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Stem Cell Science and Regenerative Biology: Tools for Building New Treatments. 干细胞科学和再生生物学:构建新疗法的工具。
Q3 Medicine Pub Date : 2023-09-01
Deneen M Wellik, Robert N Golden
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引用次数: 0
Medical Student Well-being Outcomes After a Novel Shared Meal and Resiliency Skills Course. 医学生在新的共享膳食和恢复能力技能课程后的幸福感。
Q3 Medicine Pub Date : 2023-09-01
Jessica C Babal, Liana Eskola, Andrea Jones, Roger J Schultz, Jens C Eickhoff

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.

引言:医学生的幸福感是一个主要问题。作者旨在评估一项新颖的课外共享膳食和弹性课程后6个月的幸福感结果。方法:我们在三个学年(2018-2020)实施了该课程。参与者在4个时间点接受了评估韧性、视角、自我同情和同理心的调查。我们使用线性混合效应模型来评估3年总时间段、新冠肺炎前和新冠肺炎早期从基线到疗程后评估的变化。结果:课程结束后1周和6个月,恢复力、视角和自我同情得分均有改善(P P P = 0.16)。对于具有循证解释截止值的评分,没有发生临床变化。讨论:一些幸福感指标在治疗后有统计学上的改善,但在临床上没有变化。定性研究可以更好地捕捉有意义的幸福感结果影响。
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引用次数: 0
The Impact of a Scholarly Concentration Program on Medical Student Research in Pediatrics. 学术集中计划对医学生儿科研究的影响。
Q3 Medicine Pub Date : 2023-09-01
Adam S Bauer, Pamela J Kling, Vera Tsenkova, Ethan Rosen, Elizabeth Petty

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.

引言:为了促进科学探究,医学院鼓励医学生参加学术集中计划(SCP)。手稿出版是生产力的代表,提高了医学生对科学探究的理解。为了评估医学院前两年提供的选择性医学SCP,儿科医生作者的主要目的是研究威斯康星大学医学院和公共卫生部儿科项目参与者与其他部门相比的出版生产力。次要目的是研究生产力是否受到以下预测因素的影响:(1)自我识别的医学生性别,(2)与经常的导师合作,(3)导师学位,(4)资金来源,以及(5)研究领域。方法:检索2002年至2017年PubMed联合出版物,使用医学生和导师的名字,直到毕业后2年。结果:来自华盛顿大学医学院公共卫生部门的1108名医学生自主选择了项目和导师。102名(9.2%)学生选择了儿科。这些学生中的大多数是女性(61%),而其他部门的女性医学生参与率(42%)(P = 0.0004)。大多数项目是临床(53%),基础科学(26%)和公共/全球卫生(21%)紧随其后,尽管儿科选择了更多的公共/全球健康项目(P = 0.002)与其他部门相比。总的来说,频繁的导师提高了发表率(P=0.0008),尽管频繁的导师(P = 0.45)和发表率(P = 0.60)在儿科和其他科室之间没有差异。结论:医学生的SCP手稿生产力得益于与频繁的导师合作,但儿科的生产力与其他部门没有差异。
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引用次数: 0
Teaching Students to Care (Coordinate): A Randomized Controlled Trial. 教学生关心(协调):一项随机对照试验。
Q3 Medicine Pub Date : 2023-09-01
Lara Voigt, James McCarthy, Ankur Segon

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.

导言:跨学科查房是出院规划的重要组成部分;然而,医学生很少接受如何有效贡献的培训。许多现有的出院规划课程要么耗费大量时间,要么重点狭窄。解决这一差距有助于改善跨学科护理,并加强医学生在住院团队中的作用。方法:我们制定了一份30分钟的课程表,内容包括跨学科查房、预期演讲内容和团队成员的角色,并在医学生中进行了一项关于住院内科轮换的随机对照试验。结果是通过课程前和课程后的调查以及对学生参与跨学科轮次的评估进行比较来衡量的。结果:86名医学生参与了这项研究(59名干预者,27名对照者),我们收到了142份陈述评估(91份干预者,51份对照者)。在课程结束后,所有学生对跨学科轮次的理解和舒适感以及对团队成员角色的了解都有了显著提高。陈述评价没有显示出显著差异;然而,干预组的学生能够更好地回答有关患者的问题,差异接近统计学意义(70%对57%,P = 0.069)。结论:简短、及时的课程提高了学习者对跨学科出院查房的知识,并显示出在查房期间回答问题的能力有所提高的趋势。我们的课程可以让医学生通过参加出院查房来帮助他们的住院团队,并可以在最小干扰的情况下融入现有课程。
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引用次数: 0
Amiodarone Pharmacovigilance Through an Intelligent Electronic Health Record Application. 胺碘酮药物警戒通过智能电子健康记录应用。
Q3 Medicine Pub Date : 2023-09-01
Olivia R Newgaard, Rajeev Chaudhry, Jenny A Schutte, Richard Arndt, Jennifer R Rich, Andrew D Calvin, Richard D Hanna

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.

背景:胺碘酮是最有效和最常用的抗心律失常药物。鉴于其毒性风险,建议进行常规监测,但在临床实践中难以确保。方法:我们创建了一个智能应用程序,建立在我们的电子健康记录中,该应用程序通过我们卫生系统中的临床医生的有效门诊处方来识别每一位在世的患者。该应用程序旨在识别在推荐监测中出现失误的患者,并便于安排逾期检测。结果:随着应用程序的使用,逾期监测检查的患者比例下降,肺功能检查改善最大。讨论:通过使用电子健康记录的可编程功能,实施一项监测和减轻胺碘酮不良反应的计划是可行的。
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引用次数: 0
Neck Pain Secondary to Post Radiation Fibrosis Managed With Ultrasound-Guided Adhesiolysis. 超声引导下松解术治疗放疗后纤维变性继发的颈部疼痛。
Q3 Medicine Pub Date : 2023-09-01
Mackenzie McGrath, Hariharan Shankar

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.

背景:放射治疗可能导致并发症,包括纤维化,这可能导致疼痛和行动困难 - 尤其是颈部。病例介绍:一名52岁的男子患有右侧模糊颈部疼痛,对保守治疗没有反应,他进行了计算机断层扫描,显示右侧颈动脉和颈内静脉周围的颈动脉鞘中有迷走神经副神经节瘤。放射治疗后,他注意到右下颌和颈部出现了新的疼痛,随着颈部的某些运动,疼痛加剧。包括物理治疗和药物治疗在内的非手术保守措施均未成功。超声评估显示胸锁乳突肌下方和颈动脉鞘附近存在纤维化。在使用超声成像仔细规划轨迹后,在纤维化附近实时引入25G针头。在实时超声引导下使用地塞米松/生理盐水混合物,释放粘连。3次注射后,患者的疼痛缓解率超过90%,持续了4个月。随后,他需要大约每3个月进行一次类似的注射,以达到75%以上的疼痛缓解。结论:这是超声评估和指导放射治疗后粘连松解术实用性的成功证明。
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引用次数: 0
Exploring the Feasibility of POCUS Training for Advanced Practice Providers at an Academic Medical Center. 探索在学术医疗中心为高级实践提供者进行POCUS培训的可行性。
Q3 Medicine Pub Date : 2023-09-01
Abhilash Koratala, Paige Gioia, Devin Madenberg, Anu Taylor
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引用次数: 0
Disseminated Coccidioidomycosis With Fungemia and Possible Strongyloides Co-infection. 播散性球孢子菌病伴真菌血症和可能的圆形线虫合并感染。
Q3 Medicine Pub Date : 2023-07-01
Julie Jerabek, Ahmed Abdulrahim, Stephen Cavalieri, Kelsey Witherspoon, Rima El-Herte

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.

球虫病通常是一种无症状或轻微的自限性呼吸道感染,但在极少数情况下,它可以传播并引起严重的疾病。病例介绍:一名29岁男性,原籍泰国,在亚利桑那州居住2年,出现间歇性发热、疲劳和其他非特异性症状,包括腹痛、非出血性腹泻和瘙痒性皮疹。最初的实验室值显示明显的外周嗜酸性粒细胞增多。广泛的评估显示可能存在类圆线虫感染。不久,又发现球虫属菌类。适当治疗后发热和症状消失。讨论:播散性球孢子菌病伴真菌血症在免疫正常的个体中非常罕见。与类强线虫物种的共同感染仅在另外两例报告中报告。结论:我们报告这个病例是为了提高人们对一种罕见感染的认识。在适当的流行病学情况下,在出现发烧和嗜酸性粒细胞增多的情况下,应考虑球虫和圆线虫的共同感染。
{"title":"Disseminated Coccidioidomycosis With Fungemia and Possible <i>Strongyloides</i> Co-infection.","authors":"Julie Jerabek,&nbsp;Ahmed Abdulrahim,&nbsp;Stephen Cavalieri,&nbsp;Kelsey Witherspoon,&nbsp;Rima El-Herte","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Coccidioidomycosis is most often an asymptomatic or mild self-limited respiratory infection, but in rare cases it can become disseminated and cause severe disease.</p><p><strong>Case presentation: </strong>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 <i>Strongyloides</i> species infection. Shortly after, <i>Coccidioidies</i> species fungemia was found. Fevers and symptoms resolved after adequate treatment.</p><p><strong>Discussion: </strong>Disseminated coccidioidomycosis with fungemia is very rare in immunocompetent individuals. Co-infection with <i>Stronglyloides</i> species is only reported in two other case reports.</p><p><strong>Conclusions: </strong>We report this case to raise awareness of a rare infection. In adequate epidemiological circumstances, co-infections <i>Coccidioides</i> and <i>Strongyloides</i> species should be considered in presence of fever and eosinophilia.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":"122 3","pages":"200-204"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9872627","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
How Patients With Limited English Proficiency Make Health Care Decisions: Hmong Patients' Perspectives. 英语水平有限的患者如何做出医疗保健决定:苗族患者的观点。
Q3 Medicine Pub Date : 2023-07-01
Phia Xiong, Maichou Lor, Linda S Park, Elizabeth A Jacobs

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.

关于英语水平有限的移民如何决定寻求医疗保健的信息尚不清楚。随着文化适应,移民倾向于将他们的信仰和做法转向东道国的做法。然而,很少有人知道这是否适用于苗族人的医疗保健决策。方法:为了了解英语水平有限的苗族人的医疗保健决策过程,我们对11名英语水平有限的苗族成年人进行了半结构化访谈。访谈录音,转录和分析使用定向和传统的内容分析。结果:我们确定了几个主题:参与者向精通英语和苗族语的家庭成员和/或有健康背景的家庭成员寻求建议和信息,以接受他们认为可能危及生命的治疗。然而,在时间敏感的医疗情况下,参与者更依赖于自己的决策。没有直系亲属的参与者向有过健康状况或治疗经历的社区成员或同龄人询问健康建议。结论:我们的研究结果表明,苗族医疗保健决策过程的文化转变,从依赖族长和长老到寻求成年子女和配偶的建议。了解文化决策动态的这种变化将有助于卫生保健专业人员在苗族社区有突出存在的地区提供更具文化能力的护理。
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引用次数: 0
Can Metronidazole Cause a Disulfiram-Like Reaction? A Case-Control Study Propensity Matched by Age, Sex, and Ethanol Concentration. 甲硝唑能引起双硫仑样反应吗?一项病例对照研究倾向与年龄、性别和乙醇浓度相匹配。
Q3 Medicine Pub Date : 2023-07-01
Ryan Feldman, Rachael Jaszczenski

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.

简介:甲硝唑诱导的双硫仑样反应存在争议。不受控制的病例报告表明,甲硝唑与乙醇结合可引起严重的双硫仑样反应。对这些病例的批评表明,观察到的影响似乎是由乙醇引起的,也可能是由药物相互作用引起的。对照实验数据反驳了这些报告,证明甲硝唑不会增加乙醛,也不能可靠地产生双硫仑样反应。本研究的目的是回顾性评估在接受甲硝唑治疗的确认使用乙醇的患者群体中与双硫仑样反应一致的临床效应发生率。由于酒精也可能对所见的影响负责,因此对影响的发生率进行了评估,以对照年龄,性别和乙醇浓度相匹配的对照组。方法:对2010年12月1日至2020年12月31日期间接受甲硝唑治疗且预测血清中仍存在乙醇的急诊科乙醇使用患者进行回顾性图表回顾,这些患者通过检测乙醇浓度证实使用了乙醇。一个匹配的比较组,具有相同的乙醇浓度,以及性别和年龄,产生比较。比较医疗记录中记录的双硫仑样反应症状的发生率。结果:共纳入36例患者,甲硝唑组18例,乙醇浓度匹配对照组18例。两组患者的平均年龄均为46岁。甲硝唑组男性占50%,平均乙醇浓度0.21 g/dL。对照组男性占44.4%。甲硝唑组高血压发生率明显低于对照组(16.7% vs 61.1%, P $lt;0.0001)。两组之间在双硫仑样效应方面没有其他显著差异。接受甲硝唑治疗并检测到乙醇浓度的患者在医疗记录中没有出现疑似双硫仑样反应。结论:该数据集进一步支持急性护理环境中近期使用乙醇的患者使用甲硝唑时缺乏双硫仑样反应。此外,该研究强调,无论是否使用甲硝唑,双硫仑样反应的临床效应可能存在于乙醇摄入或潜在疾病的基线。这些发现与控制良好的人类和动物数据一致,表明当甲硝唑与乙醇共给药时,乙醛浓度或双硫仑样症状没有增加。在甲硝唑作为首选药物的患者中,不应由于担心与乙醇的相互作用而避免使用甲硝唑。
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引用次数: 0
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Wisconsin Medical Journal
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