WMJ : official publication of the State Medical Society of Wisconsin最新文献_第7页

Caution Urged Regarding Role of Free Clinics in US. 呼吁谨慎对待美国免费诊所的作用。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

John J Frey

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Review of Cutaneous Blastomycosis Seen in Wisconsin. 威斯康星州皮肤布氏杆菌病回顾。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

Nina Punyamurthy, Kimberly Katz, Alan Vu, Nathan Duncan, Kimberly A Wanat

{"title":"Review of Cutaneous Blastomycosis Seen in Wisconsin.","authors":"Nina Punyamurthy, Kimberly Katz, Alan Vu, Nathan Duncan, Kimberly A Wanat","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Blastomycosis is a fungal infection caused by Blastomyces dermatitidis that is hyperendemic in Wisconsin. It commonly presents as a pulmonary infection and frequently disseminates to the skin. Studies evaluating the presentation and diagnosis of blastomycosis with skin as a presenting sign have not been thoroughly evaluated, and understanding the most accurate way to diagnose this infection is important for earlier therapeutic intervention.Methods: This is a retrospective chart review study of a single institution. Subjects were identified through a search of ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Classification of Diseases, Tenth Revision) codes for blastomycosis in the clinical record and pathology database. Patients were included if diagnosed with cutaneous blastomycosis infection or involvement of the skin from systemic infection from January 1, 2009, to June 1, 2021.Results: Twenty patients with a diagnosis of cutaneous involvement of blastomycosis were identified; 65% (n = 13) were male. Median age of diagnosis was 55.5 years. Fifty-five percent of patients were White, 35% were Black or African American. In addition to residence in an endemic area, 50% (n = 10) had exposure risk factors. Fifty percent of patients (n = 10) initially presented with a skin concerns; 65% (n = 13) had extracutaneous involvement. Diagnosis was made by histopathology alone in 55% (n = 11), culture plus histopathology in 35% (n = 7), and culture alone in 5% (n = 1) of cases.Conclusions: Our study highlighted similarities to those previously performed. Half of the patients (n = 10) who had cutaneous involvement of blastomycosis did not demonstrate clinically significant pulmonary involvement. Histopathology and culture remain critical in diagnosing cutaneous blastomycosis.","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891375","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}

引用次数: 0

Increased Incidence of Retinoblastoma in Wisconsin: Coincidence or Public Health Concern? 威斯康星州视网膜母细胞瘤发病率上升：巧合还是公共卫生问题？

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

Sudarshawn Damodharan, Eric Monroe

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Critical Reflection to Investigate Medical Student Attitudes Toward Skin Tone in Their Preclinical Years. 通过批判性反思调查医学生在临床前几年对肤色的态度。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

Molly Thapar, Elizabeth Dominguez, Katarina Stark, Johnathon Neist, Kerrie Quirk, Malika Siker, Jeffery D Fritz, Gretchen M Roth, Teresa Patitucci

{"title":"Critical Reflection to Investigate Medical Student Attitudes Toward Skin Tone in Their Preclinical Years.","authors":"Molly Thapar, Elizabeth Dominguez, Katarina Stark, Johnathon Neist, Kerrie Quirk, Malika Siker, Jeffery D Fritz, Gretchen M Roth, Teresa Patitucci","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Implicit racial bias, defined as unreasoned judgement based solely on an individual's skin color, is a persistent barrier to quality medical care for people of color in the United States. Early, learner-centered intervention is crucial to establish cultural competence within health professional training programs.Methods: Over 3 academic years, preclinical, second-year medical students were asked to submit an anonymous critical reflection regarding skin tone in medicine (n=794). Critical reflection is an instructional approach that encourages students to investigate their own thoughts and actions. Course credit was given based on the honor system. Reflection submission content and student feedback were analyzed quantitatively and qualitatively using constructivist thematic analysis.Results: Most students completed the assignment (93.0%) and reported feeling comfortable expressing themselves honestly in the anonymous format (84.6%). Students' comfort level with honesty declined if they would have had to identify themselves (50.8%). Student comments indicated relief to have a place to process experiences and emphasized the importance of anonymity for value of this assignment. Thematic analysis identified 2 themes and 13 subthemes among student submissions. Submissions varied in format and typically contained multiple codes (4.08 ± 1.77 subthemes), indicating that students participated meaningfully in the assignment.Conclusions: Although some educators may hesitate to address these topics, students at our institution appreciated having a space to process their thoughts. This assignment structure is an effective way for educators to address a difficult, sensitive, and important topic in a meaningful way with students.","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893155","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}

引用次数: 0

A Single Wisconsin High School Students' Projected Uptake of COVID-19 Vaccines at the Onset of Its Emergency Use Authorization. 威斯康星州一所高中学生在 COVID-19 疫苗紧急使用授权开始时的预计接种率。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

Krish Vasudev, Lyle Dp Mondano, Ainsley Regner

{"title":"A Single Wisconsin High School Students' Projected Uptake of COVID-19 Vaccines at the Onset of Its Emergency Use Authorization.","authors":"Krish Vasudev, Lyle Dp Mondano, Ainsley Regner","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: This study assessed high-school students' anticipated COVID-19 vaccine uptake following the US Food and Drug Administration Emergency Use Authorization - before its availability to adolescents - and compared it to current national vaccination rates in similar age groups.Methods: A web-based survey was conducted in January 2021. Data were analyzed using SurveyMonkey and SPSS. Predictors of vaccine willingness were explored.Results: One hundred twenty of 407 students responded, with 70% indicating willingness to receive the COVID-19 vaccine. Current data from the Centers for Disease Control and Prevention show a 72.2% uptake among the 12- to 17-year age group. Students with a general belief in vaccinations and those who self-identified as liberal were more willing to receive the vaccine.Discussion/conclusions: High school students exhibited positive attitudes towards COVID-19 vaccines, with acceptance influenced by general vaccine beliefs, political affiliation, and projected uptake rates aligned with national data.","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893147","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}

引用次数: 0

Early Access Physical Therapy: Utilizing Physical Therapists in Urgent Care and Emergency Settings. 早期物理治疗：在紧急护理和急诊环境中使用物理治疗师。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

Jeff Hartman, Sarah Nechvatal, Bringa Johnson

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The Art of Peer Review. 同行评审的艺术

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-05-01

David C Mallinson, Corlin Jewell, Fahad Aziz

引用次数: 0

Advanced Practice Providers' Wellness Essential for Health Care Organizations. 医疗机构高级医疗服务提供者的健康必备条件。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-02-01

Ashley Choudoir, Fahad Aziz

引用次数: 0

Feasibility Study of a Low-Carbohydrate/Time-Restricted Eating Protocol for Insulin-Using Type 2 Diabetic Patients. 针对使用胰岛素的 2 型糖尿病患者的低碳水化合物/限时饮食方案可行性研究。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-02-01

Philip N Zimmermann, Linda M Baier Manwell, Fauzia Osman, David Feldstein

{"title":"Feasibility Study of a Low-Carbohydrate/Time-Restricted Eating Protocol for Insulin-Using Type 2 Diabetic Patients.","authors":"Philip N Zimmermann, Linda M Baier Manwell, Fauzia Osman, David Feldstein","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: Low-carbohydrate diets and time-restricted eating are methods to improve hemoglobin A1C in patients with type 2 diabetes. However, insulin-using patients are often counseled against these practices due to hypoglycemia concerns. This observational study evaluated a protocol utilizing both methods coupled with proactive insulin titration.Objectives: To evaluate the safety and feasibility of a timed eating protocol for insulin-using patients and to assess its impact on outcomes, including insulin use and hemoglobin A1C.Methods: Participants included insulin-using adults ages 49 to 77 years with type 2 diabetes. They were counseled to eat 2 meals per day in a 6- to 8-hour window of their choosing, with a goal intake of ≤ 30 grams of carbohydrates per day. Glucose was closely monitored, and insulin was adjusted per study protocol. Primary outcomes included hypoglycemic events and compliance with timed eating. Insulin use, hemoglobin A1C, body mass index, blood pressure, and quality of life also were measured.Results: Nineteen of the 20 participants completed the 6-month study. No hypoglycemic events requiring urgent medical care occurred. Symptomatic episodes with glucose between 47 and 80 mg/dl were reported by 37% (7/19) of participants. Average daily insulin use decreased by 62.2 U (P < 0.001) and insulin was discontinued for 14 participants. Average hemoglobin A1C remained unchanged. Average body mass index decreased by 4.0 (P = 0.01), systolic blood pressure decreased by 9.9 mm Hg (P = 0.02), and diabetes-related quality-of-life metrics improved significantly.Conclusions: These results demonstrate that a time-restricted eating protocol is feasible and safe for insulin-using patients with type 2 diabetes when paired with a proactive insulin titration.","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140023885","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}

引用次数: 0

Postoperative Prescribing Practices Following Gynecologic Surgery. 妇科手术后的处方实践。

WMJ : official publication of the State Medical Society of Wisconsin Pub Date : 2024-02-01

Rachel J Craven, Madeline K Moureau, Heidi W Brown, Emily M Buttigieg

{"title":"Postoperative Prescribing Practices Following Gynecologic Surgery.","authors":"Rachel J Craven, Madeline K Moureau, Heidi W Brown, Emily M Buttigieg","doi":"","DOIUrl":"","url":null,"abstract":"Background: Opioids prescribed for postoperative pain have exceeded patient need in the United States, playing a significant role in the opioid epidemic. In the preintervention phase of this project (September 2018 - March 2019), a chart review and patient survey revealed that patients were prescribed double the number of opioids they consumed following gynecologic surgery.Objective: To ascertain whether an educational intervention recommending opiate prescriptions based on postoperative opioid use decreases gynecologic surgeons' opiate prescriptions.Methods: An educational intervention implemented in January 2021 communicated the discrepancy between patient need and medications prescribed and made prescribing recommendations for common gynecologic procedures. A postintervention (February 2021 - April 2021) retrospective chart review ascertained postoperative opioid prescribing practices. Residents were surveyed about their prescribing practices in June 2021. Descriptive statistics compared each phase.Results: For laparoscopic hysterectomy, the median morphine milligram equivalent (MME) was 150 (IQR 112.5-166.9) for preintervention and 150 (IQR 112.5-150) postintervention. For vaginal hysterectomy, median MME declined from 150 (IQR 112.5-225) to 112.5 (IQR 112.5-150). For laparoscopic surgery without hysterectomy, the median MME was 75 for both preintervention (IQR 75-120) and postintervention (IQR 60-80). For vaginal surgery without hysterectomy median MME went from 75 (IQR 75-142.5) to 54 (IQR 22.5-112.5). Median MME for hysteroscopy and dilation and curettage was 0 for both phases. When surveyed, residents reported prescribing lower amounts than actual prescribing practices.Conclusions: Despite education informing gynecologic surgeons that their opioid prescribing exceeded patient need, prescribing practices did not change. The difference between actual and resident-reported prescribing practices warrants further investigation.","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140023888","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}

引用次数: 0