South Dakota medicine : the journal of the South Dakota State Medical Association, 2019
Human papillomavirus (HPV) is a sexually transmitted virus that is the leading cause of cervical ... more Human papillomavirus (HPV) is a sexually transmitted virus that is the leading cause of cervical cancer world- wide. It is vaccine-preventable. According to the Centers for Disease Control, only 60 percent of girls have started the HPV vaccination series countrywide and only 50 percent of boys have started. South Dakota is below this national average. In an effort to assess - and improve - HPV vaccination rates in our practice a quality improvement effort was undertaken. Two interventions were implemented a month apart: the first was a mailing to the parent(s) of all patients 11-12 years of age during the time period of the intervention; the second was an in-office reminder system for both patients and physicians at the time of an office encounter. After each of the interventions, the immunization rate for one injection was significantly greater than baseline; while slightly higher than baseline, that for those receiving both injections was not statistically different for either int...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
In addition to being a nuisance, ticks can carry disease. This article presents a brief review of... more In addition to being a nuisance, ticks can carry disease. This article presents a brief review of ticks and associated tick-borne disease relevant to South Dakota and surrounding regions. Tick-borne diseases of special relevance in South Dakota include tularemia, Rocky Mountain spotted fever, and Lyme disease. A number of others may also be encountered in the state as well. Prompt treatment of suspected cases is important to ensure a successful recovery, and tick-avoidance measures can reduce the risks of acquiring them. Most of these conditions are nationally reportable infectious diseases.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Splenomegaly is an unusual finding among North Americans, but is commonly seen in many parts of t... more Splenomegaly is an unusual finding among North Americans, but is commonly seen in many parts of the world. Increasingly, it can be encountered locally among recent immigrant and refugee populations. A broad differential diagnosis is required. We report the case of a 33-year-old refugee with multiple potential causes for splenomegaly. Empiric treatment of one of the infectious contributors to his splenomegaly resulted in a significant improvement of his quality of life, illustrating the importance of a thorough evaluation of potential causes of splenomegaly, especially in refugee and immigrant populations.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2016
A number of chronic viral infections require special attention during pregnancy in the prenatal, ... more A number of chronic viral infections require special attention during pregnancy in the prenatal, perinatal and postnatal periods. In many rural areas of South Dakota, these conditions are present, but readily-accessible subspecialty consultation is not. Fortunately, most aspects of management of these conditions in pregnancy are easily within the scope of practice of primary care physicians. This paper presents a review of the management of pregnancies complicated by HBV, HCV, HIV, HPV and HSV, offering a quick-reference guide for physicians who may infrequently encounter these patients as a part of their practices.
Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompr... more Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompromised individuals. In reported cases of immunocompetent patients infected with this organism, it is seen exclusively in the context of polymicrobial infections. We report here the case of an abscess in an immunocompetent patient that grew out L. adecarboxylata as a pure culture. The limited literature available on this organism is reviewed, and the potential implication of this finding is discussed.
Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural... more Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural areas and was expanded to some cities about 10 years ago. Different studies reported different challenges associated with the efficacy of human resources and their training or educational program. Objectives: This systematic review of the literature was conducted to comprehensively identify and collate the challenges associated with the education of family physicians in Iran. Evidence Acquisition: All published articles related to FPP in Iran were the subject of this study. The eligibility criteria included original articles, case studies, and reports published in English or Persian during 2011 - 2021 related to the challenges in the training and educational system of FPP in Iran. Data were extracted based on the SPIDER (sample, phenomenon of interest, design, evaluation, research type) technique and were reported based on the structure of PRISMA (preferred reporting items for systemati...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Diabetes mellitus (DM) is increasing in prevalence nationwide and in South Dakota, with an especi... more Diabetes mellitus (DM) is increasing in prevalence nationwide and in South Dakota, with an especially high prevalence in its American Indian population. Screening is not recommended for type 1 DM, but is for type 2 DM and pre-diabetes in certain populations. Fasting glucose, two-hour glucose tolerance test, or hemoglobin A1c are appropriate screening options. Treatment can include diabetic self-management education programs and medications. In addition to glycemic control, other cardiovascular risk factors must be reduced in these patients and specific testing and consultations should be performed to detect complications such as nephropathy or retinopathy. Along with routine age-appropriate immunizations, most diabetic patients should receive the pneumococcal polysaccharide vaccine (PPSV-23), influenza, and the hepatitis B series. Progression from pre-diabetes to type 2 DM can be prevented or delayed in some patients through lifestyle interventions and/or metformin. The South Dakota...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2019
BACKGROUND The Sioux Falls Family Medicine Residency serves a large non-English speaking and low ... more BACKGROUND The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION This quali...
Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species... more Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species) were once rare in the United States but are now common. They cause intensely pruritic lesions on areas of exposed skin. The bites are highly allergenic and can cause asthma exacerbations or anaphylaxis. Management of bedbug bites involves symptomatic relief of itching and dealing with patient anxiety. Identification and elimination of infestation are most important. Another ectoparasite of concern is lice (Pediculus and Pthirus species), which causes head, body, and pubic infestations. Patients can experience hypersensitivity to the saliva of lice, but such symptoms often do not develop until several weeks after infestation. Diagnosis involves identification of nits (ie, eggs) or lice on the skin or hair. Several pediculicides are used for management but wet combing without use of pediculicides may be more effective. A third common ectoparasitic infestation, scabies (ie, infestation wi...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2018
Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. S... more Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. Systemic amyloidosis usually involves multiple organs, with kidneys being the most common organ involved, followed by the heart. In general, the presentation of hepatic amyloidosis varies with minimal or no symptoms commonly seen. Hepatic amyloidosis is rarely associated with multiple myeloma. We report here a case of portal hypertension, ascites, and severe intrahepatic cholestasis as the initial presentation of hepatic amyloidosis and multiple myeloma, which followed a rapidly progressive clinical course.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 addition... more The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Although the burden of infectious diseases has decreased dramatically due to advances in health c... more Although the burden of infectious diseases has decreased dramatically due to advances in health care, disease prevention and numerous public health efforts and innovations, zoonotic diseases continue to pose a problem in terms of both existing and emerging diseases. These risks are of particular concern in rural areas, in which there is more contact with animals for occupational and recreational purposes. As a rural and agricultural state, South Dakota has a large percentage of its population at risk of exposure to zoonotic diseases through their substantial contact time with animals. De-identified data from the South Dakota Department of Health containing the variables and diseases of interest from the time period of 2010-2014 was obtained. From this data were calculated the incidence rates by county, and seasonal and demographic patterns of the diseases were plotted. The incidence of disease in South Dakota were higher than the national rates for campylobacteriosis (threefold), cr...
Hereditary haemochromatosis is associated with increased susceptibility to some infections. We re... more Hereditary haemochromatosis is associated with increased susceptibility to some infections. We report here a case of Q fever in a patient with coexistent haemochromatosis. The literature is reviewed in regard to the effect of haemochromatosis on susceptibility to infectious disease in general and Q fever in particular. Although there is documented increased risk in these patients for some infectious conditions, a specific association with Q fever has not been previously reported. The present report raises the possibility of such a clinically relevant connection.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2019
Human papillomavirus (HPV) is a sexually transmitted virus that is the leading cause of cervical ... more Human papillomavirus (HPV) is a sexually transmitted virus that is the leading cause of cervical cancer world- wide. It is vaccine-preventable. According to the Centers for Disease Control, only 60 percent of girls have started the HPV vaccination series countrywide and only 50 percent of boys have started. South Dakota is below this national average. In an effort to assess - and improve - HPV vaccination rates in our practice a quality improvement effort was undertaken. Two interventions were implemented a month apart: the first was a mailing to the parent(s) of all patients 11-12 years of age during the time period of the intervention; the second was an in-office reminder system for both patients and physicians at the time of an office encounter. After each of the interventions, the immunization rate for one injection was significantly greater than baseline; while slightly higher than baseline, that for those receiving both injections was not statistically different for either int...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
In addition to being a nuisance, ticks can carry disease. This article presents a brief review of... more In addition to being a nuisance, ticks can carry disease. This article presents a brief review of ticks and associated tick-borne disease relevant to South Dakota and surrounding regions. Tick-borne diseases of special relevance in South Dakota include tularemia, Rocky Mountain spotted fever, and Lyme disease. A number of others may also be encountered in the state as well. Prompt treatment of suspected cases is important to ensure a successful recovery, and tick-avoidance measures can reduce the risks of acquiring them. Most of these conditions are nationally reportable infectious diseases.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Splenomegaly is an unusual finding among North Americans, but is commonly seen in many parts of t... more Splenomegaly is an unusual finding among North Americans, but is commonly seen in many parts of the world. Increasingly, it can be encountered locally among recent immigrant and refugee populations. A broad differential diagnosis is required. We report the case of a 33-year-old refugee with multiple potential causes for splenomegaly. Empiric treatment of one of the infectious contributors to his splenomegaly resulted in a significant improvement of his quality of life, illustrating the importance of a thorough evaluation of potential causes of splenomegaly, especially in refugee and immigrant populations.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2016
A number of chronic viral infections require special attention during pregnancy in the prenatal, ... more A number of chronic viral infections require special attention during pregnancy in the prenatal, perinatal and postnatal periods. In many rural areas of South Dakota, these conditions are present, but readily-accessible subspecialty consultation is not. Fortunately, most aspects of management of these conditions in pregnancy are easily within the scope of practice of primary care physicians. This paper presents a review of the management of pregnancies complicated by HBV, HCV, HIV, HPV and HSV, offering a quick-reference guide for physicians who may infrequently encounter these patients as a part of their practices.
Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompr... more Leclercia adecarboxylata is a rarely reported human pathogen, most commonly affecting immunocompromised individuals. In reported cases of immunocompetent patients infected with this organism, it is seen exclusively in the context of polymicrobial infections. We report here the case of an abscess in an immunocompetent patient that grew out L. adecarboxylata as a pure culture. The limited literature available on this organism is reviewed, and the potential implication of this finding is discussed.
Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural... more Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural areas and was expanded to some cities about 10 years ago. Different studies reported different challenges associated with the efficacy of human resources and their training or educational program. Objectives: This systematic review of the literature was conducted to comprehensively identify and collate the challenges associated with the education of family physicians in Iran. Evidence Acquisition: All published articles related to FPP in Iran were the subject of this study. The eligibility criteria included original articles, case studies, and reports published in English or Persian during 2011 - 2021 related to the challenges in the training and educational system of FPP in Iran. Data were extracted based on the SPIDER (sample, phenomenon of interest, design, evaluation, research type) technique and were reported based on the structure of PRISMA (preferred reporting items for systemati...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Diabetes mellitus (DM) is increasing in prevalence nationwide and in South Dakota, with an especi... more Diabetes mellitus (DM) is increasing in prevalence nationwide and in South Dakota, with an especially high prevalence in its American Indian population. Screening is not recommended for type 1 DM, but is for type 2 DM and pre-diabetes in certain populations. Fasting glucose, two-hour glucose tolerance test, or hemoglobin A1c are appropriate screening options. Treatment can include diabetic self-management education programs and medications. In addition to glycemic control, other cardiovascular risk factors must be reduced in these patients and specific testing and consultations should be performed to detect complications such as nephropathy or retinopathy. Along with routine age-appropriate immunizations, most diabetic patients should receive the pneumococcal polysaccharide vaccine (PPSV-23), influenza, and the hepatitis B series. Progression from pre-diabetes to type 2 DM can be prevented or delayed in some patients through lifestyle interventions and/or metformin. The South Dakota...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2019
BACKGROUND The Sioux Falls Family Medicine Residency serves a large non-English speaking and low ... more BACKGROUND The Sioux Falls Family Medicine Residency serves a large non-English speaking and low socioeconomic status population. We designed a quality initiative to increase influenza and pneumonia vaccination rates in our elderly patients. METHODS The main components of the project included improved clinic workflow, physician and staff education, and heightened patient awareness of vaccination importance. For the latter, we employed posters with key points about why patients should receive the vaccines, and personalized handouts with a photo of their provider discussing the importance of receiving these vaccines. The handouts were translated into the four most common non-English languages served by our clinics. RESULTS Following implementation of the initiative, influenza vaccination rates increased from 35 to 53 percent, PPSV23 vaccination rates increased from 62.5 to 64 percent, and most impressively, PCV13 vaccination rates increased from 40 to 60 percent. CONCLUSION This quali...
Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species... more Bedbugs, mites, and scabies are ectoparasites that commonly affect humans. Bedbugs (Cimex species) were once rare in the United States but are now common. They cause intensely pruritic lesions on areas of exposed skin. The bites are highly allergenic and can cause asthma exacerbations or anaphylaxis. Management of bedbug bites involves symptomatic relief of itching and dealing with patient anxiety. Identification and elimination of infestation are most important. Another ectoparasite of concern is lice (Pediculus and Pthirus species), which causes head, body, and pubic infestations. Patients can experience hypersensitivity to the saliva of lice, but such symptoms often do not develop until several weeks after infestation. Diagnosis involves identification of nits (ie, eggs) or lice on the skin or hair. Several pediculicides are used for management but wet combing without use of pediculicides may be more effective. A third common ectoparasitic infestation, scabies (ie, infestation wi...
South Dakota medicine : the journal of the South Dakota State Medical Association, 2018
Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. S... more Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. Systemic amyloidosis usually involves multiple organs, with kidneys being the most common organ involved, followed by the heart. In general, the presentation of hepatic amyloidosis varies with minimal or no symptoms commonly seen. Hepatic amyloidosis is rarely associated with multiple myeloma. We report here a case of portal hypertension, ascites, and severe intrahepatic cholestasis as the initial presentation of hepatic amyloidosis and multiple myeloma, which followed a rapidly progressive clinical course.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 addition... more The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development.
South Dakota medicine : the journal of the South Dakota State Medical Association, 2017
Although the burden of infectious diseases has decreased dramatically due to advances in health c... more Although the burden of infectious diseases has decreased dramatically due to advances in health care, disease prevention and numerous public health efforts and innovations, zoonotic diseases continue to pose a problem in terms of both existing and emerging diseases. These risks are of particular concern in rural areas, in which there is more contact with animals for occupational and recreational purposes. As a rural and agricultural state, South Dakota has a large percentage of its population at risk of exposure to zoonotic diseases through their substantial contact time with animals. De-identified data from the South Dakota Department of Health containing the variables and diseases of interest from the time period of 2010-2014 was obtained. From this data were calculated the incidence rates by county, and seasonal and demographic patterns of the diseases were plotted. The incidence of disease in South Dakota were higher than the national rates for campylobacteriosis (threefold), cr...
Hereditary haemochromatosis is associated with increased susceptibility to some infections. We re... more Hereditary haemochromatosis is associated with increased susceptibility to some infections. We report here a case of Q fever in a patient with coexistent haemochromatosis. The literature is reviewed in regard to the effect of haemochromatosis on susceptibility to infectious disease in general and Q fever in particular. Although there is documented increased risk in these patients for some infectious conditions, a specific association with Q fever has not been previously reported. The present report raises the possibility of such a clinically relevant connection.
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Papers by Mark K Huntington