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

{"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}

{"title":"Subacute Combined Degeneration of the Spinal Cord From Nitrous Oxide Abuse.","authors":"Lauren Beranek, Satchel Beranek, Benjamin Kaster","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The recreational use of nitrous oxide is surging in popularity, with nearly 13 million Americans aged 12 and older reported to have misused it, according to a 2019 survey by the Substance Abuse and Mental Health Services Administration. Prolonged use has been linked to significant neurological deficits, potentially leading to lifelong issues if not treated early.</p><p><strong>Case presentation: </strong>We present a case of a 38-year-old male with significant neurologic deficits attributed to prolonged nitrous oxide abuse, resulting in subacute combined degeneration of the spinal cord. This condition is characterized by demyelination of dorsal and lateral columns.</p><p><strong>Discussion/conclusions: </strong>The growing recreational use of nitrous oxide, facilitated by its easy availability and lack of regulation, highlights the importance of clinician vigilance in managing associated risks. Neurological symptoms from vitamin B12 deficiency are particularly worrisome. Early intervention is crucial to prevent potential long-term consequences.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"308-311"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071550","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":"Sarcoidosis Masquerading as Breast Implant- Associated Anaplastic Large Cell Lymphoma -  The Importance of Definitive Pathology to Guide Therapy.","authors":"Riley Young, Emelyn Zaworski, Melissa Hart, Bradley Grewe, Ellen Liang, Yvonne Pierpont","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare critical outcome of breast implantation that typically presents 8 to 10 years after textured-implant placement with periprosthetic seroma. Treatment consists of implant removal and capsulectomy, which is typically curative. But in rare case, malignant infiltration through the capsule results in disseminated disease, necessitating aggressive treatment with systemic chemotherapy. Sarcoidosis, a chronic systemic granulomatous disease characterized by noncaseating granulomas, is another rare cause of periprosthetic seroma.</p><p><strong>Case presentation: </strong>A 61-year-old female with a history of invasive ductal carcinoma of the breast status post textured implant-based reconstruction presented with late periprosthetic seroma and overlying rash. Cytology of seroma aspirate was suggestive of BIA-ALCL, and positron emission tomography-computed tomography was concerning for invasive disease. Surgical specimen pathology of the implant-capsule complex and skin punch biopsy of the overlying rash revealed only granulomatous inflammation. The patient was diagnosed with sarcoidosis and spared systemic chemotherapy treatment for disseminated BIA-ALCL.</p><p><strong>Conclusions: </strong>BIA-ALCL should be ruled out in all cases of late periprosthetic seroma. Definitive surgical pathology is necessary to prevent misdiagnosis and inappropriate treatment of masquerading entities, such as sarcoidosis.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"71-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059598","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":"Comment on 'Enhancing Diagnosis of Obstructive Lung Diseases: Insights From Clinical Characteristics in a Prospective Cohort Study'.","authors":"Rachana Mehta, Ranjana Sah, Shubham Kumar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060909","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":"Reflections on the Past Two Decades: Lessons Learned, Opportunities for the Future.","authors":"Robert Golden","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"199-200"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683859","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":"Case Report of Delayed Encephalopathy From Pembrolizumab.","authors":"Christopher Kotsis, Brandon H Hidaka","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Pembrolizumab is an immune checkpoint inhibitor (ICI) used to treat many types of advanced cancer. ICIs can cause encephalopathy, a severe immune-related adverse event, which is a diagnosis of exclusion. Pembrolizumab immune-related adverse events typically develop early (within a few months) in treatment; presentation after a year is extremely rare.</p><p><strong>Case presentation: </strong>A 70-year-old White female with metastatic endometrial cancer treated with pembrolizumab for 19 months presented with generalized weakness that rapidly progressed to confusion, delusions, and hallucinations.</p><p><strong>Discussion: </strong>After ruling out other causes of encephalopathy via broad-based testing of blood and cerebrospinal fluid and imaging, her neurologic status improved after treatment with high-dose glucocorticoids and intravenous immunoglobulin.</p><p><strong>Conclusions: </strong>Pembrolizumab is an ICI that can cause encephalopathy, which is challenging to diagnose. While immune-related adverse events typically emerge soon after starting treatment, pembrolizumab-induced encephalopathy can be delayed significantly.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"173-175"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683921","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":"Creating and Implementing Wisconsin's First Emergency Department-Based Universal Opt-Out HIV Testing Program.","authors":"Andrew Petroll, Joanna Woodbury, Matthew Chin, Nathan Ledeboer, Jonathan Rubin, Dawn Zakzesky, Ian Martin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The Centers for Disease Control and Prevention recommends HIV screening for all patients aged 13 to 64. We sought to improve the health of our patient population by enacting universal HIV screening in our emergency departments.</p><p><strong>Methods: </strong>Universal opt-out HIV screening was implemented in 7 southeastern Wisconsin emergency departments and included linkage to care for those diagnosed with HIV.</p><p><strong>Results: </strong>In the first year of this initiative, 57 565 patients were screened for possible testing and 24 417 patients did not opt out (42.4%). In total, 12 406 HIV tests were performed in the first year of the program.</p><p><strong>Discussion: </strong>Our emergency department opt-out HIV screening initiative identified 23 new cases of HIV, approximately 10% of the average number of incident HIV cases in Wisconsin. We linked 96% of persons newly diagnosed with HIV to HIV medical care.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"157-161"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683925","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":"'From Good to Great': A Tribute to the Visionary Leadership Behind <i>WMJ</i>'s Transformation.","authors":"Fahad Aziz, Kendi Neff-Parvin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"87-89"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683928","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}