Tuesday, December 11, 2018

Resistance Screening Set for Friday Morning

Last week's Grand Rounds at Rapid City Regional Hospital featured Dr. James M. Keegan in his presentation A Paradigm Shift in the Approach and Treatment of Infections-Antibiotic Stewardship and the Human Biome. During his talk, he discussed the consequences of over-prescribing antibiotics...particularly those that destroy helpful anaerobes in your gut. We naturally have opportunistically pathogenic microbes as part of our gut flora. Such microbes are kept at a controllable level thanks to other microbes that coexist with them in the depths of the bowels. When we disrupt the bacterial composition of this microbiome, we leave the body vulnerable to the proliferation of those opportunistically pathogenic microbes, giving them the opportunities to cause us harm.

Take for example the bacterium Clostridium difficile a.k.a. C. diff. This bacterium can be found in small amounts as part of the healthy gut flora in about 2-5% of the adult population. When prescribed antibiotics that kill off C. diff's competitors without killing C. diff, this microbe is able to take advantage of the newly available space and food resource and will begin to multiply. As it does so, C. diff will start to produce toxins, which can cause severe, even life-threatening, inflammation of the colon. We see most cases of C. diff infection in hospitals among patients who are on broad-spectrum antibiotics.

Dr. Keegan talked about how being more careful with which antibiotics are prescribed in different situations can make a big difference in protecting patients from the effects of a disrupted microbiome. He talked about the work he and his colleagues have done to bring awareness to the issues of antibiotic preservation and stewardship of the gut flora. By helping physicians to understand the broader impacts of antibiotic preservation, his team has seen remarkable improvements in hospitals. We are talking significant reductions in cases of MRSA and C. diff with very little effort once physicians are aware of how to more appropriately prescribe antibiotics that are less disruptive to the gut flora.

During his talk, he mentioned a documentary about antibiotic stewardship. The documentary is called Resistance and it explores the history of antibiotics and the rise of superbugs due to improper usage of various antibiotics. You can catch the trailer by going here: http://www.resistancethefilm.com/ 


To continue the conversation about antibiotic and gut flora stewardship, SDSM&T will be doing a screening of the film on Friday, December 14th at 9:30AM in the McKeel Conference Room in the Surbeck Center. There will also be a brief discussion of the topic following the film for those who would like to stick around to talk a little bit more about the subject.

We hope you can join us!

Monday, December 3, 2018

Finals Week Fun

It's that time of the semester...students are stressed, faculty are frantic, and everyone is ready to call it a year so that they can fully enjoy a well-earned break. To help everyone cope with the beast that is finals, the Student Success Center will have lots of food and fun freely available this week!


Swing by to grab some snacks and de-stress! 

Friday, November 30, 2018

Closed Case Friday: Intestinal Issues

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Today, we reveal that our hypothetical patient was diagnosed as having: 


Diverticulitis


In our hypothetical situation, the physician would have seen evidence of an uncomplicated form of diverticulitis on the CT scan that she ordered, which led her to create the treatment plan described above. Diverticulitis is caused by the inflammation of diverticula, which are small, bulging pouches that can form in the lining of the intestines. These often form in the lower parts of the intestines (such as the colon). Diverticula are common in patients over the age of 40 and don't cause problems unless they become inflamed. If they do become inflamed, patients experience severe abdominal pain, typically on the lower left side of the abdomen (though it is more commonly felt on the lower right side in Asian patients), along with fever, nausea, constipation, and sometimes vomiting.

Mild cases of diverticulitis are typically treated with rest, temporary movement to a liquid diet to allow the intestines to heal before gradually increasing solid food intake, and changes in regular diet and exercise habits. These cases can be accompanied by infection, which may additionally require antibiotic treatment.

In complicated cases of diverticulitis, infections can progress to abscesses or peritonitis, scarring can lead to intestinal blockage, or fistulas can form between sections of bowel. The severity of those kinds of complications can require intravenous antibiotics, draining of abscesses, or surgical interventions, which involve either primary bowel resection or a resection with colostomy.

This condition can be prevented by managing diet and exercise to lower the risk of developing diverticula. Regular exercise, eating enough fiber, refraining from smoking, and drinking enough water can all help to lower your risk of developing diverticulitis.

Thanks for joining us for this week's Mystery Case and we hope to see you next semester!

Thursday, November 29, 2018

2018 Fall Semester WALC Winner!

The moment that we have all been waiting for....



The Fall 2018 WALC Champion is:
Danielle Theis!

Danielle's cumulative score for the semester was an impressive 82.5 after collecting 28.5 points over the course of the semester and then picking up a solid 54 points during redemption week. Her feat has earned her a free t-shirt and a place on the Pre-Health Pathways Office's WALC of Fame.

Congratulations on winning this semester's WALC!

Thanks to all of the students who participated in WALC this semester! You can check out the semester rankings on our WALC Leaderboard page. Join us again next fall to compete for fame and glory (as well as for free candy and t-shirts).

See you again next fall!

Monday, November 26, 2018

FHSP Fundraiser TONIGHT!

Mystery Case Monday: Intestinal Issues

Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.

This week's hypothetical 57-year-old patient has been experiencing pain in the lower left side of his abdomen and has had a persistent fever for several days. He is constipated and has been feeling nauseous, but has only actually vomited once this week. Our patient has been a smoker most of his life and his BMI is 35. He reports having a diet that is high in red meat and dairy and low in fiber and he does not recall the last time that he engaged in any vigorous exercise. He reports using Advil frequently to relieve joint pain. After conducting a physical examination, his physician orders a liver enzyme test and CT scan. The liver enzyme test is normal, but the CT scan confirms the physician's suspected diagnosis. The physician tells the patient to move to a liquid diet for a few days before gradually introducing solid foods. They have a conversation about gradually improving diet and exercise habits to avoid further complications that could require surgical intervention. She recommends that the patient stop taking Advil and use Tylenol as needed to manage pain.

Thought Questions:

What is the most likely diagnosis for this patient?

What causes this condition? How is it prevented?

What are the anatomical structures involved in this clinical issue?

What kind of surgical intervention would be needed if this condition progressed?


Leave your comments below and check back on Friday to see how our hypothetical patient was diagnosed!

Tuesday, November 20, 2018

U.S. Army Suture Lab & HPSP Information Session

Students show their sutured pigs' feet.
From left to right: Gabrielle Smith, Kaitlyn Dickinson, Alexia Hodgson, Kaelyn Kaul, Jordan Fostvedt, Kathryn Weyeneth, & Colin Jones.

Last night, seven of our SD Mines students gathered in the Chemical & Biological Engineering and Chemistry building to learn basic suturing from U.S. Army Health Care Recruiter, Sgt. Christopher L. Sturdevant.




Sergeant Sturdevant demonstrated the most fundamental technique for suturing as the students gathered around. Next, the students were given pieces of pigs' feet that had been cut to simulate a wound. They were then given sutures and allowed to practice suturing the "wound" using what they had just learned from the demonstration. Because of the small group size, students were able to ask questions and interact with Sgt. Sturdevant throughout the suture lab. A few of the students even got to experiment with using sutures with needles of different sizes and strings of different widths and made of different materials.




After the suture lab, students cleaned up before walking upstairs to enjoy free pizza and learn a little more about the Health Professions Scholarship Program (HPSP) that is offered by the U.S. Army for those interested in health professions. The HPSP offers many benefits for students, the most attractive of which is a full-ride scholarship through medical school. Medical schools cost students an average of $200,000 in tuition over four years. Students who earn the HPSP have their tuition and books covered by the U.S. Army (along with a generous living stipend of $2,000+/month) in exchange for a 4+ year commitment to practice in an Army facility after completing your training. There is also a $20,000 sign-on bonus for the program that is paid out over three years while you are in a medical program. While in residency and during the "payback" period, HPSP scholars do not have to purchase their own malpractice insurance as they are covered by the U.S. Army.

To learn more about the HPSP, you can go to https://www.goarmy.com/amedd.html.