonatal Opioid Withdrawal Syndrome (NOWS) by government authorities, is a severe postnatal withdrawal condition caused by opioid exposure during pregnancy. NAS is diagnosed every 25 minutes in the United States. Medication-assisted treatment (MAT) with buprenorphine was used to treat opioid use disorder (OUD) and NAS. The MOTHER trial found that utilizing buprenorphine to treat mother OUD during pregnancy led to significant decreases in LOS and length of therapy.

Purpose of the Study: The purpose of this study is to evaluate the effectiveness of a prenatal care program that integrates buprenorphine-based Medication-Assisted Treatment …

Burnout For General Surgeons, Luke Edwards, Lindsay Mckelvey

Theses, Dissertations and Capstones

Introduction: In the healthcare sector, burnout among surgeons has emerged as a critical issue, impacting both the well-being of medical professionals and the quality outcomes of patient care. Research has consistently shown that long hours, high workloads, demanding results, and mental fatigue make physicians more vulnerable to experiencing burnout than others. Studies have revealed alarming statistical rates, with a significant percentage of surgeons reporting physical exhaustion and mental health repercussions. This trend is further enhanced by the demanding nature of the medical environment, where work-related stress and burnout have become common concerns.

Purpose of the Study: The negative effects of …

How Increased Ransomware Attacks Have Impacted Hospitals In The United States, Mackenzie Dotson

Theses, Dissertations and Capstones

Introduction: The healthcare industry, particularly hospitals, have fallen prey to the alarming rise of ransomware attacks. In recent years, highly sophisticated cybergroups, armed with substantial funds and advanced technology, have intensified their focus on hospitals. Despite the advice against it, most hospitals have paid the ransom in order to regain access to their electronic systems and patient data, underlining the severity of these attacks.

Purpose of the Study: The purpose of this research was to evaluate the effects of ransomware attacks on hospitals in the US to determine if the patients were at risk due to hackers withholding patient information …

The Benefits Of Medical Tetrahydrocannabinol On Glaucoma, Hunter Kane

Theses, Dissertations and Capstones

Introduction: This paper explores the potential therapeutic benefits of medical Tetrahydrocannabinol (THC) on glaucoma management, particularly in terms of intraocular pressure (IOP) reduction, ocular blood flow, and symptom management. Glaucoma, characterized by increased IOP and progressive optic nerve damage, is a leading cause of irreversible blindness. Current treatments focus on IOP control but may have inadequate efficacy or intolerable side effects, necessitating alternative approaches such as medical THC.

Methods: The study hypothesis posited that medical THC could significantly reduce IOP, enhance ocular blood flow, and improve symptom management in glaucoma patients. To test this hypothesis, a literature review supplemented by …

The Impact Of Telestroke Services On Diagnosis, Patient Outcomes, And Treatment, Dustin Baum

Theses, Dissertations and Capstones

Introduction: In 2011, an estimated 20% of U.S. residents lacked timely access to stroke care. As of 2019, that number plummeted to 4% of patients. A reason for this improved access was the implementation of telestroke services. Telestroke services have utilized remote stroke specialists to help guide local emergency department physicians in reviewing imaging, diagnosing, treating, or transferring patients appropriately.

Purpose: The purpose of this research was to analyze the impact of telestroke implementation in the hospital setting. The study hypothesized the implementation of telestroke services in the hospital setting maintained an accurate stroke diagnosis, decreased inappropriate hospital transfers, reduced …

Addressing Racism In Medicine With Community-Based Doula Services For Black Mothers, A Narrative Review Of The Literature And Historical Perspective, Brianna Roberts Canales, Emily Sloane

Marshall Journal of Medicine

No abstract provided.

Perceptions Of Diabetes Distress And Counseling During The Pandemic - Rural Provider Perspectives, Ranjita Misra, Brenna O. Kirk, William D. Lewis

Marshall Journal of Medicine

Introduction

West Virginia is an Appalachian rural state that ranks highest in the nation in the prevalence of diabetes (16.2%). The COVID-19 pandemic impacted routine diabetes care. As a result, individuals experienced diabetes distress over the physical and psychological burdens of diabetes management. In rural and medically underserved counties (71%), diabetes care is often provided by primary care physicians. However, healthcare providers’ perspectives on diabetes distress and related counseling to address them are unclear. This cross-sectional study’s objective was to explore healthcare providers’ (HCP) perspectives regarding their patient’s diabetes distress and how it guided their counseling for diabetes self-care during …

Enhancing The Rates Of Advance Directive Documentation To Improve The Quality Of Patient Care, Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman

Marshall Journal of Medicine

Introduction

Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.

Methods

A retrospective chart review was performed initially, after consolidation of the electronic health record (EHR) and after alteration of the EHR, to evaluate the availability of a patient’s medical power of attorney (MPOA), living will (LW), and code status.

Results

Baseline documentation of MPOA (7.33%), LW (6.00%), and code status (5.33%) within the outpatient EHR was low. After 2 cycles, this improved to 13.10%, …

Successful Surgical Outcome After Traumatic Diaphragmatic Intra-Pericardial Herniation From Blunt Abdominal Injury, Tyler Bayliss, Mark H. Cooper, Paul Bown

Marshall Journal of Medicine

Intrapericardial diaphragmatic hernia (IPDH) is a rare manifestation of non-hiatal diaphragmatic hernias (NHDH). Intrapericardial diaphragmatic hernia is defined as the prolapse of the abdominal viscera into the pericardium through the diaphragm. Their incidence has increased over the last 50-60 years, secondary to high-speed transport, and constitutes 5% of major thoracic and abdominal trauma today. These injuries can present during the initial workup or months after the initiating injury. These hernias can be caused by both blunt and penetrating trauma with concomitant central tendon rupture and pericardial laceration. We report an interesting case of intrapericardial diaphragmatic hernia with delayed presentation that …

Chronic Exertional Compartment Syndrome: A Case Report About Claudication In A Healthy Adult, Adrienne Mays-Kingston, Jeremy Eckels, Holly Farkosh, Austin Nichols, Paris Johnson, Adam M. Franks

Marshall Journal of Medicine

Claudication occurs when the blood supply is insufficient to service the musculature in the body with oxygen and metabolic waste management. A clinical complaint of claudication is commonly seen in primary care among older patients with vascular risk factors. A young and healthy patient presenting with claudication is less common and often results in delayed diagnosis with numerous extraneous diagnostic studies. This case discusses a young, healthy male patient with lower extremity symptoms that got worse with exercise and better with rest. He had normal physical exam findings leading to multiple diagnostic studies and over 12 months between the onset …

The Future Of Medicine Is Behind Us: The Case For A 1912 Case-Based Curricula, Aaron Mcguffin

Marshall Journal of Medicine

Patient outcomes continue to suffer despite exponential advances in access to medical knowledge. This requires an evaluation of the pedagogy of our medical education delivery. Case-based learning has long been shown to be an effective teaching method to improve student knowledge, student and faculty engagement, and improve patient outcomes. In order to improve patient outcomes specifically in accurate and timely diagnosis, we need to strongly consider converting our existing curricular models entirely to a case-based format.

Artificial Intelligence Is Revolutionizing Controlled Substance Diversion Detection, Brian Cox, Alberto Coustasse, Craig Kimble

Management Faculty Research

In community and institutional health care sectors, artificial intelligence (AI) use is expanding. AI is being tapped broadly in operations, customer service, and scheduling, with major pharmacy chains such as Kroger, CVS, and Walgreens, already starting to implement AI applications in their pharmacies. So far, Kroger has begun to use AI for employee onboarding and training processes, CVS is applying AI in negotiations with suppliers, and Walgreens is using it to streamline vaccine scheduling. With these advances in major pharmacy chains, the next extensive application for AI has become clearer: diversion monitoring. Diversion occurs in health care settings when a …

Management Of Asymptomatic Hypertension In The Inpatient Setting., Charles Meadows, Mehiar Elhamdani, Dial Larry, Murad Kheetan, Khaled Al-Baqain

Marshall Journal of Medicine

Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for management of such patients, aggressive blood pressure treatment, including the use of intravenous antihypertensives, is often undertaken. While evidence of benefit is lacking, emerging data suggest that treatment of asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, the intensification of a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Such a combination of a common problem with the demonstrable benefit …

Discontinuation Of Routine Postpartum Complete Blood Count In Uncomplicated Vaginal Deliveries, Tori Miller, Erin Light, Caleb Spainhower, David G. Chaffin, Jesse Cottrell

Marshall Journal of Medicine

Introduction

The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum …

Return To Activity Following Acl Reconstruction With The Fertilized Acl: A Retrospective Study., Chad Lavender, Timothy Hewett, John Johnson, Richard Peluso, Tyag Patel, Shane Taylor

Marshall Journal of Medicine

Introduction

The objective of this retrospective study is to evaluate outcomes in patients who underwent the fertilized anterior cruciate ligament (ACL) reconstruction procedure. We aim to investigate the return to previous level of activity, safety, and re-rupture rates of the ACL reconstruction augmented with bone marrow concentrate, demineralized bone matrix, autograft bone, and a suture tape (the fertilized ACL).

Methods

A comprehensive review of medical records was conducted for patients treated with the fertilized ACL (FACL). Medical records of all the patients who underwent reconstruction surgery between July 2018 and January 2021 were evaluated. The inclusion criteria for the study …

A Commonly Misdiagnosed Rare Pulmonary Disease: Idiopathic Pleuroparenchymal Fibroelastosis, Yonas Raru, Amro K. Al-Astal, Saroj Sigdel

Marshall Journal of Medicine

Awareness among clinicians about Idiopathic pleuroparenchymal fibroelastosis (PPFE) is lacking and by the time patients are diagnosed with it, they were seen by multiple physicians and misdiagnosed multiple times. It is a rare condition that is characterized by fibrosis of the pleura and subpleural lung parenchyma, predominantly affecting the upper lobes. Most common cause of fibrosis in other processes is collagen predominant but in PPFE fibrosis is usually caused by elastic fibers. Verhoeff-Van Gieson stain from lung biopsies in patients who presented with fibrosis in the upper pleural and parenchymal areas will help in establishing the diagnosis by demonstrating the …

Gateways To…Literacy: A Collaborative Effort., Anna Hughes

Marshall Journal of Medicine

No abstract provided.

Navigating The Path To Safe Compounding In Health Systems, Thomas Pile, Craig Kimble, Alberto Coustasse

Management Faculty Research

Across the country health systems are facing increasing drug shortages that are forcing pharmacists to rely far more heavily on compounding to meet the needs of patients. Additionally, several high-profile compounding incidents have helped highlight the importance of ensuring best practices are followed during sterile and nonsterile compounding to support patient safety and high-quality care. Specifically, in 2022, 160 drug shortages were reported in pharmacies. From January 1, 2023, to March 31, 2023, 47 drug shortages were reported, 55% of which were for injectables. In response, compounding has increasingly become a solution to bridge that gap.

A Rare Case Of Bilateral Synchronous Phyllodes Tumor And Triple Negative Breast Cancer, Micah Ray Md, Mary Legenza Md, Diane Krutzler Md

Marshall Journal of Medicine

Synchronous breast cancer is a rare event. The majority of cases of synchronous breast cancer will have minor differences in receptor status, but rarely different origins of the tumors. Various breast tumors can have either epithelial or mesenchymal origin and have different treatment strategies and outcomes. In the literature there is a paucity of information regarding the synchronous presentation and treatment of a triple negative invasive ductal carcinoma (TN IDC) and a malignant phyllodes tumor (mPT). This case presentation discusses a 64-year-old woman who presented with a left breast TN IDC and a right breast malignant phyllodes tumor.

Severe Pelvic Endometriosis Involving The Rectum With Near Complete Bowel Obstruction: A Case Report, Shelby Naegele, Stephen Bush Md, Paul Bown Md, Nadim Bou Zgheib Md

Marshall Journal of Medicine

Endometriosis is a common gynecological disease among reproductive-age women that can result in chronic pain, severely decreased quality of life, and infertility. We present a case of a 44-year-old female with a known history of endometriosis who presented with constipation, decreased appetite, iron deficiency anemia, and unintentional weight loss for 6 months. Investigation with colonoscopy discovered a partially-obstructing mass in her proximal rectum and no evidence of malignancy on biopsy. The mass was subsequently removed during a combined robotic-assisted total hysterectomy with bilateral salpingo-ophorectomy and low anterior resection with reanastomosis. Surgical pathology determined that the mass was consistent with endometriosis …

Eruptive Lentigines Confined To Resolving Psoriatic Plaques Following Treatment With Guselkumab, Jacob R. Kilgore Md, James C. Curry, Shane E. Cook Md

Marshall Journal of Medicine

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics⁵. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as …

B-Cell Non-Hodgkin’S Lymphoma: Viewing An Aggressive Neck Mass In An Older Adult From A Primary Care Perspective, Tanner Jeffrey Bakhshi Phd, Emily Hendricks Md, Evan Mcclanahan Md, Scott Gibbs Md, Adam Franks Md, Kathleen M. O'Hanlon Md, Vincent Graffeo Md, Jd

Marshall Journal of Medicine

Abstract

Patients with neck masses typically present to primary care providers, but most are unfamiliar with the management of aggressively expanding neck masses. With so many varied structures in the cervical region, a rapidly growing neck mass can be a diagnostic dilemma. The broad initial differential includes infectious, inflammatory, vascular, and malignant causes. When the clinical course points to an aggressive malignancy, the location of the mass helps provide the clues to the likely etiology. Potential sites of involvement include the musculature, bone, larynx, trachea, esophagus, lymph tissue and thyroid tissue. Anterior neck masses at the level the thyroid should …