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

{"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":"Spontaneous Splenic Hemorrhage Leading to Diagnosis of Metastatic Adenocarcinoma of Unknown Origin.","authors":"Morgan Lucero, Jordan Palmer, Shivani Kumar, Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous splenic hemorrhage is a rare initial presentation of malignancy. The objective of this case report is to elucidate the complexities of early diagnosis of splenic metastases and the complications associated with advanced malignancies of the spleen. It is also a reminder to consider splenic metastases and hemorrhage in the differential diagnosis for nonspecific presentations, such as acute abdomen, in adults.</p><p><strong>Case presentation: </strong>A 58-year-old female with 1 month of vague, worsening systemic symptoms and computed tomography findings suspicious for a subcapsular splenic hematoma was found to have splenic rupture. After undergoing emergency laparotomy with splenectomy, pathological samples revealed metastatic poorly differentiated adenocarcinoma of unknown origin. During a subsequent admission, she was found to be hemodynamically unstable, deemed a poor candidate for inpatient chemotherapy, and elected to proceed with comfort measures after which she died from multiorgan failure 3 weeks after initial presentation.</p><p><strong>Discussion: </strong>Spontaneous (nontraumatic) splenic hemorrhage secondary to metastasis should remain a differential diagnosis for patients with acute abdomen and associated risk factors for primary malignancies.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"180-183"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683860","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":"Wisconsin Young Adults' Attitudes, Beliefs, Motivations, and Behaviors Surrounding E-Cigarette Use and Cessation.","authors":"Jesse T Kaye, Brian S Williams, Jennifer Bird, Karen L Conner, Rob Adsit, Megan E Piper","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Electronic cigarette (e-cigarette) use is prevalent among young adults, yet cessation treatment options are limited and underutilized.</p><p><strong>Methods: </strong>Wisconsin residents aged 18 to 24 who had vaped nicotine in the past month (N = 480) completed an online survey assessing vaping initiation, past quit experiences, future quit intentions, and treatment knowledge and preferences. The survey also assessed perceived physical and mental health harms of vaping nicotine and other products (eg, cannabis, cannabidiol).</p><p><strong>Results: </strong>Most young adults had made a prior e-cigarette quit attempt, commonly motivated by concerns about addiction, cost, and health problems. Though 80% want support to quit, preferred methods of support were highly variable. The same methods (eg, medication, friends/family, health care provider, therapist) that were most endorsed as the form of support young adults were most likely to use were also among the most endorsed forms of support that young adults would not want to use. Nearly 40% of participants reported vaping cannabis and perceived vaping cannabis as significantly less harmful than vaping nicotine or tobacco for physical and mental health.</p><p><strong>Conclusions: </strong>Vaping cessation resources that are responsive to young adults' needs and preferences are needed. The high variability in treatment preferences suggests that multiple strategies need to be offered; there is no one-size-fits-all approach. Cannabis vaping is prevalent, and an important area for future research is to examine the impact of cannabis vaping on nicotine vaping dependence, cessation, and treatment use. Strategies to reach, motivate, and engage young adults in e-cigarette cessation and cessation treatment should highlight their concerns about addiction, costs, health harms, and desired treatment options.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"129-134"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683864","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":"Increasing Health Care Agent Documentation in a Residency Clinic.","authors":"Mariah Eggebraaten, Janisha Manhas, Zach Merten, Donald Pine, Teresa Quinn, Deborah M Mullen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Health care agent (HCA) documentation as part of advance care planning (ACP) helps clinicians understand patient care wishes. This project aimed to habituate these conversations and increase documentation rates.</p><p><strong>Methods: </strong>Workflow redesign and novel educational interventions were implemented. Patients aged 50 and older received an HCA education \"blue sheet\" at check-in as a discussion prompt.</p><p><strong>Results: </strong>Of 968 visits, patients in 44% received the intervention and 4% added HCA documentation. Chart audits found that 69% of patients had outdated (older than 5 years) ACP/HCA documentation. Clinician and staff found the process helpful, important to patients, and sustainable.</p><p><strong>Discussion: </strong>This inexpensive intervention increased HCA documentation and highlighted the need to update old ACP documents.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"162-164"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683931","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":"Interpretation of HIV Serologies in the Era of PrEP: Two Cases of False Positives.","authors":"Justin Temple, Rob Striker, Amy Pease","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>More availability of HIV pre-exposure prophylaxis (PrEP) is needed to end the HIV epidemic, but this means more clinicians will encounter false positive HIV test results. These cases highlight such occurrences and the steps a clinician may take to determine the significance of such results.</p><p><strong>Case presentation: </strong>We present the case of a 68-year-old male who presented for routine follow-up for HIV PrEP and a 41-year-old transgender male who presented to establish care with a primary care clinician. On labs, both had repeatedly positive HIV antigen/antibody tests with undetectable viral loads.</p><p><strong>Discussion: </strong>With increasing prescription of HIV PrEP comes a need for accurate interpretation of HIV serologies. HIV PrEP users may have altered stages of seroconversion. Additionally, heterophile antibody interference can lead to false positive or negative results.</p><p><strong>Conclusions: </strong>The reader should gain an understanding of HIV testing, potential pitfalls, and next steps amidst unclear results.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"176-179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683932","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 Norwegian Scabies in a Kidney Transplant Patient.","authors":"Khaing Wei, Sara Shalin, Venkata R Manchala","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Crusted scabies (Norwegian scabies) is a rare and severe presentation of skin infestation caused by the mite <i>Sarcoptes scabiei</i> in patients with compromised cellular immunity. Kidney transplant patients are maintained on immunosuppressive agents, which induce impaired T cell immune response that can lead to increased risk of crusted scabies.</p><p><strong>Case presentation: </strong>We report a case of crusted scabies in a kidney transplant patient who presented with a diffuse skin rash. Diagnosis was delayed and misdiagnosed initially, with subsequent skin biopsy leading to an accurate diagnosis and complete recovery with definitive treatment.</p><p><strong>Discussion: </strong>Unlike classical scabies, crusted scabies can occur in an atypical pattern that can be misdiagnosed as common skin lesions, and a skin biopsy is crucial to obtain an accurate diagnosis to receive definitive treatment.</p><p><strong>Conclusions: </strong>Transplant recipients are at an increased risk of severe parasitic infections such as crusted scabies due to drug-induced impairment of their cell-mediated immune response, thus maintaining a high index of suspicion for crusted scabies as a differential diagnosis in transplant kidney patients is extremely important. Early histological diagnosis of crusted scabies is essential to prevent delayed or missed diagnosis and avoid unnecessary serious complications. The combination of an oral ivermectin and topical permethrin regimen resulted in excellent clinical outcomes in our case and is recommended as the standard treatment.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"187-191"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683918","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":"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":"Worsening Epidural Lipomatosis Leading to Foot Drop Following an Epidural Steroid Injection: A Case Report.","authors":"Ragav Sharma, Sahitya Hari, Hariharan Shankar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural lipomatosis is a relatively rare condition resulting in the accumulation of unencapsulated fatty tissue within the epidural space. Steroids, either exogenous or endogenous, have been reported as a cause for this accumulation. The diagnosis is confirmed by computed tomography or magnetic resonance imaging. Symptomatic epidural lipomatosis has been reported to present with radiculopathy, myelopathy, claudication, cauda equina syndrome, or paraplegia. It is usually managed conservatively, including weight loss and avoidance of steroids.</p><p><strong>Case presentation: </strong>We report the case of a patient with sarcoidosis on oral prednisone who was referred for low back and leg pain of multifactorial origin. After addressing his low back pain, a fluoroscopically guided lumbar epidural steroid injection was performed for his neurogenic claudication. This provided 3 months of complete pain relief. But the patient also developed unilateral foot drop, possibly secondary to worsening epidural lipomatosis.</p><p><strong>Conclusions: </strong>Epidural lipomatosis may result in complications that include neurological deficits. Although various disease states may cause it, prudence is advised in the use of exogenous steroids.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"184-186"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683964","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}