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Getting SET for Student Success: Foundations for a Student Education Team. 为学生的成功做好准备:学生教育团队的基础。
Q3 Medicine Pub Date : 2022-12-01
Sarah M Strahm, Kimberly A Frodl, John Organick-Lee, Erica L Vogel, Stephanie M Raap, Justin Chilson, Mark E Deyo-Svendsen, Donn D Dexter, Terri Nordin

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.

背景:家庭医学临床教育提出了后勤问题,我们试图解决与学生教育团队模式。方法:将以团队为基础、以患者为中心的护理与学生体验相结合,形成可持续的教学模式。四名学习者成功地同时进行了诵读。调度员在团队日程中安排病人,病人知道他们会看到一个学生和一个教师团队成员。结果:与传统的教学模式相比,学生教育团队模式提高了学习者对指导者的比例。团队的使用增加了完成轮转的学习者数量。该团队的时间表几乎消除了拒绝学生参与的患者,并提高了吞吐量,因为患者看到了最方便的工作人员。讨论:团队为临床医生和学习者提供了一个将学习纳入临床医生日程安排的模型。
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引用次数: 0
Use of Peer- and Self-Evaluation to Improve Conversations with Interfacility Referring Clinicians. 使用同伴和自我评价来改善与机构间转诊临床医生的对话。
Q3 Medicine Pub Date : 2022-12-01
Anika Nelson, Svetlana Melamed, Sarah Corey Bauer, Erin Preloger, Kelsey Porada, Jennifer Hadjiev

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.

简介:儿科医院的内科医生在与机构间转诊临床医生沟通方面接受的正规培训很少。通过持续的专业发展计划,我们试图将儿科医院内科医生的信心和沟通分数在医院间转诊提供者的病人分诊电话中提高10%。方法:开展单中心10个月质量改善项目。信心是通过行动前后的调查评估的。一种新颖的自我和同行评价工具被用来评估接受儿科医院医学医师在录音通话中的沟通。在基线、周期1和周期2测量Call评估评分。干预措施包括小组讨论和脚本流程图的开发。结果:20名儿科医院内科医师参与并完成呼叫评估203次。从基线到倡议后,与转诊医生的一般信心沟通增加了13%(平均排名分别为11.8和16.8),当存在意见分歧时的具体信心沟通显著增加了37%(平均排名为9.8和19.2,P)。讨论:我们的倡议通过自我和同行评价、小组反思和脚本流程图提高了接受医生的信心和沟通评估得分。电话录音的自我和同行评价可以有效地干预建立医师与转诊临床医生沟通的信心。
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引用次数: 0
A Triad of Pericarditis, Pericardial Effusion, and Pleural Effusion as the Predominant Presentation of Rheumatoid Arthritis - A Case Report. 心包炎、心包积液、胸膜积液三联征为类风湿关节炎的主要表现- 1例报告。
Q3 Medicine Pub Date : 2022-12-01
Adam Devine, Michael Aljadah, Rebecca Weiner, Iryna Nemesh, Divyanshu Mohananey

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.

我们描述了一个病例67岁的非洲裔美国人谁提出了急诊科尖锐胸膜炎胸痛和呼吸急促。经过几次入院和广泛的检查,他最终被诊断为持续性胸腔积液、心包积液和继发性类风湿关节炎引起的缩窄性心包炎。通过在难治性心包积液和浆液炎的鉴别诊断中强调免疫疾病,如类风湿关节炎,本病例报告阐述了急诊和住院情况下表现的关键方面,回顾了类风湿关节炎的诊断标准,并强调了典型肌肉骨骼疾病的主要心肺关节外表现的重要领域。
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引用次数: 0
Simulation-Based Medical Education: Development of an Assessment Tool for Novice Use. 基于模拟的医学教育:为新手使用的评估工具的开发。
Q3 Medicine Pub Date : 2022-12-01
Sasha M Ulrich, Joseph C L'Huillier, Sarah A Jung, Laura K Krecko, Alexandra A Rosser, Amy K Schulze, Amy E Liepert, Ann P O'Rourke

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.

背景:基于模拟的医学教育是一种教育模式,在这种教育模式中,学生参与模拟的患者场景,可以提高成绩。然而,包括牛津非技术技能(NOTECHS)量表在内的评估工具需要专家评估人员。我们修改了这个工具以供新手使用。方法:医学生参与5次非技术模拟。对NOTECHS量表进行了修改,以允许新手进行评估。3名新手和2名专家评估绩效,用类内相关性评估效度。结果:22名学习者参与了模拟。新手审稿人评价间的相关性为中等至极优(0.66 <类内相关系数[ICC] < 0.95)。新手审稿人与专家审稿人的评价有中等至良好的相关性(0.51 < ICC < 0.88)。讨论:修改后的NOTECHS量表可用于新手评估模拟性能。新手评价与专家评价相关联。这些工具可能鼓励使用基于模拟的医学教育。
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引用次数: 0
Surveillance for the Rare Condition of Sickle Cell Disease in Wisconsin. 威斯康星州罕见镰状细胞病的监测。
Q3 Medicine Pub Date : 2022-12-01
Ashima Singh, Mahua Dasgupta, Dawn Retherford, Mei Baker, Mary Hulihan, Amanda M Brandow

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.

导读:尽管普遍的新生儿筛查,没有全面的监测系统来了解在威斯康星州镰状细胞病人群。方法:我们通过连接新生儿筛查数据和来自威斯康辛州儿童医院和Froedtert医院两家大型三级医疗机构的电子健康记录,启动了镰状细胞病监测系统的开发。结果:3个数据源共1478人。2013年至2019年通过新生儿筛查确定的159名新生儿中,有132名(82%)在威斯康星州儿童医院接受了护理。威斯康辛儿童医院和Froedtert医院的大多数镰状细胞病患者居住在密尔沃基县。讨论:新的监测计划将增加我们对威斯康星州镰状细胞病人群的了解,并有助于提高护理质量和健康结果。
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引用次数: 0
Increased Alcohol-Related Mortality in Wisconsin Pre-COVID: A Two-Decade Trend. 威斯康星州新冠肺炎前酒精相关死亡率上升:二十年趋势
Q3 Medicine Pub Date : 2022-12-01
Lynne Cotter, Thomas Bentley, Pamela Imm, Paul D Creswell

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.

导言:全国范围内与酒精相关的死亡率正在上升,但各州的具体趋势仍需探索。本文回顾了2019冠状病毒病大流行前20年威斯康星州居民与酒精相关的死亡模式。方法:数据来自2000年至2019年该州居民的死亡证明。我们使用潜在死亡原因代码(ICD-10)将死亡分类为100%可归因于酒精(即急性、慢性肝脏和其他慢性)。最近的死者(2015-2019年)的人口特征可用。我们评估了酒精相关死亡率的趋势,并使用卡方检验来评估与所有其他原因导致的死亡相比的人口统计学差异。结果:从2000年到2019年,威斯康星州与酒精相关的死亡人数增加了一倍多,从2000年的394人增加到2019年的857人。最近5年(2015-2019年),男性、中年人、黑人居民和西班牙裔美国人的酒精相关死亡率显著较高。受教育程度也与酒精导致的死亡率显著相关,因为受教育程度最高和最低的人死于这一原因的可能性最小。讨论/结论:这些分析结果表明,自2000年以来,酒精相关疾病导致的死亡人数显著上升,这一趋势早于COVID-19大流行。这些不断上升的死亡率值得医学界和公共卫生界的关注。我们的研究结果表明,近年来,西班牙裔个体、男性和中年人因酒精相关死亡的风险更高。利益攸关方不妨考虑针对这些群体的干预措施。
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引用次数: 0
Disseminated Histoplasmosis: An Unusual Cause of Bowel Obstruction. 弥散性组织胞浆菌病:肠梗阻的一种罕见病因。
Q3 Medicine Pub Date : 2022-12-01
Kent J Peterson, Michael R Rose, Caroline Davitt, Kirk A Ludwig

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.

虽然组织胞浆菌病是一种极其罕见的肠梗阻原因,但本病例描述了从急性结肠炎到亚急性复发性肠梗阻的弥散性胃肠道组织胞浆菌病。病例介绍:一名80岁出头的白人男性,有多发性骨髓瘤病史,以头晕和腹泻就诊于急诊科。在对未明确的结肠炎进行诊断后,尿抗原检测和内窥镜活检导致了诊断。在最初的12周抗真菌治疗期间,疾病过程从急性炎症综合征转变为复发性肠梗阻。讨论/结论:仅有一例组织胞浆菌病引起复发性肠梗阻的报道;然而,该患者在没有手术干预的情况下死于疾病。目前还没有明确的指南来指导如何处理来自罕见感染源的肠梗阻,如组织胞浆菌病,但密切监测、多学科护理和对胃肠道病理的了解可以指导临床医生在遇到非典型肠梗阻病因时。
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引用次数: 0
Intractable Seizures in Children With Type 1 Diabetes: Implications of the Ketogenic Diet. 1型糖尿病儿童难治性癫痫发作:生酮饮食的意义。
Q3 Medicine Pub Date : 2022-12-01
Kimberly K Vidmar, Allison J Pollock

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.

引言:生酮饮食是一些癫痫患儿癫痫发作的处方。1型糖尿病患儿由于胰岛素作用降低,易发生酮症引起的糖尿病酮症酸中毒。目前还没有关于生酮饮食在并发癫痫和1型糖尿病患者中的安全性和有效性的临床指南。目的:本文回顾了目前关于TID和癫痫之间关系的文献,提出了观察到的关系的机制,生酮饮食的风险和益处,以及生酮饮食在1型糖尿病和癫痫中的临床应用。方法:使用PubMed检索相关文献。关键搜索词包括“1型糖尿病”、“生酮饮食”、“癫痫”、“癫痫”和“自身免疫”。“结果:1型糖尿病和癫痫之间存在观察到的关联,其机制包括遗传易感性、抗谷氨酸脱羧酶(GAD)抗体、代谢紊乱和脑血管损伤。病例报告描述了在糖尿病儿童癫痫管理中使用生酮饮食的结果好坏参半;然而,目前还没有大型随机对照试验来评估这些发现的更广泛应用。结论:总的来说,在临床实践中,没有足够的证据支持生酮饮食在癫痫合并1型糖尿病患者中的应用。需要进一步的研究来确定生酮饮食对这些患者的有效性、安全性和监测参数。生酮饮食作为1型糖尿病和癫痫患者的医学营养疗法的风险和益处应在个体化的基础上加以考虑。
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引用次数: 0
Harnessing Data to Foster Research and Improve Population Health. 利用数据促进研究和改善人口健康。
Q3 Medicine Pub Date : 2022-12-01
Jomol P Mathew, Robert N Golden
{"title":"Harnessing Data to Foster Research and Improve Population Health.","authors":"Jomol P Mathew,&nbsp;Robert N Golden","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":"121 4","pages":"333-334"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10025965","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
Helping Residents Excel in Team-Based Care: An Interactive Case-Based Interprofessional Education Curriculum. 帮助住院医师在团队护理中脱颖而出:一个基于案例的互动式跨专业教育课程。
Q3 Medicine Pub Date : 2022-12-01
Cecilia Scholcoff, Katherine Sherman, Jessica Kuester, Amy Farkas

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.

简介:与跨专业团队的沟通和协作对于患者护理至关重要,然而向住院医师教授这些技能面临着多重挑战。方法:我们开发了一个交互式的、基于案例的跨专业沟通与协作课程,并在一家大型退伍军人事务医院实施。采用前后调查研究设计来评估课程,31名居民完成了两项调查(100%的回复率)。结果:课程结束后,住院医师与跨专业团队沟通合作的知识、舒适度和满意度均有提高。门诊满意度在各项指标上均有提高。讨论/结论:总体而言,旨在教授跨专业沟通和协作的课程提高了居民在这一领域的舒适度和满意度,并可能帮助他们在这些具有挑战性的教学技能中获得能力。
{"title":"Helping Residents Excel in Team-Based Care: An Interactive Case-Based Interprofessional Education Curriculum.","authors":"Cecilia Scholcoff,&nbsp;Katherine Sherman,&nbsp;Jessica Kuester,&nbsp;Amy Farkas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Communication and collaboration with an interprofessional team is vital for patient care, yet teaching these skills to resident physicians faces multiple challenges.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Discussion/conclusions: </strong>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.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":"121 4","pages":"313-315"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534578","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
期刊
Wisconsin Medical Journal
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