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

{"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}

{"title":"Wisconsin Adolescents' Attitudes, Beliefs, Motivations, and Behaviors Surrounding E-Cigarette Use and Cessation.","authors":"Brian S Williams, Jesse T Kaye, Karen L Conner, Jennifer Bird, Rob Adsit, Megan E Piper","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Electronic cigarettes (e-cigarettes) are the most common tobacco product used by adolescents, yet no evidence-based cessation treatment for adolescents exists.</p><p><strong>Methods: </strong>Wisconsin residents aged 13 to 17 (N = 227) completed an online survey assessing e-cigarette use, knowledge, motivations around using and quitting, and recommendations for cessation intervention content.</p><p><strong>Results: </strong>Most of our sample never vaped (76.2%), reporting concerns with health effects and addiction as motivations preventing initiation. Among adolescents who used e-cigarettes, friend use was the main motivation for initiation, and mental health symptoms promoted ongoing use. Motivations for quitting included health harms, cost, and addiction.</p><p><strong>Conclusions: </strong>This study identified various topics that motivate and demotivate e-cigarette use among adolescents. This information can be incorporated into prevention and treatment strategies tailored to adolescents.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"144-147"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683863","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":"Mind the Gap: Analysis of the Timeline of Medical Readiness and Qualitative Review of Discharge Delays.","authors":"Madeleine Nowak, Matthew Bye, Amanda Rogers","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Efficient discharges lead to decreased length of stay and improved hospital flow. An efficient discharge requires timely recognition of medical readiness for discharge (MRD) and effective preparation. The objective of this study was to better understand pediatric hospital medicine discharges by (1) analyzing the time of MRD and discharge throughout the day, (2) assessing the time from MRD to discharge, and (3) categorizing commonly identified discharge delays.</p><p><strong>Methods: </strong>A retrospective chart review of pediatric hospital medicine patients with the diagnoses of asthma, \"brief resolved unexplained event,\" hyperbilirubinemia, or \"rule out sepsis neonates\" was completed. MRD was determined by reviewing the patient's chart for completion of diagnosis-specific discharge criteria. MRD was compared to the time of discharge order and discharge. Delayed discharges were reviewed further to identify reasons for the delay.</p><p><strong>Results: </strong>One hundred discharge events were analyzed - 25 from each of the 4 selected diagnoses. MRD occurred throughout the day (33% morning, 43% afternoon, 14% evening, and 10% night). The median time from MRD to discharge was 1.7 hours (0.5 hours from MRD to discharge order and 0.9 hours from order to discharge), with the longest MRD to discharge time in asthma patients. Forty percent of patients had a delayed discharge, and identified reasons for delays were further categorized.</p><p><strong>Conclusions: </strong>MRD occurred throughout the day, suggesting the MRD to discharge time may be an informative metric of discharge efficiency. Next steps include developing forward-facing electronic health record alerts noting MRD for improved tracking and real-time communication and targeted interventions to address reasons for discharge delays.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"96-101"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683933","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":"Characteristics of Patients Disengaged From Pharmacist-Led Hypertension Management in Primary Care: An Observational Study.","authors":"Isabel Wedig, Anupama Joseph, Tyler Ho","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is a leading cause of morbidity and mortality worldwide. Although it is often asymptomatic, adequate blood pressure control can help decrease the risk of cardiovascular, renal, and neurologic diseases. Clinical pharmacists can play a critical role in blood pressure management and have been shown to help patients meet their goals. Despite this, patients often disengage from pharmacy services, and reasons for this are not well understood. This study sought to evaluate characteristics of patients who are referred but not engaged in a primary care pharmacy antihypertensive service and explore potential reasons for disengagement.</p><p><strong>Methods: </strong>Data from the 2023 fiscal year (July 1, 2022 - June 30, 2023) were collected from UW Health's electronic health record. Inclusion criteria were prespecified to include adults referred by their primary care provider to pharmacy services but who did not engage in care. Retrospective chart reviews were performed to gather demographic information on this population, and descriptive statistics were used for data analysis.</p><p><strong>Results: </strong>Of the 168 individuals who met the inclusion criteria, 66.1% of participants were not currently at their blood pressure goal. The majority of patients did not engage in pharmacist services due to lack of patient interest (n = 114, 67.9%) or being managed by another health care member team (n = 36, 21.4%).</p><p><strong>Conclusions: </strong>The majority of patients who did not engage with a pharmacist for hypertension medication management despite referral from their primary care provider are not achieving their blood pressure goal.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"230-235"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071318","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 Novel Coach-Approach to Clinical Faculty Mentoring and the UW Department of Medicine Clinical Faculty Development Program.","authors":"James H Stein, James D Alstott, Chariti Gent, Christine Fabian Bell, Daniel R Marlin, Anthony Hernandez, Esther Schulman, Sharon Gehl, Lynn M Schnapp","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical faculty at academic health centers may benefit from specific mentorship and proficiencies that are distinct from those on research tracks. We describe the creation, activities, and 1-year impact of a faculty development program that included novel professional coaching training (the Clinical Faculty Mentoring Program), which was supplemented by skills- and knowledge-building activities (the Clinical Faculty Development Series).</p><p><strong>Methods: </strong>The goals and components of the Clinical Faculty Mentoring Program and Clinical Faculty Development Series are described in detail. A mixed methods evaluation plan guided collection of confidential survey and interview data before and after the first year of these activities. We used paired t tests to identify statistically significant changes.</p><p><strong>Results: </strong>The 43 clinical mentors reported significant gains in job satisfaction, teaching attitudes, knowledge of mentorship competencies, and confidence with coaching skills for mentorship (all <i>P</i> < 0.05). Of mentor respondents, 88% found the coach approach to mentoring program to be \"very\" or \"somewhat\" helpful. Coaching behavioral domains with the greatest evidence of improvement were supporting the mentee to integrate new awareness, insight, and learning into their worldview and behaviors (<i>P</i> = 0.0503) and managing time and focus of mentoring sessions (<i>P</i> = 0.022). All 37 mentees had at least 1 meeting with a mentor (100%). Over 9 months, 39 virtual Clinical Faculty Development Series sessions had an average participation of 38 participants (range 22-59). A majority of surveyed faculty (>55%) agreed or strongly agreed the sessions provided valuable opportunities for skills development with teaching, leadership, wellness, diversity, equity, inclusion, and promotion.</p><p><strong>Conclusions: </strong>Among clinical mentors, our novel coach approach to clinical faculty mentoring and skill-building had favorable effects on job satisfaction, knowledge of mentorship competencies, and confidence in coaching skills. Outcomes from the Clinical Faculty Development series supported the mentoring program outcomes. Longitudinal follow-up is needed to determine how this program will impact mentees.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071320","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":"<i>Candida Auris</i> Total Knee Arthroplasty Infection in an Immunocompetent Individual: Case Report and Literature Review.","authors":"Pinky Jha, Milan Patel, Jacob Kodra, Riya Singh, Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong><i>Candida auris (C auris)</i>, a multidrug-resistant fungus, was declared by the Centers for Disease Control and Prevention as a serious global health threat in 2016. It is hard to identify, resistant to standard antifungal treatments, and spreads within health care settings, resulting in high morbidity and mortality in critically ill patients.</p><p><strong>Case presentation: </strong>We report the case of a 60-year-old immunocompetent male with a protracted course of prosthetic knee joint infections. He received medical care at several health care facilities across 2 Midwestern states culminating in wound dehiscence and <i>C auris</i> infection necessitating prolonged antimicrobial treatment.</p><p><strong>Discussion: </strong><i>C auris</i> has been a pathogen of increasing nosocomial transmission with particular concern for multidrug resistance. Treatment is with prompt irrigation and debridement and polyethylene exchange and systemic antifungal treatment. Local treatment with antimicrobial impregnated cement can be used to reduce treatment duration and mitigate resistance.</p><p><strong>Conclusions: </strong>With emerging concerns and the prevalence of infection with <i>C auris</i>, there should be greater vigilance in evaluating patients with repeat surgeries and health care contacts for fungal infection.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"291-295"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071357","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-Based Approach to Racial Health Disparities in Infertility Diagnosis and Management-From Reproductive Life Planning to Treating Infertility.","authors":"Micaela Stevenson Wyszewianski, Eliyah J Stevenson, Jayme Bosler","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Increasing attention has been paid to medical racial health disparities, though limited attention has been paid to mitigating these disparities in access to fertility care and reproductive life planning. Workshops previously have been shown to increase physician awareness and practice improvements.</p><p><strong>Objective: </strong>We sought to develop an education tool to provide structured, case-based learning for physicians to reflect on bias in fertility assessment and treatment and discuss changes in practice.</p><p><strong>Methods: </strong>Authors created reproductive life planning and infertility management cases and arranged them for review informed by reproductive justice and fertility scholars. The resulting workshop was piloted to a group of 10 residents in person at a single academic institution. The cases were presented in a large group style and participants discussed cases in pairs. At the workshop's conclusion, participants were prompted to provide feedback via a survey.</p><p><strong>Results: </strong>One hundred percent (10/10) of respondents reported that the workshop helped them think about bias in medicine. Ninety percent (9/10) of respondents reported that after the workshop, they will think differently about how they approach marginalized patients in their practice. Eighty percent (8/10) of participants reported that the workshop gave them tools on how to approach marginalized patients in their practice.</p><p><strong>Discussion/conclusions: </strong>Participants reported overwhelmingly that they found the workshop valuable and that it assisted them in making goals to change their practice to improve fertility care for racially marginalized patients.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"277-279"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071375","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":"Comparing Magnetic Resonance Imaging and Computed Tomography Machine Accessibility Among Urban and Rural County Hospitals in Wisconsin.","authors":"Benjamin Burdorf, William MacDonald, Pravallika Kesarla, Samantha Burdorf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is higher disease incidence and worse outcomes in rural America when compared to urban America. In states like Wisconsin, where 32.9% of the population resides in rural areas, this is particularly worrisome. The Center for Healthcare Quality and Payment Reform found that 30% of rural hospitals in the US are at risk of closing due to financial instability. A substantial cost to rural hospitals is the provision of radiologic services. Thus, the study investigated if a disparity exists in availability of magnetic resonance imaging (MRI) and computed tomography (CT) machines among Wisconsin's urban and rural county hospitals.</p><p><strong>Methods: </strong>Wisconsin hospitals were asked how many MRI and CT machines were carried at their facility. This information was compiled in a spreadsheet and cross-referenced with the county in which it resided, along with the county's population, urban-rural classification, and land area in square miles.</p><p><strong>Results: </strong>We found that the state of Wisconsin compared favorably with the national average in terms of the number of persons and square miles per MRI and CT machine. When comparing Wisconsin counties based on their urban-rural classification, a disparity exists in rural counties regarding square mileage per CT and MRI machine.</p><p><strong>Conclusions: </strong>With distance for service creating a barrier to accessibility, rural county residents would benefit from more in-hospital MRI and CT machines. Based on these findings, further research is warranted to investigate the potential vulnerability of other rural populations regarding accessibility to radiologic resources.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"243-248"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071408","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":"Statistical Thinking in Medicine, Part 6: Creating Evidence (or What to Know Before Visiting a Statistician).","authors":"Robert A Calder, Jayshil J Patel","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"312-316"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071516","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}