WMJ : official publication of the State Medical Society of Wisconsin最新文献

{"title":"Next Steps: Teaching Future Generations an Interprofessional Approach to Diabetic Foot Ulcer Care.","authors":"Shalvi B Parikh, Jamie N LaMantia, Meghan B Brennan, Jessica S Tischendorf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess the effectiveness of interprofessional teaching sessions focused on the care of patients with diabetic foot ulcers.</p><p><strong>Methods: </strong>We conducted a pre-/post-intervention, quasi-experimental study with repeat evaluations on either side of the teaching sessions (n = 28). Surveys and chart reviews were used to assess changes in attitude, knowledge, practice, and patient outcomes.</p><p><strong>Results: </strong>All 5 infectious disease fellows favorably reviewed the sessions. Positive baseline attitudes towards interprofessional care further improved with respect to shared learning and teamwork (5-point Likert scale scores pre- and post-session: 4.13 vs 4.44, respectively, <i>P</i> < 0.01). No other significant changes were observed.</p><p><strong>Discussion: </strong>Our sessions were associated with improved attitudes toward interprofessional care but likely need to be augmented with experiential learning to achieve practice and outcome improvements.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Rare Variants in Kidney Developmental Genes With Chronic Kidney Disease and Blood Pressure: A UK Biobank Study.","authors":"Benjamin L Spector, Byunggil Yoo, Neil Miller, Monica Gaddis, Isabelle Thiffault, Laurel Willig","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) and hypertension are heritable traits. The source of this heritability remains largely unknown, and exploration has been limited principally to common genetic variants, with few studies having examined rare variants.</p><p><strong>Methods: </strong>In this cross-sectional observational study, we evaluate whole exome sequencing data using the UK Biobank to identify the ability of rare variants in 58 kidney developmental genes to predict CKD or elevated blood pressure using logistic regression models with subgroup analysis performed by ancestry.</p><p><strong>Results: </strong>Significant predictors of CKD included rare variants in <i>CLCN5</i> (OR 1.59; 99% CI, 1.02-2.47; <i>P</i> = 0.007). Predictors of blood pressure included rare variants in <i>SIX1</i> (OR 0.57; 99% CI, 0.35-0.94; <i>P</i> = 0.004) and <i>NPHS1</i> (OR 0.84; 99% CI, 0.72-0.99; <i>P</i> = 0.005), which were protective against blood pressure elevation, and <i>WT1</i> (OR 1.58; 99% CI, 1.02-2.45; <i>P</i> = 0.007), which was associated with elevated blood pressure. In individuals of White British ancestry, rare variants in <i>SIX1</i> protected against elevated blood pressure (OR 0.58; 99% CI, 0.34-0.99; <i>P</i> = 0.009). Among individuals of non-White British ancestry, predictors of CKD included rare variants in <i>SLC12A3</i> (OR 2.02; 99% CI, 1.08-3.78; <i>P</i> = 0.004) and <i>CALB1</i> (OR 3.12; 99% CI, 1.15-8.47; <i>P</i> = 0.003). Presence of rare variants in <i>WT1</i> significantly predicted elevated blood pressure (OR 2.49; 99% CI, 1.08-5.78; <i>P</i> = 0.005).</p><p><strong>Conclusions: </strong>From this study, we conclude that rare variants in kidney developmental genes contribute to the risk of developing CKD and elevated blood pressure. These associations vary by ancestry.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Flags in the Electronic Medical Record: A Retrospective Analysis.","authors":"Natalie Yass, Rebekah Walker, Sneha Nagavally, Cynthia Kay","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Implicit bias in patient care and outcomes is well documented. However, the presence of bias in hospital security interactions is a relatively new area of research. Flags placed on the electronic medical record identify patients considered high risk for negative outcomes, including those with security interactions.</p><p><strong>Objective: </strong>We sought to explore the types of flags and their frequency, differences among patients with flags, and their pattern over time.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of flags placed on electronic medical records over 13 years of adults 18 years or older who were patients at a Midwest, tertiary, academic medical center. Descriptive statistics were used to explore patient demographic data. Chi-square tests were executed to compare patients with different flag types.</p><p><strong>Results: </strong>Three flag types were investigated: \"communication alert,\" \"vulnerable/unsafe, behavior\" and \"risk management.\" The communication alert flag was most common, although Black male patients were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). Patients who were prescribed anti-anxiety medications, antidepressants, antipsychotics, and psychotherapeutics also were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). The highest number of flags was placed during quarter 3 - the months of July, August, and September.</p><p><strong>Conclusions: </strong>Records of patients with certain demographics and on certain medications were more likely to be labeled with vulnerable/unsafe behavior flags. There is no clear protocol to determine what behaviors elicit which flag. Standardized procedures could help provide transparency to this issue.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"42-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Care at Home: The Physician Perspective.","authors":"Joshua Shapiro, Nicole Bonk, Melissa Dattalo, Mandy McGowan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"8-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Assessment of Interprofessional Knowledge Gaps in the Setting of Child Physical Abuse.","authors":"Elizabeth A Cleek, Lynn K Sheets, Joshua P Mersky, Joan P Totka, Kristin A Haglund","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Health care professionals can protect children by identifying and reporting injuries concerning for child physical abuse, such as sentinel injuries (bruising and intra-oral injuries in precruising infants). Citing knowledge and collaboration barriers, health care professionals sometimes fail to recognize sentinel injuries as concerning for abuse. Interprofessional education may be an ideal format to improve health care professional's responses to sentinel injuries. However, it is traditionally limited to health care professions, while responding to suspected child physical abuse requires collaboration between health care professionals and non-health care professionals. This study's purpose was to understand if an interprofessional education framework could support the need and development of interprofessional education for child physical abuse beyond health care professions.</p><p><strong>Methods: </strong>Data were collected through semistructured interviews and analyzed using a qualitative descriptive methodology. Participants included 27 professionals who had engaged in child physical abuse responses in a US midwestern urban county. Participant professions included health care, child protective services, law enforcement, courts, victim advocates, and child advocacy center employees.</p><p><strong>Results: </strong>Six themes were identified: 4 themes aligned with competencies of the interprofessional education framework, 1 described engaging with families, and 1 described features unique to sentinel injury investigations.</p><p><strong>Conclusions: </strong>This study supports the need for child physical abuse interprofessional education beyond health care professions. Legal thresholds for responding to suspected abuse differ by profession, and there is no shared interprofessional language around child physical abuse. This contributes to a steep learning curve for new professionals. This study also supports that an existing interprofessional education framework can provide the foundational framework for development of such education.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"10-16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Travel-Associated Tick-Borne Relapsing Fever in Wisconsin.","authors":"Michael E Rockman, Zaynab Almothafer, Rylee Doucette, Daniel J Robbins, Michael Scolarici, Manlu Liu, Caitlin S Pepperell, Eduard Matkovic, Jordan Kenik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Tick-borne relapsing fever is a zoonotic infection caused by members of the Borrelia genus of spirochetes found predominantly in the southwestern United States.</p><p><strong>Case presentation: </strong>A 65-year-old woman presented to a Wisconsin emergency department with a 2-day history of fevers and altered mental status after returning from a 5-week stay in Colorado. Initial labs were notable for elevated transaminases, thrombocytopenia, mild hyponatremia, mild hypokalemia, and elevated procalcitonin.</p><p><strong>Discussion: </strong>Rapid identification of patients with tick-borne relapsing fever is essential to minimize morbidity and mortality. Peripheral blood smear - especially during a febrile episode - can serve as a quick and accurate way to diagnose the illness with direct visualization of spirochetes.</p><p><strong>Conclusions: </strong>Early analysis of a peripheral blood smear can lead to a swift diagnosis of tick-borne relapsing fever, particularly in nonendemic states such as Wisconsin.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"59-62"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Service Line Director Appraisal: Evaluating Impact on Provider Satisfaction in a Rural-Based Clinic.","authors":"Adedayo Onitilo, Ya-Huei Li, Neel Shimpi, Ingrid Glurich, David Putthoff, Abdul Shour, Heather Bender, William F Melms","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Rural-based health care systems face unique concerns, including the struggle to recruit and retain quality clinicians. We evaluated health care providers' perceptions of their service line directors (SLDs) in the Marshfield Clinic Health System to understand how these perceptions affect job satisfaction in a rural health care setting.</p><p><strong>Methods: </strong>Utilizing quantitative and qualitative methods, we reached out to providers within the health system, excluding SLDs to prevent bias. The survey, with a 43% response rate, encompassed 14 questions focusing on 8 domains of engagement. Data analyses included chi-squared tests, t tests, analysis of variance, and correlation matrices. To delve deeper into perceptions, a qualitative approach was employed, analyzing open-ended feedback.</p><p><strong>Results: </strong>Of the 457 respondents, 70% reported satisfaction with their SLDs. High meeting frequencies with SLDs were positively correlated with satisfaction. The majority acknowledged the positive attributes of SLDs in domains like availability, recognition, and feedback. However, significant variations in perceptions arose between physicians and advanced practice clinicians and between surgeon and non-surgeon SLDs. Qualitative feedback elucidated themes including engagement, communication, and advocacy. Positive attributes, such as competence and proactivity, were mentioned frequently, while negatives highlighted disconnectedness and being uninformed.</p><p><strong>Conclusions: </strong>The quality of interactions with SLDs significantly influences clinician satisfaction. Regular, meaningful interactions - especially recognizing and providing feedback - enhance satisfaction. However, certain groups like advanced practice clinicians under surgeon SLDs felt less engaged. Our findings underscore the importance of tailored leadership training for SLDs and suggest organizational strategies to boost satisfaction, potentially affecting recruitment and retention in rural health care settings.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"47-54"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Workers' Views of Health Care's Contribution to Greenhouse Gas Emissions and Reducing Health Care Emissions.","authors":"Claire Gervais","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is the greatest global public health threat of this century, increasing respiratory, cardiovascular, and vector-borne diseases; mental health effects; and premature deaths. The US health care sector is responsible for 8% to 10% of the nation's greenhouse gas emissions; therefore, engaging health care systems in emissions reduction could improve health for all communities.</p><p><strong>Methods: </strong>A 10-question survey was emailed to a convenience sample consisting of 211 faculty physicians, nurse practitioners, and physician assistants and an unknown number of other staff employed at 21 UW Health family medicine clinics. The survey measured knowledge of health care greenhouse gas emissions and included 2 open-ended questions to solicit opinions on sustainability priorities and barriers to waste reduction. Each clinic also received a 15-minute presentation on health care climate impact during one of their regularly scheduled meetings.</p><p><strong>Results: </strong>Of the 130 survey respondents, 34% knew the health care sector is responsible for 8% to 10% of the US carbon emissions and 9% of non-greenhouse air pollutants. Only 26% knew that most of these emissions come from purchasing and transportation. However, 92% thought environmental sustainability should be incorporated into all clinical operations, and 74% wanted to know how to affect purchasing to reduce emissions. Top priorities were identified as investing in renewable energy, increasing recycling, and reducing waste (eg, single-use instruments). Top barriers to waste reduction were thought to be cost, complacency, and time.</p><p><strong>Conclusions: </strong>Despite lack of knowledge of the health care sector's contribution to US greenhouse gas emissions, most surveyed health care workers wanted their health care system to incorporate environmental sustainability into all clinic operations. Additional research identifying knowledge gaps and soliciting opinions of other medical specialties and health care systems on health care greenhouse gas emissions may increase awareness of health care emissions, inform health care leaders, and lead to emissions reduction.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostatic Abscess Presenting as Penile Discharge: A Case Report.","authors":"Jenna Wettstein, Whitney Lynch, Mary Beth Graham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>While prostatic abscess formation is often mitigated by initiating antibiotics for prostatitis, early recognition and treatment are important to avoid risk of sepsis and death.</p><p><strong>Case presentation: </strong>A 79-year-old male presented with milky-white penile discharge during bowel movements. He had no fever, dysuria, or perineal pain. The discharge culture grew multidrug resistant Escherichia coli. Computed tomography of abdomen/pelvis showed a heterogenous, enlarged prostate leading to diagnosis of a prostatic abscess. The abscess was treated successfully with cystourethroscopy, transurethral unroofing, and a course of intravenous ertapenem.</p><p><strong>Discussion: </strong>Previous research shows patients with prostatic abscesses present with perineal pain, dysuria, and fever. This case demonstrates the importance of considering a prostatic abscess in a patient with penile discharge alone.</p><p><strong>Conclusions: </strong>We report a unique presentation of prostate abscess to educate and improve clinical suspicion of a rare, yet potentially fatal urological complication.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"69-70"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Health Care Barriers for the Unhoused: Insights from a Rural Midwestern Community.","authors":"Reilly A Coombs, Payton Jorgenson, Corina Norrbom, Amy Prunuske","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing homelessness are more likely than the general population to have chronic health conditions and often encounter significant barriers to health care access. Many of these barriers can be affected by community-based factors, such as availability of reliable transportation, past experiences with health care systems, and community attitudes toward the unhoused population. This project aims to assess the needs and barriers to health care identified by people experiencing homelessness in a rural Midwestern city.</p><p><strong>Methods: </strong>The survey used was adapted from a survey previously conducted to assess the needs of the homeless population in Milwaukee, Wisconsin. Surveys were distributed during outreach around the city of Wausau, Wisconsin. Data were transcribed and reviewed, and descriptive statistics were calculated.</p><p><strong>Results: </strong>A total of 45 surveys were completed. Most participants identified as White, non-Hispanic males (n = 24, 53%) and were 46 to 55 years old (n = 14, 31%). Barriers to health care included lack of housing, cost, transportation, lack of a mailing address, inadequate hours, and disrespectful care. Eighty-six percent of participants (n = 38) reported having a mental health diagnosis, yet only 26% (n = 12) stated that they see a mental health professional.</p><p><strong>Conclusions: </strong>Individuals experiencing homelessness in a rural community have broad and complex barriers to accessing health care. Given limited resources in smaller communities, innovative and holistic solutions should be considered when aiming to make care more equitable.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}