Missouri Medicine

No abstract text is available yet for this article.

No abstract text is available yet for this article.

In the era of targeted treatments based on next generation sequencing (NGS) analysis, clinicians must be diligent in aligning patients with treatments giving them the best chance of survival while weighing the risk of toxicity caused by agents targeting specific gene mutations. In this case, we describe a patient with Epidermal Growth Factor Receptor (EGFR) exon 20 insertion mutation positive recurrent lung adenocarcinoma who received amivantamab and experienced severe dermatologic toxicity.

The pyramidalis muscle (PM) is an abdominal muscle with unclear function. The current study determined the presence of the PM in Midwestern American cadavers. Of 33 cadavers, 22 had bilateral PM (12 [54.5%] female, 10 [45.5%] male). Overall, variation was observed in PM measurements with a mean length of 1.7 inches, and a mean width of 0.3 inches. Results highlight variations in the presence and morphometric characteristics of the PM, suggesting underlying clinical implications.

Awareness with recall is an uncommon but potentially devastating neurological complication following perioperative care. End-tidal anesthetic gas concentration alarms can supplement usual care to reduce risk. Processed electroencephalographic (EEG) measures provided by depth-of-anesthesia monitors may be helpful, particularly for high-risk patients. Interpretation of EEG waveforms may supplement these processed EEG metrics to minimize risk of awareness with recall.

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Physician-mentored patient rounds (PMPR) were used to assess diagnostic accuracy and treatment plans of preclinical medical students. During 4 PMPR sessions, students gathered patient history, observed a physical exam, analyzed diagnostic tests, and developed treatment plans for a patient with chronic obstructive pulmonary disease. Of 470 students, 99.4% correctly diagnosed the patient. Nearly 78% prescribed long-acting beta-agonists or long-acting muscarinic antagonists. Most included appropriate pharmacologic treatments...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The optimal dose of physical activity and best types of exercise for improving cardiovascular (CV) durability and optimizing longevity are unknown. The purpose of this article is to review the recent literature on the effects of duration and intensity of exercise, physical fitness, and specific types of training/sports on long-term CV health and life expectancy. A systematic review of recent studies (2011 to 2022) was conducted using PubMed. Studies were included if they addressed the topic of fitness and/or exercise dose/type and CV health and/or life expectancy...

Biomechanically, the patellofemoral joint is one of the most complex human articulations and a common source of pain for active adults and adolescents, particularly females.1-4 Patellofemoral disorders account for 20%-40% of all knee problems seen in family practice, sports medicine, and orthopedic clinics.1, 3-5.

This study evaluated advanced pulmonary ultrasonography training for COVID-19 lung examination. Students completed identical pretests and post-tests and a survey. Changes were found for individual questions and overall scores (all P≤.02), specifically image identification, previous material, and COVID-19 questions. Students were receptive to the training for education and future practice (P<.001), and they felt capable using ultrasound for diagnosis and management of COVID-19 patients. Pulmonary ultrasonography training should be considered for the medical school curriculum...

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Understanding which tick species Missourians interact with and where exposures occur can help prevent and diagnose tickborne diseases. A statewide survey of ticks and tickborne pathogens was conducted using citizen science. Missourians submitted 12,819 ticks from April-December 2021. In total, 71% of ticks were Amblyomma americanum, and 89% were collected from a person or a pet. These preliminary data provide tick distributions at the county level and identify patterns of direct tick exposure to humans.

The Agency for Healthcare Research and Quality (AHRQ) report "Diagnostic Errors in the Emergency Department" generated significant mass media interest with negative implications for the safety of contemporary emergency care. The assumptions and methodology underlying this report are problematic, while multiple ongoing efforts to improve the quality and quantity of diagnostic research are missed, neglected, or ignored. The AHRQ report identifies reasonable target diseases for targeting diagnostic quality improvement efforts, as well as viable methods by which to measure any initiatives impact on diagnostic error...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The COVID-19 pandemic challenged physicians in academic medicine and clinician-educators in the classroom and at the patient bedside. Medical educators had to pivot overnight-adaptability was essential to providing quality medical education despite government shut-downs, accrediting body recommendations, and institutional limitations on clinical rotations and in-person meetings. Academic institutions faced multiple challenges in making the switch from in-person teaching to online learning. Through those challenges, many lessons were learned...

BACKGROUND: Next generation sequencing (NGS) has become standard practice for identification and treatment of targetable driver mutations in advanced cancer. However, NGS interpretation of clinical applicability can be challenging to clinician, with potential impact on patient's outcome. Specialized precision medicine services are poised to bridge this gap by creating collaborative frameworks to formulate and deliver genomic patient care plans. METHODS: Saint Luke's Cancer Institute in Kansas City, Missouri, (SLCI) instituted the Center for Precision Oncology (CPO) in 2017...

Missouri's dramatic rise in fentanyl-related overdoses was reported in Part I of this two-part series. In Part II, we report that previous efforts to combat the surge in illicit fentanyl supply from China failed, as Chinese factories shifted production to basic fentanyl precursor chemicals, known as dual-use pre-precursors. Mexican drug cartels now synthesize fentanyl from these basic chemicals and have overpowered the Mexican government. All efforts to reduce the fentanyl supply appear to be failing. Missouri has implemented harm reduction methods: training first responders and educating people who use drugs in safer practices...