Wisconsin Medical Journal最新文献

Introduction: Patient care reports contain critical elements related to interventions rendered and medical decision-making. Yet, little consensus exists around reader expectations, leaving emergency medical services (EMS) providers unaware of critical content.

Objectives: This 2-phase study aimed to answer the questions "What do EMS providers know about report readers?" and "What do report readers expect from reports?" through surveys and interviews. In doing so, this study gauged EMS providers' audience awareness of report readership and determined what readers expected from reports.

Methods: A prospective survey was conducted with 57 EMS providers to gauge their level of audience awareness or how often they thought of specific report reader groups when writing reports. Interviews were conducted with 14 report readers following retrospective think-aloud protocol, where participants verbalized their questions, comments, and concerns about reports while reading.

Results: Surveys indicate participants lacked a full, accurate sense of audience awareness. When writing reports, they thought of audiences, such as patients, who do not regularly read reports, while reporting not thinking of actual report readers-such as billing specialists-often or at all. Interview analysis indicated that report readers looked for 21 elements in high-quality, effective report narratives.

Conclusions: These data formalize and reinforce what a high-quality narrative should include, with "high-quality" meaning the narrative allows readers to do their jobs without follow-up or an amendment needed to the report.

Background: Medical students represent the next generation of physician educators, yet may not be prepared to meet future teaching responsibilities.

Methods: An electronic survey was sent to medical students at a US allopathic institution to assess their experience, interest, and confidence in teaching.

Results: Most students indicated interest in teaching medical students (n = 91, 62%) or residents (n = 88, 60%) postresidency. Less than half expressed confidence in teaching clinical interviewing/physical exam skills (n = 71, 49%), lecture/didactic (n = 62, 42%), and procedural techniques (n = 41, 28%).

Discussion: Many medical students identified having only nascent medical teaching skills and expressed interest in elective opportunities. Formal teaching programs are necessary to cultivate medical students as effective physician educators.

Introduction: The vascular form of Ehlers-Danlos syndromes occurs due to alterations in the COL3A1 gene. It has been associated with major vascular and hollow organ complications, leading to increased morbidity and mortality rates with pregnancy.

Case presentation: We report a woman (gravida 9, para 9) diagnosed with vascular Ehlers-Danlos syndrome in her 70s after bowel rupture. Genetic testing revealed a null mutation in COL3A1 that is predicted to result in haploinsufficiency. Preceding diagnosis, she had 9 pregnancies with minimal complications.

Discussion: While no evidence-based guidelines for obstetric care in vascular Ehlers-Danlos syndrome have been well-established, patients often are counseled and followed as high-risk pregnancies.

Conclusions: Null mutations resulting in haploinsufficiency likely have lower pregnancy risks than reported in the literature for vascular Ehlers-Danlos syndrome overall. Thus, understanding the specific COL3A1 mutation may help optimize counseling regarding pregnancy and facilitate decision-making regarding management.

Background: Significant interpersonal barriers impede the delivery of quality adolescent health care. While a complex issue, public health and health care entities continue to seek ways to work with the populations they serve to better address such challenges.

Methods: The PATCH Teen Educator Program, an initiative of the Providers and Teens Communicating for Health (PATCH) Program, promotes open, honest, and medically accurate conversations between health care professionals and adolescents via youth-led workshops for both clinicians and adolescents.

Results: Across 6 program sites, workshop participants noted positive changes towards enhancing patient-clinician communication. Youth facilitators also reported notable changes related to workforce and youth development after their 9-month commitment to the program.

Discussion: These results showcase promising effects of the youth-driven initiative on enhancing local adolescent patient-clinician communication, as well as effects on engaged youth.

Background and objectives: Many highly capitated systems still pay physicians based on relative value units (RVU), which may lead to excessive office visits. We reviewed electronic health records from the family medicine clinic panel members of 97 physicians and 42 residents to determine if a change from RVUs to panel-based compensation influenced care delivery as defined by the number of office visits and telephone contacts per panel member per month.

Methods: A retrospective analysis of the electronic health records of patients seen in 4 residency training clinics, 10 community clinics, and 4 regional clinics was conducted. We assessed face-to-face care delivery and telephone call volume for the clinics individually and for the clinics pooled by clinic type from 1 year before to at least 1 year after the change.

Results: Change in physician compensation was not found to have an effect on office visits or telephone calls per panel member per month when pooled by clinic categories. Some significant effects were seen in individual clinics without any clear patterns by clinic size or type.

Conclusions: Change in physician compensation was not a key driver of care delivery in family medicine clinics. Understanding changes in care delivery may require looking at a broad array of system, physician, and patient factors.

Introduction: Tobacco dependence treatment is usually offered in primary care settings. Yet, if many patients who smoke do no not access primary care, cessation interventions may be missing those who most need them. This study describes Wisconsin adults' health care utilization by smoking status.

Methods: Data were analyzed from 1726 individuals participating in a population-based, cross-sectional, in-person health survey of Wisconsin residents (2014-2016). Demographic characteristics were compared across smoking status using Wald chi-square tests weighted for the complex survey design. Odds ratios were calculated using multivariate logistic regression models.

Results: Of 1726 respondents, 15.3% reported current smoking, 25.4% former smoking, and 59.4% never smoking. Those currently smoking were more likely than former- or never-smoking respondents to report emergency departments as their "usual place to go when sick" (12% vs 3%) or report they had "no place to go when sick" (16% vs 7%). People who currently smoke also reported more emergency department visits during the past year (mean = 1.4 visits) than did others (mean = 0.4, P< 0.01). Among those currently smoking, 18% reported that they "needed health care but didn't get it" over the past year, compared to 6% of others (P<  0.01). Those currently smoking also were more likely to report a "delay in getting care" (16% vs 9%, P = 0.02) and were less likely to have had a "general health checkup" within the past year (58% vs 70%, P<  0.02). These relationships persisted in logistic regression models controlling for variables related to smoking status and health care utilization, including health insurance.

Conclusions: These findings suggest that more than a quarter of Wisconsin adults who smoke do not receive primary care every year and that they delay care or seek care in emergency departments more frequently than do those who never smoked or who quit smoking. As a result, such individuals may be missing out on evidence-based tobacco cessation treatment.

Background: Current estimates of snowmobile-related injuries are largely based on inpatient data from trauma centers. These centers care for severely injured patients and may not capture treatment information and outcomes for minor snowmobile-related injuries, therefore underestimating their volume and overestimating patient acuity.

Methods: Medically attended snowmobile injuries were identified retrospectively from inpatient and outpatient records from a health system in north-central Wisconsin using a hierarchical method of International Classification of Diseases external cause codes and text searches for key words. Manual reviews of the medical record collected information on patient characteristics, accident details, and clinical information. Descriptive analyses, comparisons between hospital admitted and nonadmitted cases, and calculations of seasonal incidence rates were conducted.

Results: From November 1, 2013, through April 30, 2018, there were 1013 snowmobile-related injuries, with 264 (26%) cases hospitalized and 749 (74%) treated as outpatients. Text search alone identified 61% of all incidents and about a quarter (26%) of hospitalized incidents. Inpatients were older and a higher percentage wore helmets, sustained multisystem trauma, sustained more fractures, more organ injuries, and had higher need surgery and intensive care. Mortality was 1%. The average annual injury incidence rate was 313 per 100,000 snowmobiles registered.

Conclusions: Currently available studies of snowmobile-related injuries have underestimated their number and burden. Studies combining datasets from health systems in the state and statewide mortality records for cases who died prior to care could elucidate the full statewide impact of snowmobile-related injuries in Wisconsin, leading to better assessment of prevention efforts and staffing in rural trauma systems.