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The Effect of a Mock Medical Visit on Refugee Health Self-Efficacy and Medical Trainee Communication Apprehension. 模拟医疗访问对难民健康自我效能感和医疗实习生沟通恐惧的影响。
Q3 Medicine Pub Date : 2023-03-01
Gabriel N De Vela, Caitlin Kaeppler, Sonia B Mehta, Jaimee M Hall, Kelsey Porada, Carmen E Cobb

Introduction: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health.

Methods: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees.

Results: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10).

Discussion: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.

导言:随着难民适应一个新的国家,他们的医疗保健可能会付出代价。难民可能难以适应新的医疗保健系统,健康自我效能感较低。另一个可能的因素是涉及难民健康问题的见习医疗课程不足。方法:我们设计了模拟临床体验,称为模拟医疗访问。在模拟医疗访问前后采用问卷调查对难民健康自我效能感量表和学员跨文化交际恐惧个人报告进行评估。结果:健康自我效能量表得分由13.67分提高到15.47分(P = 0.08, n = 15)。跨文化交际理解个人报告得分从27.1分下降到25.4分(P = 0.40, n = 10)。讨论:虽然我们的研究没有达到统计意义,但总体趋势表明,模拟医疗访问可以成为提高难民社区成员健康自我效能感和减少医学实习生跨文化交流恐惧的有价值的工具。
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引用次数: 0
Ambulatory Intensive, Multidisciplinary Telehealth for High-Risk Discharges: Program Development, Implementation, and Early Impact. 高风险出院的门诊密集、多学科远程医疗:项目开发、实施和早期影响。
Q3 Medicine Pub Date : 2023-03-01
Brian C Hilgeman, Geoffrey Lamb

Introduction: Creating and implementing programs aimed at reducing readmissions for high-risk patients is critical to demonstrate quality and avoid financial penalties. Intensive, multidisciplinary interventions providing care to high-risk patients utilizing telehealth have not been explored in the literature. This study seeks to explain the quality improvement process, structure, intervention, lessons learned, and early outcomes of such a program.

Methods: Patients were identified prior to discharge with a multicomponent risk score. The enrolled population was managed intensively for 30 days after discharge through a suite of services, including weekly video visits with an advanced practice provider, pharmacist, and home nurse; regular lab monitoring; telemonitoring of vital signs; and intensive home health visits. The process was iterative, including a successful pilot phase followed by an expanded health system-wide intervention analyzing multiple outcomes including satisfaction with video visits, self-rated improvement in health, and readmissions compared to matched populations.

Results: The expanded program resulted in improvements in self-reported health (68.9% reported health was some or greatly improved) and high satisfaction with video visits (89% rated satisfaction with video visits 8-10). Thirty-day readmissions were reduced compared to individuals with similar readmission risk scores discharged from the same hospital (18.3% vs 31.1%) and individuals who declined to participate in the program (18.3% vs 26.4%).

Conclusions: This novel model using telehealth to provide intensive, multidisciplinary care to high-risk patients has been successfully developed and deployed. Key areas for growth and exploration include developing an intervention that captures a greater percentage of discharged high-risk patients, including non-homebound patients, improving the electronic interface with home health care, and reducing costs while serving more patients. Data show that the intervention results in high patient satisfaction, improvements in self-reported health, and preliminary data showing reductions in readmission rates.

引言:创建和实施旨在减少高危患者再入院的项目对于展示质量和避免经济处罚至关重要。密集,多学科的干预措施提供护理高风险患者利用远程医疗尚未探讨在文献。本研究旨在解释质量改进过程、结构、干预、经验教训和早期结果。方法:在出院前用多成分风险评分对患者进行鉴定。入选人群出院后30天通过一系列服务进行集中管理,包括每周与高级执业医师、药剂师和家庭护士进行视频访问;实验室定期监测;生命体征远程监测;以及密集的家庭健康检查。该过程是反复进行的,包括一个成功的试点阶段,随后是一个扩大的卫生系统范围的干预,分析多种结果,包括对视频就诊的满意度、健康状况的自评改善以及与匹配人群相比的再入院率。结果:扩大后的项目改善了自我报告的健康状况(68.9%的人报告健康状况有一些改善或很大改善),对视频就诊的满意度也很高(89%的人认为视频就诊的满意度为8-10)。与从同一家医院出院的再入院风险评分相似的个体(18.3%对31.1%)和拒绝参加该计划的个体(18.3%对26.4%)相比,30天再入院率降低。结论:这种利用远程医疗为高风险患者提供密集、多学科护理的新型模式已经成功开发和部署。发展和探索的关键领域包括开发一种干预措施,以捕获更大比例的出院高风险患者,包括不在家的患者,改善家庭保健的电子界面,并在为更多患者服务的同时降低成本。数据显示,干预导致患者满意度高,自我报告健康状况改善,初步数据显示再入院率降低。
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引用次数: 0
One Hospital-Five Doors: A Model for Critical Access Hospital Sustainability. 一所医院五扇门:关键通道医院可持续发展模式。
Q3 Medicine Pub Date : 2023-03-01
Henry J Simpson, Dean B Eide, Richard A Helmers, Jason E Craig, Bailey G Salimes

Background: We wanted to assess whether a regional approach to bed management and staffing could improve financial sustainability without reducing services in rural communities.

Methods: Regional approaches to patient placement, hospital throughput, and staffing were coupled with enhanced services at 1 hub hospital and 4 critical access hospitals.

Results: We improved the use of patient beds in the 4 critical access hospitals, increased hub hospital capacity, and improved the health system's financial performance while maintaining or enhancing services at the critical access hospitals.

Discussion: Sustainability of critical access hospitals can be attained without a decrease in services for rural patients and communities. One way to achieve this result is to invest in and enhance care at the rural site.

背景:我们想评估在不减少农村社区服务的情况下,采用区域性的床位管理和人员配置方法是否可以改善财务可持续性。方法:在1个中心医院和4个关键通道医院采用区域方法对患者安置、医院吞吐量和人员配备进行改进。结果:我们改善了4家关键医院的病床使用情况,增加了中心医院的容量,并在维持或加强关键医院服务的同时改善了卫生系统的财务绩效。讨论:在不减少对农村病人和社区的服务的情况下,可以实现关键医院的可持续性。实现这一结果的一种方法是投资并加强农村地区的护理。
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引用次数: 0
'The Biggest Problem With Access': Provider Reports of the Effects of Wisconsin 2011 Act 217 Medication Abortion Legislation. “获取的最大问题”:威斯康星州2011年第217号法案药物流产立法影响的供应商报告。
Q3 Medicine Pub Date : 2023-03-01
Taryn M Valley, Meghan Zander, Laura Jacques, Jenny A Higgins

Background: Abortion legislation in the United States determines people's access to services, including the abortion modality of their choice. In 2012, Wisconsin legislators passed Act 217, banning telemedicine for medication abortion and requiring the same physician to be physically present when patients signed state-mandated abortion consent forms and to administer abortion medications over 24 hours later.

Objective: No research documented real-time outcomes of 2011 Act 217 in Wisconsin; this study documents providers' descriptions of the effects of Wisconsin abortion regulations on providers, patients, and abortion care in the state.

Methods: We interviewed 22 Wisconsin abortion care providers (18 physicians and 4 staff members) about how Act 217 affected abortion provision. We coded transcripts using a combined deductive and inductive approach, then identified themes about how this legislation affects patients and providers.

Results: Providers interviewed universally reported that Act 217 negatively affected abortion care, with the same-physician requirement especially increasing risk to patients and demoralizing providers. Interviewees emphasized the lack of medical need for this legislation and explained that Act 217 and the previously enacted 24-hour waiting period worked synergistically to decrease access to medication abortion, disproportionately affecting rural and low-income Wisconsinites. Finally, providers felt Wisconsin's legislative ban on telemedicine medication abortion should be lifted.

Conclusion: Wisconsin abortion providers interviewed underscored how Act 217, alongside previous regulations, limited medication abortion access in the state. This evidence helps build a case for the harmful effects of non-evidence-based abortion restrictions, which is crucial considering recent deferral to state law after the fall of Roe v Wade in 2022.

背景:美国的堕胎立法决定了人们获得服务的机会,包括他们选择的堕胎方式。2012年,威斯康星州的立法者通过了第217号法案,禁止远程医疗用于药物流产,并要求同一名医生在患者签署州强制流产同意书时在场,并在24小时后给患者服用流产药物。目的:没有研究记录2011年威斯康星州第217号法案的实时结果;本研究记录了提供者对威斯康星州堕胎法规对提供者、患者和该州堕胎护理的影响的描述。方法:我们采访了22名威斯康星州堕胎服务提供者(18名医生和4名工作人员)关于第217法案如何影响堕胎服务。我们使用演绎和归纳相结合的方法对文本进行编码,然后确定有关该立法如何影响患者和提供者的主题。结果:接受采访的提供者普遍报告说,第217号法案对堕胎护理产生了负面影响,同一医生的要求尤其增加了患者的风险,使提供者士气低落。受访者强调这项立法缺乏医疗需求,并解释说,第217号法案和以前颁布的24小时等待期协同作用,减少了获得药物流产的机会,不成比例地影响了农村和低收入的威斯康星人。最后,供应商认为威斯康星州对远程医疗药物流产的立法禁令应该解除。结论:接受采访的威斯康星州堕胎提供者强调了第217号法案如何与以前的法规一起限制了该州的药物堕胎。这一证据有助于为非循证堕胎限制的有害影响建立一个案例,考虑到最近在2022年罗伊诉韦德案(Roe v Wade)败诉后推迟到州法律,这一点至关重要。
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引用次数: 0
Pediatric Orbital Cellulitis/Abscess: Microbiology and Pattern of Antibiotic Prescribing. 儿科眼眶蜂窝织炎/脓肿:微生物学和抗生素处方模式。
Q3 Medicine Pub Date : 2023-03-01
Alina G Burek, Geanina Tregoning, Amy Pan, Melodee Liegl, Gerald J Harris, Peter L Havens

Introduction: The treatment for pediatric orbital cellulitis/abscess is trending towards intravenous antibiotic management alone in appropriate cases. Without cultures to guide therapy, knowing the local microbiology is of utmost importance in managing these patients.

Methods: We conducted a retrospective case series for patients age 2 months to 17 years, who were hospitalized between January 1, 2013, and December 31, 2019, to evaluate the local microbiology and pattern of antibiotic prescribing in pediatric orbital cellulitis.

Results and discussion: Of 95 total patients, 69 (73%) received intravenous antibiotics only and 26 (27%) received intravenous antibiotics plus surgery. The most common organism cultured was Streptococcus anginosus, followed by Staphylococcus aureus, and group A streptococcus. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence was 9%. MRSA-active antibiotics remain the most frequently used antibiotics.

儿童眼眶蜂窝织炎/脓肿的治疗在适当的情况下倾向于静脉注射抗生素治疗。在没有培养物指导治疗的情况下,了解当地微生物学对管理这些患者至关重要。方法:回顾性分析2013年1月1日至2019年12月31日期间住院的2个月至17岁儿童病例系列,评估儿童眼眶蜂窝织炎的局部微生物学和抗生素处方模式。结果与讨论:95例患者中,69例(73%)仅静脉注射抗生素,26例(27%)静脉注射抗生素加手术。最常见的细菌是血管链球菌,其次是金黄色葡萄球菌和A群链球菌。耐甲氧西林金黄色葡萄球菌(MRSA)患病率为9%。抗mrsa活性抗生素仍然是最常用的抗生素。
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引用次数: 0
Cannabidiol. 大麻二酚。
Q3 Medicine Pub Date : 2023-01-01
Kong Choua Thao, Abir T El-Alfy, Kristin Busse
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引用次数: 0
Auvelity (dextromethorphan/bupropion). Auvelity(右美沙芬/安非他酮)。
Q3 Medicine Pub Date : 2023-01-01
Anas Abuzoor, Abir T El-Alfy, Kristin Busse
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引用次数: 0
Elevating Science at the Medical College of Wisconsin. 威斯康辛医学院的科学提升课程。
Q3 Medicine Pub Date : 2022-12-01
Joseph E Kerschner
{"title":"Elevating Science at the Medical College of Wisconsin.","authors":"Joseph E Kerschner","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":"121 4","pages":"335-336"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10025968","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
Adherence to Clinical Practice Guidelines for Treatment of Bell's Palsy. 遵守贝尔氏麻痹治疗临床实践指南。
Q3 Medicine Pub Date : 2022-12-01
Nancy Ly, Bethany R Powers, Scott R Chaiet

Background: Bell's palsy is the most common cause of acute facial nerve paresis and paralysis with devastating disability yet high rate of spontaneous recovery. Patients who do not fully recover have functional disability that may require reconstructive surgery. The Clinical Practice Guideline: Bell's Palsy recommends treatment with high-dose steroids as it shows a higher likelihood of complete recovery. However, guideline adherence rates are inconsistent and unstudied.

Objective: To identify the frequency at which hospital-based clinicians at the University of Wisconsin-Madison follow recommended clinical guidelines and prescribe high-dose steroid medication.

Methods: Charts were reviewed from a single hospital (University Hospital) to evaluate Bell's palsy guideline adherence. All hospital-based encounters from 2008 through 2018 with primary diagnosis of Bell's palsy (ICD-9 351.0 and ICD-10 G51.0) were identified. Encounters were excluded if they had a diagnosis of Bell's palsy within 1 year prior (n=250) and did not have a medication list available (n=353). We examined patient demographics, common comorbidities, and any radiology and lab orders.

Results: We identified 565 patients with a primary diagnosis of Bell's palsy with available medication lists; 77.70% received the recommended treatment. The patients' median age was 47 (interquartile range 34-59), 52.16% were male, and 82.46% were treated by emergency medicine clinicians. Other treating clinicians were hospital-based primary care, otolaryngology and plastic surgery, and others. Multivariate analysis showed that treating clinician specialty was the only significant positive predictor.

Conclusions: A significant portion of clinicians followed treatment guidelines for Bell's palsy. Further and larger research is needed to better identify points of intervention to improve guideline adherence.

背景:贝尔麻痹是最常见的急性面神经麻痹和瘫痪的原因,具有毁灭性的残疾,但自发恢复率高。不能完全康复的患者有功能障碍,可能需要进行重建手术。临床实践指南:贝尔氏麻痹建议使用大剂量类固醇治疗,因为它显示出更高的完全恢复的可能性。然而,指南依从率是不一致和未经研究的。目的:确定以医院为基础的临床医生在威斯康星大学麦迪逊分校遵循推荐的临床指南和开大剂量类固醇药物的频率。方法:对一家医院(大学医院)的图表进行回顾,评估贝尔麻痹指南的依从性。确定了2008年至2018年期间所有初步诊断为贝尔麻痹(ICD-9 351.0和ICD-10 G51.0)的医院就诊情况。如果他们在1年内被诊断为贝尔麻痹(n=250),并且没有可用的药物清单(n=353),则排除。我们检查了患者的人口统计学特征、常见合并症以及任何放射学和实验室指令。结果:我们确定了565例初步诊断为贝尔麻痹的患者,并提供了可用的药物清单;77.70%的患者接受推荐治疗。患者年龄中位数为47岁(四分位间距34 ~ 59岁),男性占52.16%,82.46%的患者就诊于急诊临床医生。其他治疗临床医生是基于医院的初级保健,耳鼻喉科和整形外科等。多变量分析显示,治疗临床医师专业是唯一显著的正向预测因子。结论:相当一部分临床医生遵循贝尔麻痹的治疗指南。需要进一步和更大规模的研究来更好地确定干预点,以提高指南的依从性。
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引用次数: 0
Collaborative Rooming: An Innovative Pilot Project to Overcome Primary Care Challenges. 协作分房:克服初级保健挑战的创新试点项目。
Q3 Medicine Pub Date : 2022-12-01
Gagandeep Singh, Jill G Lenhart, Richard A Helmers, Michele Renee Eberle, Heather Costley, Joel B Roberts, Robert S Kaplan

Background: Primary care physicians are overburdened with growing complexities and increasing expectations for primary care visits. To meet expectations, primary care physicians must multitask during visits and spend extra hours in the office for charting, billing, and documentation. This impacts the physician's quality of life and may affect the quality of patient care. Many of the administrative tasks performed by physicians could, alternatively, be performed by nonphysician staff, leading to the adoption of team-based collaborative models.

Methods: Mayo Clinic Health System piloted a team-based collaborative model in a small physician practice in Osseo, Wisconsin, where which staff could be trained quickly and efficiently. The model used medical assistants/licensed practical nurses (MA/LPN) to partner with primary care physicians during a patient visit. The LPN/MA, under physician supervision, ordered and monitored pending orders/labs, coordinated patient care, provided after-visit educational needs, and communicated other urgent messages to team members.

Results: After 6 months, a comparison of pre- and posttrial data showed improved staff and patient satisfaction, decreased physician administrative work, and no cost-effectiveness improvement. Screening of medical conditions in the elderly improved, but no change was noted with chronic disease metrics.

Conclusions: Data showed improved staff and patient satisfaction, decreased physician clerical burden, increased appointment slots, mixed clinical outcomes, and did not demonstrate cost-effectiveness. The authors recommend that similar models be conducted in large settings to see if these results are reproducible.

背景:初级保健医生负担过重的复杂性和日益增长的期望初级保健访问。为了满足期望,初级保健医生必须在就诊期间多任务处理,并在办公室花费额外的时间来制作图表、账单和文档。这会影响医生的生活质量,并可能影响病人的护理质量。由医生执行的许多管理任务也可以由非医生人员执行,从而导致采用基于团队的协作模式。方法:Mayo Clinic Health System在威斯康辛州Osseo的一家小型医师诊所试行了一种基于团队的协作模式,该模式可以快速有效地培训员工。该模型使用医疗助理/执业护士(MA/LPN)在患者就诊期间与初级保健医生合作。LPN/MA在医生的监督下,订购和监测待处理的订单/实验室,协调患者护理,提供术后教育需求,并向团队成员传达其他紧急信息。结果:6个月后,比较试验前后的数据显示,工作人员和患者的满意度提高了,医生的行政工作减少了,但成本效益没有改善。老年人的医疗状况筛查有所改善,但慢性病指标没有变化。结论:数据显示提高了工作人员和患者的满意度,减少了医生文书负担,增加了预约时间,混合临床结果,并没有显示成本效益。作者建议在大型环境中进行类似的模型,看看这些结果是否可重复。
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引用次数: 0
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Wisconsin Medical Journal
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