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

{"title":"Incidence of Lymph Node Metastasis in Patients With a Preoperative Diagnosis of Endometrial Intraepithelial Neoplasia.","authors":"Matthew K Wagar, Allison Zinter, Stephanie M McGregor, Makeba Williams, Lisa M Barroilhet, Katherine Sampene","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Endometrial cancer is the most common gynecologic cancer in the United States, and endometrial cancer staging historically has included lymph node assessment to inform prognosis and guide recommendations for adjuvant treatment. This study sought to determine the incidence of lymph node involvement in patients undergoing hysterectomy with sentinel lymph node dissection for a preoperative diagnosis of endometrial intraepithelial neoplasia (EIN) to allow for risk stratification and management by general gynecology and gynecologic oncology.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients diagnosed with EIN who underwent hysterectomy from January 2018 through July 2021. We collected and analyzed patient characteristics, perioperative metrics, and postoperative data. Incidence of lymph node positivity on final pathology was the primary outcome of interest. We analyzed clinical and histologic risk factors for correlation with a final diagnosis of endometrial carcinoma. Chi-square, Fisher exact, and <i>t</i> tests were used for comparisons.</p><p><strong>Results: </strong>One hundred patients met inclusion criteria, 40 of whom had an underlying endometrial cancer. The majority were stage IA grade 1 endometrioid carcinomas (95%). Per institutional protocol, all patients were recommended sentinel lymph node dissection, of which 84 (84%) patients ultimately underwent lymph node dissection. One patient was found to have a positive sentinel lymph node on final pathology (1.2%). Increasing endometrial stripe thickness was positively associated with risk of endometrial carcinoma on final pathology (22.39 mm ± 31.87 vs 11.78 mm ± 5.17, <i>P</i> = 0.023).</p><p><strong>Conclusions: </strong>The incidence of lymph node involvement in patients with a preoperative diagnosis of EIN is low. Sentinel lymph node dissection is unlikely to affect adjuvant treatment recommendations following surgical staging. Standardized risk assessment methods are warranted for patients with a preoperative diagnosis of EIN to delineate the utility of lymph node assessment in this population.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"223-229"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071576","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":"An Innovative Course for the Clinical Years: A Look Back at the Last Decade.","authors":"Cynthia Kay, Leslie Ruffalo, Marika I Wrzosek, Carley Sauter, Ashley Pavlic, Mary Ann Gilligan, Kathleen Beckmann, Svetlana Melamed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>In the traditional 4-year medical school model, the final 2 years are the clinical years. These years bear challenges and experiences distinct from the preclinical part of medical school.</p><p><strong>Methods: </strong>We implemented a longitudinal, multifaceted, 2-year course involving advising, Objective Structured Clinical Examination, and discussions to help students at a private, Midwestern medical school navigate the clinical years, ensure graduation competencies are met, and prepare for residency. Participants were third- and fourth-year medical students from 2013 to 2022. The course, titled \"Continuous Professional Development,\" was run by a core group of faculty representing a variety of specialties.</p><p><strong>Results: </strong>At the end of each academic year, students completed evaluations on the components of the course and the course as a whole. Feedback was generally positive, with students rating the one-on-one advising and short sessions related to clerkship and residency transitions particularly beneficial.</p><p><strong>Conclusions: </strong>Students value educational content specifically tailored to their clinical experience. While having a single course responsible for multiple programs and sessions appears to be uncommon for undergraduate medical education, our course shows that it is possible and can be done effectively with a relatively small cohort of faculty.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"123-128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683919","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":"Intentional Hydroxychloroquine Overdose Leading to Severe Hypotension and Multiorgan Failure.","authors":"Drake Ws Giese, Katherine M Ernste, Muhammed B Gilani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The use of hydroxychloroquine for treating malarial infections and certain autoimmune diseases is well established, but data on hydroxychloroquine overdose and management are relatively scarce. Given its increased use in recent years and because life-threatening symptoms can occur within hours of ingestion, it is important to understand its potential for toxicity and available treatment options.</p><p><strong>Case presentation: </strong>We present a case of a 43-year-old male with intentional overdose of 6 grams hydroxychloroquine, along with 6 grams trazodone and 30 grams metformin. He presented in respiratory failure, later developing severe hypokalemia and electrocardiogram abnormalities. He was managed with activated charcoal, intravenous 20% lipid emulsion, intravenous epinephrine, intravenous diazepam, and intravenous sodium bicarbonate, which resulted in clinical improvement. Unfortunately, aspiration pneumonia and severe hypotension led to fatal multiorgan failure.</p><p><strong>Discussion: </strong>This case highlights the potential treatment options for hydroxychloroquine overdose, given its more recent use in the treatment of COVID-19 and increased incidence of toxicity.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"304-307"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071544","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":"Cultivating the Next Generation of Physician-Scholars.","authors":"Fahad Aziz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"203-204"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071464","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":"Cobenfy (xanomeline-trospium).","authors":"Brandon Johnson, Abir T El-Alfy, Kristin Busse","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 ","pages":"P1-P2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039582","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":"Shifting From 'Patient-Centered' to 'Patient-Wanted' Approach.","authors":"Gagandeep Singh","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058492","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":"Chlamydia and Gonorrhea Infection Rates in Wisconsin, 2010-2022.","authors":"Laura Jacques, Kyla Quiqley, Elise S Cowley, Kaitlyn Landry, Jessica Dalby, Ryan Westergaard","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chlamydia and gonorrhea are the most commonly reported bacterial communicable diseases in Wisconsin, with rising incidence rates despite effective treatments. Examining demographic trends can inform public health strategies.</p><p><strong>Methods: </strong>We analyzed Wisconsin Electronic Disease Surveillance System data (2010-2022) to assess chlamydia and gonorrhea incidence by sex, age, and race.</p><p><strong>Results: </strong>From 2010 through 2022, chlamydia rates in Wisconsin rose 4.9% (415.5 to 435.9 per 100 000), while gonorrhea rates increased 62.8% (90.7 to 147.7 per 100 000). Among females 15 to 24 years old, chlamydia rates declined 12.0% (3308.5 to 2912.8 per 100 000) but increased 30.1% (203.1 to 264.2 per 100 000) among females 25 years old and older. Gonorrhea rates rose 6.3% (574.7 to 610.6 per 100 000) in females 15 to 24 years old but nearly doubled (47.4 to 82.0 per 100 000) for those 25 and older. Among males 15 to 24 years old, chlamydia rates increased 10.7% (1046.4 to 1158.8 per 100 000) and increased 47.7% in males 25 years old and older (130.7 to 193.1 per 100 000). Gonorrhea rates rose 52.2% in males 15 to 24 years old (295.7 to 450.1 per 100 000) and rose 226.8% in males 25 years old and older (40.7 to 133.0 per 100 000). In 2010, chlamydia rates were 14 times higher and gonorrhea rates nearly 40 times higher among Black individuals compared to White individuals, narrowing to 11 and 30 times higher, respectively, by 2022.</p><p><strong>Conclusions: </strong>Chlamydia and gonorrhea incidence rates have risen across most populations in Wisconsin but disproportionately affect Black individuals, with the largest racial disparities seen in the nation. While chlamydia rates remained stable among young females, they increased among males and older adults. Gonorrhea rates surged across nearly all groups. These findings highlight the need for targeted interventions to expand screening, address structural barriers to health care, and reduce disparities.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"138-143"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683922","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":"Community Paramedic Pilot Program Operational Metrics and Impact on Patient Emergency Medical Services Utilization.","authors":"Michael Mancera, Nicholas Genthe, Megan Gussick, Michael Lohmeier, Manish Shah, Paul Hick, Christopher Carbon, Gail Campbell, Andy Stephani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Community paramedicine (CP) is an expanding area of interest within the field of emergency medical services. Few studies have established operational metrics and outcome measures for CP programs. We aimed to evaluate change in 911 use and operational metrics among patients enrolled in a pilot, fire department-based, CP program.</p><p><strong>Objective: </strong>The purpose of this study was to determine if the ongoing CP program decreased unscheduled emergency health care utilization among high utilizers. It was hypothesized that the implementation of community paramedicine visits would reduce 911 calls among this cohort.</p><p><strong>Methods: </strong>A retrospective cohort study of adults enrolled in a CP program during 2016 to 2020 was performed. Patients were enrolled in the CP program if they frequently used a community emergency department or 911 services. This was defined as greater than 4 uses in the past 12 months. A select group of experienced paramedics received targeted training in relevant concepts. Paramedics frequently contacted patients via both in-home visits and phone calls based on perceived clinical need. Through a review of electronic medical records, we collected patient demographic and clinical information and program operational metrics. The primary outcome of interest was the change in 911 use after enrollment. These 2 groups were compared using a paired <i>t</i> test.</p><p><strong>Results: </strong>Of 33 patients who met inclusion criteria, 29 were successfully enrolled. Pre-enrollment 911 calls averaged 31.8 calls per month. Post-enrollment 911 calls averaged 14.2 calls per month. Average calls per month decreased by 54.2% (<i>P</i> = .003) post-enrollment, a reduction of 207 calls per year across the cohort. Length of program enrollment also was found to have a greater impact on 911 call reduction.</p><p><strong>Conclusions: </strong>A fire-department based CP program effectively reduced 911 calls for high utilizer emergency medical services and emergency department patients by 54.2%. Program participation for 6 months or longer was associated with greater reductions in 911 calls, regardless of the number of existing comorbidities.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"102-105"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683924","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":"Evaluation of an Innovative Medical Student Course Integrating Medicine and Public Health.","authors":"Isha Jain, Parvathy Pillai, Patrick L Remington","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Educating medical students about the importance of integrating public health into their careers is challenging.</p><p><strong>Methods: </strong>Medical student demographics, weekly written reflections, and course evaluations for a storytelling-based, public health-oriented elective were reviewed.</p><p><strong>Results: </strong>Compared to students who did not enroll in the course, enrolled students were more likely to be female (71% vs 48%, P = 0.001). Student reflections revealed 2 major themes: (1) public health can be integrated into any specialty career; (2) career paths are often nonlinear. Students were highly satisfied with the course (mean 6.5, scale 1-7).</p><p><strong>Discussion: </strong>Courses aiming to inspire medical students to integrate public health into their career should consider a similar storytelling approach.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"165-168"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683927","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":"nequal Access to Sun Protection: Disparities in Sunscreen Availability in Wisconsin.","authors":"Simran Kaur, Eva M Shelton, Alexa Figueroa Baiges, Janmesh D Patel, Yaohui Gloria Xu","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"83-84"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683934","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}