Wisconsin Medical Journal最新文献

Background: Family medicine clinical education poses logistic issues that we sought to address with the Student Education Team model.

Methods: The model combined team-based, patient-centered care with student experiences in a sustainable precepting model. Four learners successfully underwent precepting simultaneously. Schedulers booked patients in the team schedule, and the patients knew they would see a student and a faculty team member.

Results: The Student Education Team model increased the learner to preceptor ratio compared to traditional precepting models. Use of the team increased the number of learners completing rotations. The team schedule nearly eliminated patients refusing student involvement and enhanced throughput because patients saw the most readily available staff.

Discussion: The team offered clinicians and learners a model for incorporating learning into clinicians' schedules.

Introduction: Pediatric hospital medicine physicians receive little formal training in communicating with interfacility referring clinicians. We sought to improve pediatric hospital medicine physician confidence and communication scores by 10% during patient triage calls from interfacility referring providers via a continuing professional development initiative.

Methods: We conducted a single-center 10-month quality improvement project. Confidence was assessed via survey before and after the initiative. A novel self- and peer-evaluation tool was used to assess accepting pediatric hospital medicine physician communication on recorded calls. Call assessment scores were measured at baseline, cycle 1, and cycle 2. Interventions included group discussion and development of a scripting flowsheet.

Results: Twenty pediatric hospital medicine physicians participated and completed a total of 203 call assessments. From baseline to post-initiative, general confidence communicating with referring clinicians increased by 13% (mean ranks 11.8, 16.8, respectively), and specific confidence communicating when there is a difference of opinion increased significantly by 37% (mean ranks 9.8, 19.2, P < 0.001). Interfacility transfer conversation evaluation scores increased by 11%.

Discussion: Our initiative improved accepting physician's confidence and communication evaluation scores using self- and peer-evaluation, group reflection, and a scripting flowsheet. Self- and peer-evaluation of recorded calls can be an effective intervention for building physician confidence in communicating with referring clinicians.

We describe a case of a 67-year-old African American man who presented to the emergency department with a sharp, pleuritic chest pain and shortness of breath. After several admissions and extensive workup, he ultimately was diagnosed with a persistent pleural effusion, pericardial effusion, and secondary constrictive pericarditis due to rheumatoid arthritis. By highlighting immunological disorders such as rheumatoid arthritis in the differential diagnosis, in the setting of a refractory pericardial effusion and serositis, this case report addresses key aspects of the presentation both in the emergency and inpatient settings, reviews the criteria for a rheumatoid arthritis diagnosis, and emphasizes areas of importance in predominantly cardiopulmonary extra-articular manifestations of a typically musculoskeletal disease.

Background: Simulation-based medical education, an educational model in which students engage in simulated patient scenarios, improves performance. However, assessment tools including the Oxford Non-Technical Skills (NOTECHS) scale require expert assessors. We modified this tool for novice use.

Methods: Medical students participated in 5 nontechnical simulations. The NOTECHS scale was modified to allow for novice evaluation. Three novices and 2 experts assessed performance, with intraclass correlation used to assess validity.

Results: Twenty-two learners participated in the simulations. Novice reviewers had moderate to excellent correlation among evaluations (0.66 < intraclass correlation coefficients [ICC] < 0.95). Novice and expert reviewers had moderate to good correlation among evaluations (0.51 < ICC < 0.88).

Discussion: The modified NOTECHS scales can be utilized by novices to evaluate simulation performance. Novice assessment correlates with expert review. These tools may encourage the use of simulation-based medical education.

Introduction: Despite universal newborn screening, there is no comprehensive surveillance system to understand the sickle cell disease population in Wisconsin.

Methods: We initiated the development of a sickle cell disease surveillance system by linking newborn screening data and electronic health records from 2 large tertiary health care institutions in Wisconsin: Children's Wisconsin and Froedtert Hospital.

Results: There were 1478 individuals within the 3 data sources. One hundred thirty-two (82%) of 159 identified by newborn screening from 2013 through 2019 received care at Children's Wisconsin. The majority of individuals with sickle cell disease at Children's Wisconsin and Froedtert Hospital resided in Milwaukee County.

Discussion: The new surveillance program will increase our understanding of the sickle cell disease population in Wisconsin and help improve quality of care and health outcomes.

Introduction: Alcohol-related mortality is increasing nationally, but state-specific trends still need to be explored. This paper reviews the patterning of alcohol-related deaths among Wisconsin residents in the 2 decades prior to the COVID-19 pandemic.

Methods: Data are from death certificates for state residents from 2000 through 2019. We used underlying cause of death codes (ICD-10) to classify deaths as 100% attributable to alcohol (ie, acute, chronic liver, and other chronic). Demographic characteristics were available for the most recent decedents (2015-2019). We assess trends in alcohol-related mortality and used chi-square tests to assess demographic differences compared to deaths from all other causes.

Results: The number of alcohol-related deaths more than doubled from 2000 through 2019 in Wisconsin, rising from 394 in 2000 to 857 in 2019. In the 5 most recent years (2015-2019), the populations with significantly higher rates of alcohol-related deaths included men, middle-aged adults, Black residents, and those of Hispanic descent. Education level also was significantly related to alcohol-attributable mortality, as those with the highest and lowest education levels were the least likely to die from this cause.

Discussion/conclusions: Results of these analyses show that the number of deaths due to alcohol-related diseases has risen significantly since 2000, and this trend preceded the COVID-19 pandemic. These rising mortality rates deserve the attention of the medical and public health communities. Our findings show that, in recent years, Hispanic individuals, men, and middle-aged adults are at a higher risk for alcohol-related deaths. Stakeholders may wish to consider interventions targeted to these groups.

Introduction: Although histoplasmosis is an extremely rare cause of bowel obstruction, this case describes disseminated gastrointestinal histoplasmosis as it progresses from acute colitis to subacute recurrent bowel obstructions.

Case presentation: A White man in his early 80s with history of multiple myeloma presented to the emergency department with lightheadedness and diarrhea. Following a diagnostic journey for unspecified colitis, urine antigen testing and endoscopic biopsies led to the diagnosis. During the initial 12 weeks of antifungal treatment, the disease process transitioned from an acute inflammatory syndrome into a recurrent bowel obstruction.

Discussion/conclusions: Only one other case of histoplasmosis causing recurrent bowel obstruction has been reported; however, that patient succumbed to the disease without surgical intervention. No clear guidelines exist of how to manage bowel obstructions from rare infectious sources, such as histoplasmosis, but close surveillance, multidisciplinary care, and an understanding of gastrointestinal pathology can guide clinicians when encountering atypical etiologies of bowel obstruction.

Introduction: The ketogenic diet is prescribed for seizures in some children with epilepsy. Children with type 1 diabetes are at risk for diabetic ketoacidosis caused by ketosis due to decreased insulin effect. Currently there are no clinical guidelines regarding the safety and efficacy of the ketogenic diet in patients with concurrent epilepsy and type 1 diabetes.

Objectives: This review examines the current literature regarding the association between TID and epilepsy, proposed mechanisms for the observed relationship, risks and benefits of the ketogenic diet, and clinical applications of the ketogenic diet in the context of type 1 diabetes and epilepsy.

Methods: PubMed was used to identify relevant articles. Key search terms included, "type 1 diabetes," "ketogenic diet," "seizure," "epilepsy," and "autoimmunity."

Results: There is an observed association between type 1 diabetes and epilepsy, with proposed mechanisms including genetic predisposition, anti-glutamic acid decarboxylase (GAD) antibodies, metabolic derangements and cerebrovascular damages. Case reports describe the use of the ketogenic diet for epilepsy management in children with diabetes with mixed results; however, there are no large, randomized controlled trials to evaluate the broader application of these findings.

Conclusions: In summary, there is inadequate evidence to support the use of the ketogenic diet in patients with coexisting epilepsy and type 1 diabetes in clinical practice. Further research is needed to determine the effectiveness, safety, and monitoring parameters of the ketogenic diet for these patients. The risks and benefits of the ketogenic diet as medical nutrition therapy for patients with both type 1 diabetes and epilepsy should be considered on an individualized basis.

Introduction: Communication and collaboration with an interprofessional team is vital for patient care, yet teaching these skills to resident physicians faces multiple challenges.

Methods: We developed an interactive, case-based curriculum on interprofessional communication and collaboration and implemented it at a large Veterans Affairs hospital. A pre/post survey study design was used to evaluate the curriculum, with 31 residents completing both surveys (100% response rate).

Results: After the curriculum, there was improvement in the residents' knowledge, comfort, and satisfaction in communicating and collaborating with the interprofessional team. Satisfaction scores with clinic also improved in all measures.

Discussion/conclusions: Overall, a curriculum aimed at teaching interprofessional communication and collaboration improved residents' comfort and satisfaction in this realm and may help them achieve competence in these challenging-to-teach skills.