Medicine and Health Sciences Commons^™

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.

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.

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 …

Subcutaneous Sarcoid Nodules: A Dermatologic Presentation Of Systemic Sarcoidosis For Primary Care Physicians, Kathryn Taylor Bs, Clayton Curry Bs, Evan Stalnaker Md, Hannah Leport Md, Morgan Stickler Md, Tammy Bannister Md

Marshall Journal of Medicine

Sarcoidosis is a multisystem granulomatous disease primarily characterized by pulmonary manifestations. Extrapulmonary involvement in sarcoidosis is well documented and common, but isolated extrapulmonary involvement is rare at around 10% of cases at the time of diagnosis. Cutaneous presentations vary significantly, with erythema nodosum being the most common. Since extrapulmonary symptoms most likely suggest systemic involvement, any way to identify sarcoidosis early is paramount. We present a case of a 63-year-old Caucasian female with multiple palpable 0.5-3cm nodules under the skin of the bilateral forearms, left hand, and lower extremities. A biopsy of a lesion revealed numerous sarcoidal phenotype granulomas without …

Transdiaphragmatic Intercostal Hernia Repair In A Patient With Previous Thoracic Surgery, Lilyan T. Starkey, Ruth P. Gerola, David A. Denning

Marshall Journal of Medicine

A transdiaphragmatic intercostal hernia (TDIH) describes the herniation of abdominal contents through diaphragm and chest wall defects. It has been documented following traumatic injuries as well as after episodes of increased thoracoabdominal pressure. However, those resulting from iatrogenic cause remain uncommon and are less often recorded. We report an iatrogenic TDIH in a patient presenting 39 days after a complicated thoracic procedure, highlighting the surgical technique used for successful hernia reduction, diaphragmatic closure, and rib re-approximation. The case reinforces the possibility of a TDIH occurring as a post-surgical complication. Surgeons should anticipate the potential development of TDIH, particularly after thoracic …

A Case Of Immune-Mediated Necrotizing Myopathy In A 75-Year-Old With Anti-Hmg-Coa Reductase Antibodies, Dylan Smith, Kassandra Flores, Adenrele Olajide

Marshall Journal of Medicine

No abstract provided.

Propofol Related Infusion Syndrome: A Subtle Adversary, Brandon Harris, Elizabeth C. Taylor, John W. Pickstone, Errington C. Thompson Md

Marshall Journal of Medicine

Propofol Related Infusion Syndrome (PRIS) was first described in 1998. It has a strange collection of symptoms, including marked bradycardia, persistent, recalcitrant metabolic acidosis, liver enlargement, rhabdomyolysis, and lipemic blood. We present two recent patients who appeared to have had PRIS. Creatinine kinase seems to be an early detector of PRIS. If PRIS is recognized early, this complex metabolic process seems to be completely reversible.

Robotic Hysterectomy: Surgical Approach And Outcomes Among A Large Institutional Cohort, Shirin Azadi, Sydney Graham, Stephen Bush, Rachel Lee, Nadim Bou Zgheib

Marshall Journal of Medicine

Introduction

The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature.

Methods

Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated.

Results

826 cases of rTLH were performed during the …

Leading Positive Change In Academia, Brad D. Smith President

Marshall Journal of Medicine

No abstract provided.

Integrating Feminist Approaches In Counseling Work With Adult Women, Kristen M. Toole

Adultspan Journal

The scope of ‘women’s issues’ in counseling is an ever-evolving landscape. Recent events such as the reversal of Roe v. Wade and the disproportionate impact of COVID-19 on women serve as powerful reminders of the necessity of this focus while underscoring a deep-rooted history of oppressive patriarchal structures. Therefore, counselors must remain informed of the unique considerations surrounding adult women in counseling and acquire proficiency in versatile techniques to meet this population’s nuanced needs. This article examines the complexity of contemporary womanhood and explores the fundamentals of Feminist Counseling Theory (FCT), a holistic, multiculturally conscious, social justice theory in counseling. …

Recognizing Ableism And Practicing Disability Humility: Conceptualizing Disability Across The Lifespan, Katherine M. Atkins, Tamekia Bell, Tilottama Roy-White, Maria Page

Adultspan Journal

Disability culture is often misunderstood by counselors who lack extensive training in working with individuals with disabilities (IWDs) (Stuntzner & Hartley, 2014). This quantitative study used the Counseling Clients with Disability Survey (CCDS) to explore the beliefs and perceived knowledge of counselors-in-training (CITs), counselors, and counselor educators regarding preparation to counsel IWDs, which is particularly important as disability status can change across the lifespan, and given that the Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards Review Committee provided a guide to the draft standards incorporating the infusion of disability concepts. Results indicate that counselors were competent …

Connecting With Clients In Later Life: The Use Of Telebehavioral Health To Address Older Adults’ Mental Health Needs, Jordan B. Westcott, Nicolette Castagna, Megan K. Baker, Jaclyn Musci, Nick Gowen, Benjamin Wiley, Benjamin Comire, Anne Patterson, Matthew C. Fullen

Adultspan Journal

Telebehavioral health offers a unique opportunity to expand access to mental health services for older clients by addressing systemic barriers that often render mental health care inaccessible in later life. Although health interventions facilitated by technology, including telebehavioral health approaches, proliferated at the start of the COVID-19 pandemic, little guidance exists for counselors seeking to provide such services to clients in later life. In this manuscript, we describe challenges accessing mental health services, how telebehavioral health services can address these barriers, and practical consideration for delivering telebehavioral health approaches for counselors who work with older clients.