Family Medicine Commons^™

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%, …

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 …

Analysis Of Blood Borne Pathogen Exposure Monitoring Protocol Adherence In An Academic Medical Center: A Seven Year Analysis And Literature Review, Natavoot N. Chongswatdi Md, Callie Seaman Md, Diane Harman Rn, Bsn, William Rollyson Md, Adam M. Franks Md

Marshall Journal of Medicine

Introduction

Health care workers (HCW) are at risk for occupational blood borne pathogen exposures (BBPE). Effective prevention and management of BBPEs relies upon reporting and post-exposure follow-up protocol adherence. As post-exposure monitoring completion is largely unexplored, seven years of a university healthcare system’s BBPE exposure data was explored and compared to documented rates.

Methods

The Marshall Health Occupational Health and Wellness division collected seven years (2012-2018) of BBPE follow-up monitoring adherence rates and demographic data. Data for HCW occupation, exposure incident, and source patient disease status were evaluated. Differences were analyzed with Chi square, Fischer Exact and logistic regression tests. …

Over-The-Counter Analgesic Use Patterns In Appalachian Older Adults, Focusing On Non-Steroidal Anti-Inflammatory Drugs, Courtney Wellman Md, Jordan Ratcliffe Bs, William Rollyson Md, Adam M. Franks Md, Mike Grome Pa-C, Robert Walker Md

Marshall Journal of Medicine

Introduction

Over-the-counter (OTC) medications are commonly used by elderly patients to self-manage pain symptoms. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and topical analgesics are readily available and therefore may seem harmless to patients. In the growing population of those 65 years and older, providers need to inquire about OTC medication use due to the increased risk for adverse reactions in this population. Complications related to these medications can be worsened by chronic disease, variable metabolism, polypharmacy, etc. which become more common in the older adults.

Methods

A survey was created to determine the prevalence and habits of OTC …

Alpha-Gal Allergy: A New Threat To Appalachia, Adam M. Franks Md, Makala Murphy Bs, Madison Griffis Md, Rebekah Franks Ba, Cwr, Colin M. Franks, Gary Petty Md

Marshall Journal of Medicine

Abstract

Alpha-gal allergy, or mammalian meat allergy, is described as the development of IgE antibodies to the oligosaccharide galactose-a-1,3-galactose following a bite from the tick species Amblyomma americanum (Lone Star tick) or Dermacentor variabillis (Wood tick). Dermatologic or gastrointestinal symptoms are usually delayed by four to six hours after exposure, making the diagnosis difficult. Due to the use of mammalian proteins in many common medications, surgical equipment and prosthesis, unexpected reactions can occur. In the United States, this pathology is predominately seen in the southeast, but has been associated with other tick species on every continent except Antarctica. As the …

Physician Burnout Among West Virginia Primary Care Providers, Kevin S. Mccann, Adam Baus, Joanna Bailey, Laura Boone, Jennifer Boyd, Martha Cook-Carter, Dan Doyle

Marshall Journal of Medicine

Introduction

Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians.

Methods

Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling.

Results

Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Diagnosis Obscured By Concomitant Recreational Drug Use, Paige Lester Ms Ii, Adam M. Franks Md, William Rollyson Ms Iv, Jenna K. Barbour Md, Matthew B. Curry Md

Marshall Journal of Medicine

Anti-NMDA receptor encephalitis (aNMDAre) is a relatively newly discovered autoimmune and inflammatory disorder affecting the limbic system. It has a clinical course that includes Prodromal, Psychiatric, Unresponsive and Hyperkinetic stages. These stages are often confused with mental health issues in the medical literature, but they also share symptoms of various drug intoxication and withdrawal states. Implicit bias in physicians regarding substance use disorder and patient demographics can impair delivery of care and outcomes in patients with aNMDAre, especially in an environment of recreational drug use. When clinical presentation aligns, this diagnosis should be investigated as soon as possible, even in …

Mr. Watson, Come Here-I Want To See You: One Rural Residency Program’S Rapid Pivot To Telemedicine During The Pandemic, William J. Crump, Diana M. Nims, Douglas J. Hatler

Marshall Journal of Medicine

Introduction

Telemedicine has been used for over a generation, but application has been limited in rural areas due to lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients.

Methods

We collected data over a four-week period in April 2020 as we transitioned to 100% telemedicine consultations. We compare that to a four-week period prior to mid-March when COVID-related shutdowns began. We collected detailed visit summaries, patient feedback, and physician feedback to compare these two periods. …

Chronic Inflammatory Demyelinating Polyneuropathy (Cidp) In A Patient With Diabetes: A Primary Care Perspective, Jordan Dever, Adam M. Franks, Laura M. Given, William Rollyson, Adrienne Mays-Kingston

Marshall Journal of Medicine

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a recurrent and progressive disease that causes proximal, symmetrical extremity weakness. The disease is diagnosed using clinical features, electrophysiologic testing, albumino-cytological disassociation in the cerebrospinal fluid, and sural nerve plexus biopsy. However, because of the low sensitivity of diagnostic criteria and other similar neuropathies, including diabetic polyneuropathy (DPN), accurate diagnosis is difficult. Differentiating between these diseases is especially important as CIDP’s changes are reversible and DPN’s are not. Making this differentiation allows for symptomatic improvement in a patient’s quality of life that would not be achieved otherwise. Early recognition and treatment, with modalities including …

Nadolol In Pregnancy: A Medical Student’S Reflection On Her Pregnancy, Rebecca King-Mallory, Shawndra Barker, Kaitlin Mcgrogan, Adam M. Franks

Marshall Journal of Medicine

Hypertension is a common concern during pregnancy. Beta-blockers are one potential treatment, but third trimester exposure has correlated with an increased risk of perinatal events. Nadolol, a nonselective beta blocker, has properties that differ from those of its selective counterparts, including longer half-life, decreased protein binding, and renal excretion in the unchanged form. There is very limited data on the use of nadolol during pregnancy, and its safety has not been completely evaluated. This case study documents the perinatal outcomes of nadolol use throughout a medical student’s pregnancy and explores the experience in obtaining and undergoing medical care.

Post-Traumatic Stress Disorder: Review Of Dsm Criteria And Functional Neuroanatomy, Cornelius W. Thomas

Marshall Journal of Medicine

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD) consist of over twenty possible symptoms that can be divided into six broad categories. These categories correlate with specific brain networks that regulate emotions, behaviors, and autonomic function. Normal functioning of these networks depends on two key regions; the prefrontal cortex and the amygdala. The prefrontal cortex provides top-down executive control over amygdala, whereas the amygdala is critical for threat detection and activation of the ‘fight or flight’ response. Events that trigger extreme and/or prolonged fear can cause persisting dysregulation within the prefrontal-amygdala circuit; resulting …

Effect Of A Brief Patient Communication Teaching On Both Attendee And Non-Attendee Family Medicine Residents., Dilip Nair, Adrienne Mays, Mohit Harsh

Marshall Journal of Medicine

Physician-patient communication skills are important for physicians to acquire. Teaching skills is thought to require attendance by learners but this is difficult in graduate medical education settings. We asked if an educational intervention on physician-patient communication was associated with a "spill-over" effect to non-attendees in the same family medicine residency program.

We surveyed residents regarding communicating instructions to patients before the intervention and one month later, regardless of their attendance. Residents’ assessment of their patients’ understanding increased significantly post-intervention only if non-attendees were included.

This pilot study suggests a beneficial “spill-over” effect to non-attendee residents that warrants further study.

Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir

Marshall Journal of Medicine

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing …

Improving The Pharmacologic Management Of Patients After Osteoporotic Hip Fractures, Joseph Klaus, Milad Modarresi, Rodrigo Aguilar, Nasreen Benhamed, Franklin D. Shuler

Marshall Journal of Medicine

Abstract

Background

Osteoporotic hip fractures have become an increasingly common healthcare burden with significant morbidity and mortality in the geriatric population. Pharmacological management of the underlying osteoporosis is critical. Our objective is to determine the percentage of patients older than 65 who receive pharmacologic treatment of osteoporosis within six months after a fragility fracture at Cabell Huntington Hospital.

Methods

Data was extracted from medical records for patients age 65 or older who sustained a hip fracture during June 2013 - March 2015. Patients who received any form of pharmacologic treatment within six months after their fractures were identified. All analyses …

When It Isn’T Always Lyme: Expanding The Differential Diagnosis For Acute-Onset Polyarthralgia In The West Virginia Eastern Panhandle, Natalie A. Moffett, Rosemarie Lorenzetti

Marshall Journal of Medicine

This case presentation discusses a 36 year-old female animal care worker presenting with an acute-onset polyarthropathy during the summer months in a Lyme endemic region. Though she appeared to be a good candidate for the diagnosis of Lyme borreliosis, her screening serology reported negative results and alternative diagnoses were considered. Her subsequent diagnosis with parvovirus B19 acts to remind the general practitioner to have confidence in the accuracy of a negative Lyme screen and, upon negative result, to expand the differential to include less common infections including parvovirus B19. It also highlights the need to remember parvovirus B19 in a …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K₂ (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation …