Multiple myeloma (MM) rarely presents with a primary neurological dysfunction, and if it does it is usually due to a plasmacytoma. This is the first case to discuss hypoglossal nerve dysfunction as the first sign of MM progression secondary to severe pathophysiologic bone lysis. A PubMed-based literature search was completed on April 17, 2016 for the terms “multiple myeloma” and “hypoglossal nerve neuropathy”. A 73-year-old woman with known MM who received little treatment for several years, presented secondary to dysarthria and at first was thought to have hyperviscosity syndrome. On further examination, it was found she had light chain disease and her symptoms were secondary to severe disease progression. Imaging revealed multiple lytic lesions in the skull on skeletal survey and brain MRI revealed boney lysis near the occipital condyle and clivus likely interfering with the coursing of the hypoglossal nerve. Advanced progressing MM can cause severe boney destruction which can interfere with cranial nerve canals and cause neuropathy as a presenting symptom.
Background and Objectives: The aim of this study was to examine experiences of New Jersey family medicine residents and preceptors with the etonogestrel subdermal contraceptive implant and to explore barriers to and facilitators of training. Methods: In this qualitative study, we conducted semistructured individual interviews to explore residents’ and preceptors’ experiences with contraceptive implant procedural training. We invited residents and preceptors from programs with high (5.2–10.9) and low (0.0–0.1) implant procedures per resident to participate. Participants discussed factors that supported or inhibited implant training and provision. We transcribed, coded, and analyzed interviews on a rolling basis. We used memoing to reflect on the data and identify saturation. We developed and refined our codebook using a collaborative, iterative process. We analyzed interviews using deductive and inductive techniques to identify themes. Results: We interviewed 25 subjects: 14 residents and 11 preceptors from four family medicine residency programs with the highest and lowest implant training numbers. Common barriers included lack of hands-on experience with the procedure, lack of teaching with the procedure, and difficulty scheduling patients. Facilitators included formal training and inclusion of contraception in residency curricula, preceptors’ comfort with the procedure, office sessions dedicated to procedures or gynecology visits, and patient familiarity with the implant. Conclusions: Family medicine residencies provide unique opportunities to impact provision of long-acting reversible contraception (LARC). We identified potential interventions, including formal implant training sessions, dedicated procedure office sessions, stocking of devices in the office, and staff focused on reproductive health that can aid in scheduling, obtaining devices, and setup.
Background: Promise Clinic, a student-run continuity-based free health clinic affiliated with Rutgers Robert Wood Johnson Medical School, serves the uninsured and low-income population in New Brunswick, New Jersey. Though it has been operating for over ten years, Promise Clinic does not yet have a formalized system for evaluating quality of care from a patient’s perspective. The purpose of this study was to investigate patient satisfaction and expectations at Promise Clinic. Methods: Over a two-month span, we interviewed 21 patients at Promise Clinic. The interview addressed a variety of factors, including patient satisfaction with student doctors, health education and awareness, and understanding of and access to community health options. Furthermore, we elicited open-ended feedback from patients, allowing them to express opinions regarding their healthcare and reasons for attending Promise Clinic over other low-income healthcare providers. Results: We found that while patients were highly satisfied with their overall experience and student doctor teams, there were some concerns about wait times, the timing of clinic, and student doctor preparedness. Patient health education was strong in many, but not all, areas. Of eligible patients, 40.0% reported receiving regular cancer screenings and 33.3% were unaware of other healthcare options. Conclusions: Overall, this study provides a patient-centered assessment of the clinic. Insight obtained has helped medical students and faculty administrators at Promise Clinic address chief patient concerns and improve upon the patient experience. We hope that patient interviews will continue to be a part of quality improvement processes at Promise Clinic and other similar clinics.
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