Journal of the Oklahoma State Medical Association

Objective: Geographic access to primary care can be a barrier to receiving appropriate preventative services. Oklahoma has been identified as having relatively few primary care providers per capita to care for its population compared to the US. The goal of this analysis was to identify the areas in Oklahoma with significant concentrations of children under five, no pediatrician within reasonable driving distance, and whether other primary care providers are present. Methods: The 2016 American Community Survey was used to estimate the total population of children under five years of age for each Census Block Group in Oklahoma...

Importance: Oklahoma's infant mortality remains among the highest in the nation.1 Infant mortality rates are highest within the African American community.2 Physician and community partner efforts to decrease infant mortality are discussed to encourage more involvement in addressing infant mortality. The purpose of this article is to describe both provider and community-based efforts to combat infant mortality, particularly those focused on infant mortality disparities. Observations: The leading causes of infant deaths are prematurity, congenital malformations and/or chromosomal anomalies, and unclassified deaths such as Sudden Infant Death Syndrome or accidents...

Clinical Question: In adults with osteoarthritis of the knee, do conservative management methods such as weight reduction, physical therapy, Tai Chi, non-steroidal anti-inflammatory drugs (NSAIDs), and others provide more and longer pain relief and functionality of the knee, as well as overall well-being, when compared to corticosteroid knee injections? Answer: Yes. Although there are limited head-to-head trials directly comparing each alternative method to corticosteroid injections, overall evidence appears to indicate conservative methods as being more effective than injections, especially when considering long-term pain relief and functionality...

No abstract text is available yet for this article.

Delivery occurs before 37 weeks in up to 12.7 percent of all births in the United States with many more pregnant women experiencing preterm labor.1 Current therapy includes corticosteroids to hasten fetal lung development administered from 24 to 34 weeks of gestation, tocolysis, antibiotics for infections, and Group B streptococcus prophylaxis when indicated. Further study has been completed to determine risks and benefits of repeated doses of corticosteroids for women who have previously been treated but are still at risk for preterm delivery after 7 days...

While screening for dementia in patients without symptoms is not recommended by the United States Preventative Services Task Force (USPSTF), screening in those presenting with symptoms may help patients and caregivers prepare for the future. When selecting which screening tool to use in a primary care office, one needs to consider practicality, feasibility, applicability, and psychometric properties. The MIS, MiniCog, PhotoTest, and GPCOG have been found to have short administration times, good accuracy, and applicability for a broad range of patient education and backgrounds...

CLINICAL QUESTION: In menopausal women who experience regular hot flashes, does treatment with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) reduce the frequency and/or severity of hot flashes? ANSWER: Yes. Review of the literature suggests that treatment with SSRIs or SNRIs reduces the frequency and severity of hot flashes in menopausal and post-menopausal women. Studies demonstrated that paroxetine (Paxil), citalopram (Celexa) and escitolapram (Lexapro) were the most effective SSRIs, and venlafaxine (Effexor) was the most effective first line SNRI, with desvenlafaxine as a second option...

No abstract text is available yet for this article.

ANSWER: Insufficient evidence. DATE ANSWER WAS DETERMINED: June 28, 2016. PROGRAM NAME: Great Plains Family Medicine Residency Program, Oklahoma City, OK.

A 33 year-old female at 38 weeks gestation with a history of Complex Regional Pain Syndrome (CRPS) Type 1 of the upper extremities, diagnosed 13 years prior to this admission, was scheduled for an elective cesarean section (C-Section). She refused neuraxial anesthesia and requested general anesthesia. This abstract discusses the general anesthesia steps taken to pre-empt recurrence of CRPS symptoms.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

IMPORTANCE: Oklahoma has one of the highest rates of infant mortality and poor birth outcomes in the U.S., particularly among minority populations. OBJECTIVES: To describe the formation and implementation of a state-led infant mortality prevention program which sought to: educate minorities about their disproportionate risk for infant mortality; improve pregnancy, infancy, and early childhood outcomes; and prevent infant mortality. DESIGN, SETTING, AND PARTICIPANTS: Participants completed one of many community baby shower events and were evaluated pre- and post-shower on infant mortality and well-baby knowledge...

CLINICAL QUESTION: In adults and adolescents using cigarettes and/or smokeless tobacco, is motivational interviewing (MI) more effective compared to counseling, medical therapies or no intervention for improving tobacco cessation? ANSWER: yes. Evidence is modest but conclusive that using MI alone or in conjunction with other therapies results in greater rates of tobacco cessation compared to interventions that did not include MI. LEVEL OF EVIDENCE OF THE ANSWER: A. DATE SEARCH WAS CONDUCTED: September 2015...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

CLINICAL QUESTION: In non-diabetic, non-immunocompromised individuals with skin abscesses, does packing after incision and drainage (I&D) reduce the risk of recurrence or reintervention compared with not packing? ANSWER: No. If the abscess is less than 5 cm, packing does not affect outcomes. LEVEL OF EVIDENCE FOR THE ANSWER: B. DATE SEARCH WAS CONDUCTED: November 2014. INCLUSION CRITERIA: Published RCTs and meta-analysis studies. EXCLUSION CRITERIA: Abscess greater than 5 cm, abscess in diabetics, abscess in immunocompromised...

No abstract text is available yet for this article.

No abstract text is available yet for this article.