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

{"title":"A Silent Wave: Increases in Wisconsin's Alcohol- Related Mortality During the COVID-19 Pandemic.","authors":"Thomas Bentley, Paul D Creswell","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Alcohol-related mortality is an increasing public health concern in the United States. To date, no study has considered trends in alcohol-related deaths during the full COVID-19 pandemic period.</p><p><strong>Methods: </strong>We analyzed deaths from Wisconsin vital statistics to explore the relationship between the pandemic period and any changes in alcohol-related mortality.</p><p><strong>Results: </strong>In Wisconsin, the pandemic period was associated with additional alcohol-related mortality above and beyond a previously reported upward trend.</p><p><strong>Discussion: </strong>We show that the COVID-19 pandemic was associated with exacerbated alcohol-related mortality in Wisconsin. Alcohol use may need to be considered as an additional public health risk in future pandemic scenarios.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"270-273"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071342","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 Eye for an Eye, An Ear for an Ear: A Midwestern Case Report of Vogt-Koyanagi-Harada Disease.","authors":"Neil Dixit, Emily Koller, Nicole Avendaño, Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Vogt-Koyanagi-Harada (VKH) disease is an autoimmune condition affecting both ocular and extraocular systems. This case highlights the need for research into the epidemiology and pathophysiology of VKH.</p><p><strong>Case presentation: </strong>A 23-year-old cisgender Hispanic female presented to our tertiary care center with severe headache, eye pain, vision changes, photophobia, hearing loss with tinnitus, phonophobia, nausea, vomiting, and vertigo. She was diagnosed with VKH disease.</p><p><strong>Discussion: </strong>This report shares a case of VKH disease in the Midwestern United States. A 2023 Northwestern University study highlights the orphan nature of the disease; even with a small sample size, that study proved to be a larger cohort in studies of VKH.</p><p><strong>Conclusions: </strong>This report contributes to the growing literature documenting VKH disease. Especially in diagnoses associated with certain racial groups, a broad differential diagnosis is essential, as delay in diagnosis may result in irreversible sequelae. Prompt coordination with colleagues may reduce subsequent morbidity and mortality.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"300-303"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071365","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":"The Empty SmartLink Solution: A Quality Improvement Initiative to Improve History and Physical Notes Documentation Using Clinical Decision Support.","authors":"Sabrina E Carro, Sarah Milota, Danita Hahn, Amanda Rogers, Sarah C Bauer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The use of structured documentation via auto-populated discrete fields is important to facilitate medical decision-making, research, and quality improvement. If these fields are not filed properly, they will appear \"empty,\" leaving behind incomplete documentation. Examples include past medical history (PMH), past surgical history (PSH), family history (FH), and active hospital problems (AHP).</p><p><strong>Objectives: </strong>Our SMART aim was to decrease the incidence of \"no PMH/PSH/FH/AHP on file\" in history and physical notes (H&Ps) at our single children's hospital from 7.9%, 18.7%, 8.3%, and 17.0%, respectively, to less than 5% over 4 months.</p><p><strong>Methods: </strong>A multidisciplinary team utilized quality improvement methodology. The population included all encounters admitted to pediatric hospital medicine. The outcome measure was percentage of H&Ps with \"no PMH/PSH/FH/AHP on file.\" The process measure was percentage of H&Ps using the proper template. Interventions included a clinical decision support tool in H&P templates to display a hard stop if \"no PMH/SH/FH/AHP on file\" appears and documentation education. Statistical process control charts were used to analyze measures.</p><p><strong>Results: </strong>\"No PMH/PSH/FH/AHP on file\" decreased from baseline to 1.2%, 2.2%, 2.9%, and 4.2%, respectively, showing special cause variation. H&P template use remained high at 87.2%.</p><p><strong>Conclusions: </strong>The creation of a simple clinical decision support tool was associated with a decreased incidence of \"no PMH/PSH/FH/AHP on file,\" achieving our goal. Utilizing automatic clinical decision support reduced the need to rely on education to cause a change, an important element of our tool. Future steps include implementation of a hard stop in other required areas of discrete documentation and ongoing evaluation of sustained change.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"236-242"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071532","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":"Mitochondrial Neurogastrointestinal Encephalomyopathy Presenting with Peripheral Neuropathy and Hearing Loss.","authors":"Milan Patel, Kaleb Keener, Gina LaWall, Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is a rare and often fatal genetic disorder caused by mutations in the thymidine phosphorylase gene (<i>TYMP</i>), leading to mitochondrial dysfunction. Symptoms include severe gastrointestinal and neurological issues, such as dysmotility, ophthalmoplegia, leukoencephalopathy, and peripheral neuropathy. Diagnosis typically is delayed until the second decade of life, with an average lifespan of 37 years.</p><p><strong>Case presentation: </strong>The patient is a 20-year-old female who initially presented with progressive bilateral peripheral lower extremity neuropathy. She was treated symptomatically for years prior to the onset hearing loss, which prompted further imaging and genetic workup revealing MNGIE. She then opted to undergo liver transplant and is awaiting a donor.</p><p><strong>Discussion: </strong>Currently, MNGIE treatment options include hematopoietic stem cell transplantation, orthotopic liver transplantation, hemodialysis, and platelet infusion. Hematopoietic stem cell transplantation treatments help restore TYMP gene activity, but carry with them increased risk of transplant-related morbidity and mortality. Orthotopic liver transplantation appears to have a more favorable safety profile when compared to hematopoietic stem cell transplantation.</p><p><strong>Conclusions: </strong>This case highlights the importance of adequate monitoring and interdisciplinary thinking, especially when caring for diseases with wide clinical manifestations. A thorough review of symptomology that includes various specialists may translate to improved diagnosis and care of MNGIE.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"287-290"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071555","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":"Climate Change Vulnerability and Opportunities for Adaptive Capacity in Patients with Heart Failure in an Ambulatory Setting.","authors":"Rachel Heschke, Abigail Thorgerson, Margaret Angeli, Joanne Bernstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change, a global crisis, affects health through changes such as more intense and longer lasting heatwaves. Some populations are more vulnerable to such events, including those with certain medical conditions, like heart failure. This study aimed to improve understanding of heat-related vulnerabilities and opportunities to enhance adaptive capacity of patients within an ambulatory heart failure clinic.</p><p><strong>Methods: </strong>Heart failure clinic patients at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin, voluntarily completed a 25-question multiple-choice survey. We present descriptive statistics of the survey responses with count and percentage for categorical responses.</p><p><strong>Results: </strong>We found that out of 60 survey respondents, 46.55% agreed or strongly agreed they would benefit from discussing heat illness risks with their physician, and 31.58% were not aware their heat illness risk is higher on days hotter than 90 °F (32.2 °C). Several vulnerability factors were common: 70.69% follow a prescribed fluid restriction, 33.33% live alone, 20.34% lack a car with air conditioning, and 20.00% worry about their ability to pay electric bills. Notable knowledge gaps included 65% do not check forecasted temperatures, 60% do not plan activities for the coolest times of day, 43.10% lacked awareness of cooling centers, 33.33% were unsure of heat illness symptoms, and 27.12% lacked awareness of Wisconsin's Focus on Energy program.</p><p><strong>Conclusions: </strong>A sizable portion of survey respondents indicated they would benefit from discussing their heat illness risk with their clinicians, and many underestimated their personal risk of heat illness. Additionally, multiple vulnerability factors were highly prevalent and knowledge gaps were demonstrated in this population. Our findings support adaptive capacity opportunities through heat illness education, anticipatory guidance, and increased resource awareness for patients with heart failure in an ambulatory setting.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"106-110"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683923","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":"Fibrocartilaginous Embolism Spinal Cord Infarction, Mistaken for Glial Fibrillary Acidic Protein Autoimmune Transverse Myelitis: A Case Report.","authors":"Felix E Chukwudelunzu, Timothy Young","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrocartilaginous embolism causing spinal cord infarct is rare, and a high index of clinical suspicion is needed for accurate diagnosis.</p><p><strong>Case presentation: </strong>A 65-year-old woman presented to our hospital with back pain, paraparesis, and neurogenic bladder. Magnetic resonance imaging showed a T4-T7 signal abnormality that was misdiagnosed initially and treated as autoimmune myelitis.</p><p><strong>Discussion: </strong>Fibrocartilaginous spinal cord infarction is rare and remains a clinical diagnosis with supportive imaging findings. The imaging findings may be nonspecific, and other etiologic diagnostic considerations must be excluded.</p><p><strong>Conclusion: </strong>Fibrocartilaginous embolism causing spinal cord infarct can be mistaken for transverse myelitis. A high index of clinical suspicion with clinical and radiologic correlation is necessary to make accurate diagnosis and avoid unnecessary treatment.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"63-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034258","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 LGBTQ+ Health Education in the Preclinical Curriculum at a Public Midwest Medical School.","authors":"Tess I Jewell, Elizabeth M Petty","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>People who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) face health disparities and negative health care experiences. Medical student education may be leveraged as a strategy to improve care for these patients; however, studies suggest gaps in current LGBTQ+ health education.</p><p><strong>Objective: </strong>This project sought to evaluate how LGBTQ+ health is taught in the preclinical curriculum at a Midwest medical school.</p><p><strong>Methods: </strong>The institution's curriculum repository was searched systematically for materials that included information on LGBTQ+ health used in preclinical courses in the 2021-2022 academic year. Information was compiled based on previously utilized evaluation tools and additional measurements developed by the authors to provide further clarity.</p><p><strong>Results: </strong>Seventy items were identified in the curriculum repository; 38 (54%) were required for students to review. Commonly addressed topics include communication skills, terminology, and variations in sex characteristics. Topic gaps identified include mental health, cancer screening, and gender-affirming care. Among the 33 clinical skills sessions in the preclinical curriculum, 5 standardized patient cases included LGBTQ+ patient representation.</p><p><strong>Conclusions: </strong>There was variability in coverage of LGBTQ+ health topics, with particularly more on language and variations in sex characteristics and less on mental health, cancer screening, and gender-affirming care. This study identifies opportunities to improve LGBTQ+ health education and demonstrates a framework that may be applied to evaluate curricula in other programs, to ideally enhance coverage of this material and, ultimately, improve care of LGBTQ+ patients.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059597","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":"The Importance of Body Donation to Wisconsin Health Science Programs and the Role a Health Care Team Can Play.","authors":"Meghan M Cotter, Ryan Hilmer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063382","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":"Hidden Bias in EMR Flagging Systems: A Call for Standardization.","authors":"Farzana Hoque","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 2","pages":"84"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683929","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 Doctors: Evaluating a Mental Health Initiative for Elementary Students.","authors":"Parnika Telagi, Jessica Liu, Bryan Johnston","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Brain Doctors is a community-engaged mental health education program developed using the Food Doctors model to enhance third-grade students' understanding of self and community wellness. This study serves as an evaluation of the pilot program.</p><p><strong>Methods: </strong>Two dynamic, interactive 1-hour sessions were created, with pre-session and post-session assessments used to measure student growth. The sessions were presented at 2 elementary schools in Milwaukee, Wisconsin by medical students. Feedback was gathered through participant satisfaction surveys following each session.</p><p><strong>Results: </strong>Student feedback indicated that most participants had a positive experience with the program. Pre-assessment (n = 116) and post-assessment (n = 125) results revealed areas of improvement and areas where performance declined.</p><p><strong>Discussion: </strong>The elementary students' positive response demonstrated their enthusiasm for the program. This study affirmed our perception that elementary and medical students can engage meaningfully in emotional wellness education.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"124 3","pages":"283-286"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071353","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}