The West Virginia medical journal | Year: 2012
The treatment of depression in primary care has become a pressing clinical topic in recent years. Research has detailed the chronic, common, and costly nature of the disease. In an effort to meet the proactive preventive challenge of physicians, this review integrates current research and suggestions for practice across the spectrum of preventive medicine. Patient education, screening, and follow up care are among the topics discussed with a special consideration for the unique cultural, environmental, and demographic influences of West Virginia residents. The overall objective of this review is to raise awareness of depression and increase access to mental health services within primary care.
The West Virginia medical journal | Year: 2012
Falls are the number one cause of injury-related morbidity and mortality in West Virginia senior citizens. Poor outcomes following falls are exacerbated by numerous comorbidities which are prevalent in the elderly population in West Virginia. This study describes the injury patterns, resource utilization and dispositions of WV seniors injured in a fall. This is a descriptive retrospective cohort study utilizing the West Virginia State Trauma System registry; which collects trauma data from 33 acute care facilities in West Virginia. Data from 5498 cases were reviewed for patients enrolled in the Registry in 2010. Fall victims aged 65 and older were included. Most falls occurred in the home (75.2%) or in a residential institution (11.3%). Femur fractures (36.3%) and intracranial hemorrhages (8.2%) were the most common injury diagnoses. Disposition back home declined from 58.6% in the 60-65 age group to 20.9% returning home following falls in the age 90-94 group. Conversely, disposition to a skilled nursing facility rose from 20.1% in the age 60-65 group to 49.1% in the age 90-94 group. The case fatality rate for all the seniors enrolled in the trauma system was 3.3%. Fall was the mechanism of injury for 83.3% of traumatic injuries in persons over the age of 65 enrolled in the WV trauma system. Older West Virginians suffer from numerous comorbidities that increase the risk of fall as well as the severity of injuries from a fall. In West Virginia, there is a correlation between increasing age and less desirable outcomes and dispositions from trauma centers for senior citizens after a fall. West Virginia patients, families and care providers must frequently face complicated treatment dilemmas, especially as the related risk of falling and the co-morbid conditions are commonly seen in older West Virginians. Multi-modal fall prevention programs can reduce the risk of falls in senior citizens.
The West Virginia medical journal | Year: 2011
Dr. Albrink's review of information available in 1969 did not allow her to determine a physiologic basis for the use of hCG or any proof of immediate or long term benefit. Subsequent discoveries and clinical studies only support her impressions. Despite these facts, this form of therapy has achieved a resurgence in popularity. The difference today is that patients no longer have to rely on health care providers to prescribe their medications since internet sites allow them to obtain medications "on line". This has potential adverse ramifications when we consider that the initial use of gonadotropins derived from the human pituitary was discontinued due to the iatrogenic transmission of Creutzfeld-Jakob disease. It is thought that the disease is transmitted by an abnormal protein called prion protein. Subclinical forms of the disease exist and the prions could potentially be transmitted in urine. No cases or transmission via urine have been reported and reputable sources of hCG would appear to be safe, but products from countries with greater risk have the potential for contamination. The increased demand for hCG from reputable sources has led to shortages and increased expense for the legitimate uses of hCG in treatment of endocrine disorders and infertility. Obesity and the adverse impact on health has become a priority in public health policies for the state of West Virginia and for our nation as a whole. The benefit of longevity in the practice of medicine is that one is given the opportunity to observe attempts to "reinvent the wheel" where medical practices that have been previously disproven are reintroduced. Fineberg and Hiatt state this more eloquently when they said: "What is unacceptable is to persist in demonstrably ineffective practices either because we fail to collect systematic information about the effects of our actions or because we establish and respond to inappropriate incentives." Systematic information has been obtained and has shown lack of evidence for the benefit of this therapy. The alternative explanation for the persistence and promotion of this treatment is unacceptable.
The West Virginia medical journal | Year: 2012
All-terrain vehicles (ATVs) are a popular source of outdoor activity in the United States, particularly in West Virginia. During the period of time from 1999 to 2007, deaths associated with ATVs in West Virginia increased by 28%. Helmet use among bicycle and motorcycle riders has been shown to decrease morbidity and mortality following trauma. We performed a retrospective observational study to compare injury patterns, hospital course, and resource utilization of non-helmeted and helmeted riders involved in ATV accidents using data from the West Virginia Trauma Center System. Descriptive statistics were calculated for all study variables and comparisons were made between helmeted and non-helmeted riders. In 2010, there were 1,059 patients aged 18 and over with traumas resulting from ATV accidents within the System. Riders involved in ATV trauma occurring on farms and streets were significantly more likely to be non-helmeted, while those using ATVs for recreational purposes were more likely to be helmeted. Non-helmeted riders were significantly more likely to arrive to the hospital via helicopter than helmeted riders, and were less likely to be discharged home from the ED compared to helmeted riders. Non-helmeted riders sustained significantly more head, neck, soft tissue injuries, concussions, intracranial hemorrhages, facial fractures, skull fractures, and thoracic spine fractures than helmeted riders. The findings of the current study support previous studies documenting that helmet use is protective against intracranial injury and other injuries of the head and neck. ATV use continues to be a significant contribution to trauma morbidity and mortality in West Virginia. Efforts that focus on increased helmet use have the potential to significantly reduce morbidity and mortality following ATV trauma. Enforcement of the current West Virginia ATV Law should be encouraged. Legislation expanding the mandatory use of safety equipment and rider training should be enacted in West Virginia.
The U.S. Department of Energy's National Energy Technology Laboratory (NETL), recently selected West Virginia University, Morgantown, to conduct a $937,000 research project in support of the DOE's program to Recover Rare Earth Elements from Coal and Coal Byproducts. Rare earth elements, or REEs, are chemical elements in earth's crust that are essential ingredients in modern technologies such as cell phones, rechargeable batteries, DVDs, GPS equipment, medical equipment, and many defense applications. Demand for REEs continues to grow, but mining and processing these elements is expensive and difficult. Conventional rare earth extraction grinds large volumes of hard rock and removes rare earths through acid extraction. The process is energy intensive, disturbs large areas of pristine land, and generates large volumes of toxic tailings. Because of this and the cost of developing domestic sources, the U.S. imports nearly all of its REEs. There are other methods for obtaining REEs. Some coal-related waste streams are enriched with REEs, sparking interest in evaluation of these wastes as a potential domestic supply. WVU's project, "Recovery of Rare Earth Elements from Coal Mine Drainage," brings together academia, state regulators, and industry to collaborate on finding a successful recovery technology for total REEs from acid mine drainage, or AMD. Paul Ziemkiewicz, director of the West Virginia Water Research Institute and principal investigator for the project, and co-investigators Xingbo Liu, professor of mechanical engineering, and Aaron Noble, professor of mining engineering, will test different sources of AMD solids and methods for extracting valuable REEs. The team has already identified solids precipitated during treatment of AMD, as an enriched source of REEs, particularly the more valuable, heavy elements. AMD is a waste stream generated by Appalachian coal mining that is created when sulfide minerals in rocks are exposed to air and water. Active coal mines are required to treat this water resulting in the precipitation of AMD solids which must be disposed of. In Pennsylvania and West Virginia alone, it is estimated that AMD generates more than 45,000 tons of total REEs per year or about three times the current U.S. demand for total REEs. The team will work with industry partners Mepco Inc., Houston, Consol Energy, Canonsburg, Pa., and Rosebud Mining, Shelocta, Pa., as well as the West Virginia Department of Environmental Protection's Office of Special Reclamation to not only identify enriched AMD solids but to develop ways to integrate rare earth extraction with their current mine drainage treatment operations. WVU's approach capitalizes on the fact that acid mine drainage is an existing source of acid which extracts rare earths from coal-related rock. As the coal industry treats this acid water to meet regulatory requirements it generates huge volumes of solids which require disposal. "Those solids are our feedstock," Ziemkiewicz says. "And in a sense, it's already pre-processed." Liu and Noble will develop ways to further concentrate REEs so that it can supply the metal refining industry. No new mines will be needed to generate this domestic supply of rare earths, and rejects will be returned to the AMD treatment plant's disposal system requiring a negligible environmental footprint. "Successful development of this concept will generate an additional revenue stream for the coal industry, create jobs and incentivize acid mining treatment," Ziemkiewicz says. "At the same time it will reduce U.S. reliance on foreign supplies of rare earth elements." The research team acknowledges NETL for its support of this project and looks forward to working with NETL's scientists in advancing this technology.