The Journal of the Kentucky Medical Association
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Hypertonic sodium phosphate enemas are available for relief of constipation. They are widely used as colorectal laxatives because of their efficacy and because most patients tolerate the preparation well. Nevertheless, their use has been associated with decreases in intravascular volume as well as measurable changes in serum phosphorus and calcium levels. ⋯ Severe toxicity may occur when the osmotically active hypertonic phosphate enema is retained or when it is administered to a patient with a decreased glomerular filtration rate. We report an elderly patient with previously normal renal function who developed severe hyperphosphatemia, hypocalcemia, and cardiac arrest after the administration of hypertonic sodium phosphate enemas for the treatment of an ileus. We review the patient characteristics that increase the risk of adverse effects from hypertonic sodium phosphate enemas and emphasize the danger that moderate dehydration poses when considering the use of these cathartics.
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As medical schools across the nation consider the recent call made by the Association of American Medical Colleges to increase numbers of medical school students by 30% by 2015, it is important to explore the characteristics of the applicant pool. Understanding the make-up of the pool of recent applicants to the University of Kentucky College of Medicine can assist us in defining areas where the pool could be expanded in the future. ⋯ We will describe demographic characteristics of our applicants and matriculants with regard to gender, race and ethnicity, and international backgrounds. We will also look at factors that may discourage or dissuade prospective applicants from seeking admission to medical school including undergraduate grades, denial of the initial application to medical school, and cost considerations.
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Comparative Study
Cost-benefit analysis on the HPV vaccine in Medicaid-enrolled females of the Appalachian region of Kentucky.
The objective of this study was to determine the cost-efficiency of vaccinating against Human Papillomavirus (HPV) in Medicaid enrolled females of the Appalachian region of Kentucky (n = 49,411 females) aged 12 to 25 years, versus paying for the treatment of cervical cancer cases (n = 643 cases) within this population later in life. ⋯ Implementing a prevention plan for cervical cancer that includes annually vaccinating Medicaid-enrolled adolescent females of the Appalachian region of Kentucky against HPV infection is cost-efficient for the Medicaid system when considering the total expenditures associated with the illness. Recognition of an actual cost savings would not occur for several decades as the vaccinated population ages.
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Kentucky continues to report the highest adult smoking rates in the nation, and this persistent public health problem leads to substantial morbidity, mortality, and economic costs for the state. Given that physician intervention has been shown to increase cessation rates, the Kentucky Cancer Program developed a self-study continuing education program for physicians to promote the implementation of effective tobacco cessation treatment strategies. As a preliminary component, a pre-program survey was administered to participants to measure current knowledge, attitudes, and practices regarding the treatment of tobacco use and dependence. ⋯ They also reported implementing several of the recommended "5 A's" from the Treating Tobacco Use and Dependence: Clinical Practice Guideline. Further examination of the data, however, revealed that knowledge, attitudes, and practices were weaker regarding specific, formal, and systematic implementation of tobacco cessation treatment. Effective training and resources would provide physicians with the tools necessary to intervene with tobacco users more consistently and to reduce the health and economic burden of tobacco use and dependence in Kentucky.