Wisconsin Medical Journal最新文献

Introduction: Medical student well-being is a major problem. The authors aimed to assess well-being outcomes 6-months after a novel extracurricular shared meal and resiliency course.

Methods: We implemented the course during 3 academic years (2018-2020). Participants received surveys assessing resilience, perspective-taking, self-compassion, and empathy at 4 timepoints. We used linear mixed effects models to assess changes from baseline to post-course assessments for the 3-year aggregate and pre-COVID and early-COVID time periods.

Results: One week and 6 months post-course, resilience, perspective-taking, and self-compassion scores improved (P < 0.01). Notably, resilience changed significantly only during early-COVID (P < 0.01), not pre-COVID (P = 0.16). For scores with evidence-based interpretation cut-offs, no clinical changes occurred.

Discussion: Several well-being measures statistically improved post-course but did not change clinically. Qualitative studies may better capture meaningful well-being outcome impact.

Introduction: To promote scientific inquiry, medical schools encourage medical students to participate in scholarly concentration programs (SCP). Manuscript publishing, a proxy of productivity, enhances medical student understanding of scientific inquiry. To evaluate an elective medical SCP offered between the first two years of medical school, the pediatrician authors' primary aim was to study the publishing productivity of the program participants in the University of Wisconsin (UW) School of Medicine and Public Health Department of Pediatrics compared to other departments. Secondary aims were to study whether productivity was influenced by the following predictors: (1) self-identified medical student gender, (2) working with a frequent mentor, (3) mentor degree, (4) funding source, and (5) area of research.

Methods: PubMed joint publications from 2002 through 2017 were searched using both medical student and mentor names through 2 years post-graduation.

Results: From all UW School of Medicine Public Health departments, 1108 medical students self-selected projects and mentors. One hundred two (9.2%) students chose the Department of Pediatrics. The majority of these students were female (61%) compared to female medical student participation (42%) in other departments (P = 0.0004). The majority of projects were clinical (53%), with basic science (26%) and public/global health (21%) following, though with more public/global health projects chosen in the Department of Pediatrics (P = 0.002) versus other departments. Overall, frequent mentors improved publication rates (P =0.0008), though frequent mentors (P = 0.45) and publication rates (P = 0.60) did not differ between pediatrics and other departments.

Conclusions: Medical students' SCP manuscript productivity benefitted from working with frequent mentors, but productivity in the Department of Pediatrics did not differ from other departments.

Introduction: Interdisciplinary rounds are a vital part of discharge planning; however, medical students receive little training in how to contribute effectively. Many existing discharge planning curricula are either prohibitively time consuming or narrowly focused. Addressing this gap can help improve interdisciplinary care and enhance the role of medical students on inpatient teams.

Methods: We developed a 30-minute curriculum on the purpose of interdisciplinary rounds, expected presentation content, and team members' roles and conducted a randomized controlled trial among medical students on their inpatient internal medicine rotation. Outcomes were measured using pre- and post-curriculum surveys and comparison of evaluations of student participation in interdisciplinary rounds.

Results: Eighty-six medical students participated in the study (59 intervention, 27 control), and we received 142 presentation evaluations (91 intervention, 51 control). There was significant post-curriculum improvement in all students' understanding of and comfort presenting in interdisciplinary rounds and knowledge of team members' roles. Presentation evaluations did not show a significant difference; however, students in the intervention group were better able to answer questions about their patients, with a difference approaching statistical significance (70% vs 57%, P = 0.069).

Conclusions: A brief, just-in-time curriculum improved learners' knowledge of interdisciplinary discharge rounds and showed a trend towards improvement in their ability to answer questions during rounds. Our curriculum can empower medical students to help their inpatient teams by participating in discharge rounds and can be integrated into existing curricula with minimal disruption.

Background: Amiodarone is the most effective and commonly used antiarrhythmic medication. Given its risk of toxicity, routine monitoring is recommended but is challenging to ensure in clinical practice.

Methods: We created an intelligent application, built within our electronic health record, that identified every living patient with an active outpatient prescription by a clinician in our health system. The application was designed to identify patients with lapses in recommended monitoring and facilitate scheduling of overdue testing.

Results: The percentage of patients with overdue monitoring tests decreased with use of the application, with greatest improvement in pulmonary function testing.

Discussion: Implementing a program to monitor and mitigate adverse reactions to amiodarone by using programable features of an electronic health record is feasible.

Background: Radiation therapy may result in complications, including fibrosis, which can result in pain and difficulty with movement - especially in the neck.

Case presentation: A 52-year-old man with right-sided vague neck pain unresponsive to conservative management had a computed tomography scan that showed a vagal paraganglioma in the carotid sheath surrounding the right carotid arteries and internal jugular vein. Following radiation therapy, he noticed a new pain in his right jaw and neck worse with certain movements of the neck. Nonsurgical conservative measures including physical therapy and pharmacological management were unsuccessful. An ultrasound evaluation demonstrated fibrosis beneath the sternocleidomastoid muscle and in proximity to the carotid sheath. After careful trajectory planning using ultrasound imaging, a 25 G needle was introduced real time in proximity to the fibrosis. Using a dexamethasone/saline mixture under real-time ultrasound guidance, adhesions were released. After 3 injections, the patient reported greater than 90% pain relief, which lasted 4 months. Subsequently, he required similar injections approximately every 3 months to achieve greater than 75% pain relief.

Conclusions: This is a successful demonstration of the utility of ultrasound evaluation and guidance for adhesiolysis following radiation therapy.

Introduction: Coccidioidomycosis is most often an asymptomatic or mild self-limited respiratory infection, but in rare cases it can become disseminated and cause severe disease.

Case presentation: A 29-year-old man who was originally from Thailand and had been living in Arizona for 2 years presented with intermittent fevers, fatigue, and other nonspecific symptoms, including abdominal pain, nonbloody diarrhea, and pruritic rash. Initial laboratory values showed significant peripheral eosinophilia. Extensive evaluation revealed possible Strongyloides species infection. Shortly after, Coccidioidies species fungemia was found. Fevers and symptoms resolved after adequate treatment.

Discussion: Disseminated coccidioidomycosis with fungemia is very rare in immunocompetent individuals. Co-infection with Stronglyloides species is only reported in two other case reports.

Conclusions: We report this case to raise awareness of a rare infection. In adequate epidemiological circumstances, co-infections Coccidioides and Strongyloides species should be considered in presence of fever and eosinophilia.

Introduction: Information about how the limited English proficiency immigrants make their decisions to seek health care is not well understood. With acculturation, immigrants tend to shift their beliefs and practices towards the practices of their host country. Yet, little is known whether this holds true for the Hmong's health care decision-making.

Methods: To understand the health care decision-making process of limited English proficiency Hmong, we conducted semistructured interviews with 11 Hmong adults with limited English proficiency. Interviews were audio-recorded, transcribed, and analyzed using directed and conventional content analysis.

Results: We identified several themes: participants sought advice and information from family members who were proficient in English and Hmong and/or who had a health background for a treatment that they perceived to be potentially life-threatening. However, participants were more reliant on their own decision-making in medical situations that were time sensitive. Participants without immediate family asked for health advice from community members or peers who had personal experience with the health condition or treatment.

Conclusions: Our findings suggest a cultural shift in Hmong health care decision-making processes from relying on clan leaders and elders to seeking out the advice of adult children and spouses. Understanding this change in cultural decision-making dynamics will help health care professionals provide more culturally competent care in areas where the Hmong community have a prominent presence.

Introduction: There is controversy over the existence of a metronidazole-induced disulfiram-like reaction. Uncontrolled case reports suggest metronidazole can cause a severe disulfiram-like reaction in combination with ethanol. Criticism of these cases suggest the observed effects appear to be as likely caused by ethanol as by a drug interaction. Controlled experimental data refute these reports, demonstrating metronidazole does not increase acetaldehyde and cannot reliably produce disulfiram-like reactions. The purpose of this study is to retrospectively assess the incidence of clinical effects consistent with a disulfiram-like reaction in a population of patients with confirmed ethanol use who received metronidazole. As alcohol may also be responsible for the effects seen, the incidence of effects is assessed against a control group matched for age, sex, and ethanol concentration.

Methods: A retrospective chart review was performed from December 1, 2010, through December 31, 2020 on emergency department patients with ethanol use confirmed via detectable ethanol concentration who received metronidazole while ethanol was predicted to still be present in the serum. A matched comparator group with the same ethanol concentrations, as well as sex and age, was generated for comparison. The incidence of disulfiram-like reaction symptoms documented in the medical record was compared between groups.

Results: Thirty-six patients were included in the study: 18 in the metronidazole group and 18 in the ethanol concentration matched control group. The mean age in both groups was 46 years. The metronidazole group was 50% male, and the mean ethanol concentration was 0.21 g/dL. The control group was 44.4% male. There was significantly less hypertension in the metronidazole group compared to the control group (16.7% vs 61.1%, P $lt;  0.0001). There were no other significant difference in disulfiram-like effects between the two groups. No patients who received metronidazole and had a detectable ethanol concentration had a suspected disulfiram-like reaction documented in the medical record.

Conclusions: This data set further supports the lack of a disulfiram-like reaction when metronidazole is used in patients with recent ethanol use in the acute care setting. Additionally, it highlights that the clinical effects of a disulfiram-like reactions may be present at baseline from ethanol ingestion or underlying disease regardless of metronidazole use. These findings are consistent with well-controlled human and animal data demonstrating no increase in acetaldehyde concentrations or disulfiram-like symptoms when metronidazole is co-administered with ethanol. In patients where metronidazole is indicated as the superior agent, its use should not be avoided due to concern about an interaction with ethanol.