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

{"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":"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":"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 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":"Brain and Body Fitness Group for Those With Dementia and Their Caregivers Through Community Partnership: A Program Evaluation.","authors":"Lindsey Jg Creapeau, Norah Mm Airth-Kindree, Jeffrey A Goodman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The growing prevalence of dementia calls for nonpharmacological interventions to reduce negative quality of life effects for those living with dementia and their caregivers. Brain and Body Fitness, a community-based collaborative group program, engages people living with dementia and their caregivers through a combination of physical, cognitive, and socialization strategies, to maximize health benefits for sustained functioning.</p><p><strong>Methods: </strong>Using an adapted form of the Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition tool, ex post facto data were collected from both participants affected with Alzheimer's disease and related dementias and their caregivers during 12 biweekly sessions of the Brain and Body Fitness program conducted from 2017 through 2021.</p><p><strong>Results: </strong>Brain and Body Fitness program participants were affected by 4 quality of life indicators: anxiety, sleep, fatigue, and depression. Data reveal significant reductions in anxiety symptoms and significant improvements in fatigue for affected participants. Anecdotally, the program demonstrates nonsignificant trends of overall mood improvement.</p><p><strong>Conclusions: </strong>Given the positive outcomes, communities may consider adopting a similar program to provide additional support for participants.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"265-269"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071299","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":"Drivers of Opioid Prescriptions for Medicare Patients at an Urban Tertiary Center.","authors":"Elise A Biesboer, Abdul Hafiz Al Tannir, Leonard E Egede, Rebekah J Walker, Sneha Nagavally, Sarah A Endrizzi, William J Peppard","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Froedtert & the Medical College of Wisconsin belongs to a minority of institutions in which opioids are more frequently prescribed to non-Hispanic Black patients than their non-Hispanic White counterparts. The objective of this study was to evaluate racial and ethnic differences in prescribing practices for Medicare patients to determine areas for intervention.</p><p><strong>Methods: </strong>This was a retrospective review of adult patients with Medicare insurance who received an ambulatory opioid prescription for pain. Outcomes included number of prescriptions, and maximum morphine milligram equivalent (MME). Unadjusted and adjusted linear regression models were used to examine associations between race and ethnicity and each outcome with and without adjustments for covariates.</p><p><strong>Results: </strong>A total of 17 105 patients were given an ambulatory opioid prescription over the study period. Although most prescriptions were provided to non-Hispanic White patients, non-Hispanic Black patients had a higher mean number of prescriptions (4.36; 95% CI, 4.08 - 4.63) and higher MMEs at 495.31 (95% CI , 445.72 - 544.91). After controlling for demographics and comorbidities, individual comorbidities emerged as independent variables associated with greater numbers of prescriptions, with sickle cell disease (β 9.86; 95% CI, 9.08-10.64; <i>P</i>P <  0.001), drug abuse (β 5.22; 95% CI, 4.96-5.48; <i>P</i>P < 0.001), and paralysis (β 2.20; 95% CI, 1.73-2.67; <i>P</i>P <0.001) having the strongest relationships, while after adjustment, the significance of race and ethnicity was lost.</p><p><strong>Conclusions: </strong>Institutions should explore reasons for racially inequitable opioid receipt. Individual comorbidities were associated with differences in opioid prescribing, allowing for targeted interventions in these patient groups.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"208-215"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071476","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":"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":"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}