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Leading by Example: How a Health Care Provider's Actions Can Impact the Public's Perspectives. 以身作则:卫生保健提供者的行为如何影响公众的观点。
Q3 Medicine Pub Date : 2022-12-01
Uyi Jefferson Imasuen, Sandesh Parajuli
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引用次数: 0
Documenting Patient Interaction: Emergency Medical Services Report Reader Expectations and Improvements for Providers. 记录病人互动:紧急医疗服务报告读者的期望和提供者的改进。
Q3 Medicine Pub Date : 2022-12-01
Elizabeth L Angeli, Julia Jezykowski, Patrick Sinclair, Tom Grawey, James T Poltrock, Ben Weston

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.

患者护理报告包含与干预措施和医疗决策相关的关键要素。然而,关于读者期望的共识很少,使得紧急医疗服务(EMS)提供者不知道关键内容。目的:本研究分为两个阶段,旨在通过问卷调查和访谈来回答“EMS供应商对报告读者了解多少?”和“报告读者对报告的期望是什么?”在此过程中,本研究测量了EMS供应商对报告读者的受众意识,并确定了读者对报告的期望。方法:对57家EMS供应商进行了前瞻性调查,以衡量他们的受众意识水平或他们在撰写报告时考虑特定报告读者群体的频率。对14名报告读者进行了采访,他们遵循回顾性的大声思考协议,参与者在阅读报告时用语言表达他们对报告的问题、评论和关注。结果:调查显示,参与者缺乏完整、准确的受众意识。在撰写报告时,他们考虑的是不经常阅读报告的受众(如患者),而在撰写报告时,他们通常或根本不会考虑实际的报告读者(如账单专家)。访谈分析表明,报告读者在高质量、有效的报告叙事中寻找21个要素。结论:这些数据形式化并强化了高质量的叙述应该包括的内容,“高质量”意味着叙述允许读者在不需要跟踪或修改报告的情况下完成他们的工作。
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引用次数: 0
Medical Students as Educators: Students' Experience, Interest, and Confidence in Teaching. 医学生作为教育者:学生在教学中的经验、兴趣和信心。
Q3 Medicine Pub Date : 2022-12-01
Leah Cha, Lydia Buzzard, Mallory Jasicki, Jennifer Mirrielees, Aimee T Broman, Scott Mead

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.

背景:医学生代表下一代医师教育者,但可能还没有准备好满足未来的教学责任。方法:对美国一所对抗疗法机构的医学生进行电子调查,以评估他们的教学经验、兴趣和信心。结果:大多数学生表示有兴趣在实习后教医学生(n = 91, 62%)或住院医生(n = 88, 60%)。不到一半的人对临床访谈/体检技能(n = 71, 49%)、讲座/教学(n = 62, 42%)和程序技术(n = 41, 28%)表示有信心。讨论:许多医学生认为自己的医学教学技能刚刚起步,并表示对选修机会感兴趣。正规的教学计划是培养医学生成为有效的医师教育者的必要条件。
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引用次数: 0
Leveraging Virtual Platforms to Overcome the Minority Tax Among International Medical Students and Professionals. 利用虚拟平台克服国际医学生和专业人员的少数民族税。
Q3 Medicine Pub Date : 2022-12-01
Gopika SenthilKumar, Matheus Moreira S Peraci
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引用次数: 0
Wisconsin Medical Journal: Past, Present, and Future. 威斯康星医学杂志:过去、现在和未来。
Q3 Medicine Pub Date : 2022-12-01
Fahad Aziz
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引用次数: 0
Nine Successful Pregnancy Outcomes in a Woman With Vascular Ehlers-Danlos Syndrome: A Case Report and Literature Review. 9例血管性埃勒-丹洛斯综合征妇女妊娠成功:1例报告和文献复习。
Q3 Medicine Pub Date : 2022-12-01
Zarif Zaman, Sonja J Henry, Laura E Birkeland, Elizabeth M Petty

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.

ehers - danlos综合征的血管形式是由于COL3A1基因的改变而发生的。它与主要血管和中空器官并发症有关,导致怀孕期间发病率和死亡率增加。病例介绍:我们报告一名妇女(妊娠9期,第9段)在70多岁时肠破裂后被诊断为血管性埃勒-丹洛斯综合征。基因检测显示COL3A1存在零突变,预计会导致单倍功能不全。在诊断之前,她有9次怀孕,并发症很少。讨论:虽然血管性埃勒-丹洛斯综合征的产科护理尚无明确的循证指南,但患者经常被告知并被视为高危妊娠。结论:与文献报道的血管性埃勒-丹洛斯综合征相比,导致单倍功能不全的零突变可能具有更低的妊娠风险。因此,了解COL3A1特异性突变可能有助于优化妊娠咨询和促进管理决策。
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引用次数: 0
Enhancing Communication Among Adolescents and Health Care Providers: Evolution and Evaluation of Youth-Driven Initiative Addressing Barriers. 加强青少年和卫生保健提供者之间的沟通:青年驱动的解决障碍倡议的演变和评价。
Q3 Medicine Pub Date : 2022-12-01
Chelsea J Aeschbach, Amy B Olejniczak, Erica R Koepsel, Mary M Kusch

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.

背景:显著的人际障碍阻碍了优质青少年卫生保健的提供。公共卫生和保健实体虽然是一个复杂的问题,但仍在继续寻求与它们所服务的人口合作的方法,以更好地应对这些挑战。方法:PATCH青少年教育计划是提供者和青少年健康沟通(PATCH)计划的一项倡议,通过青年主导的临床医生和青少年研讨会,促进卫生保健专业人员和青少年之间开放、诚实和医学上准确的对话。结果:在6个项目现场,研讨会参与者注意到在加强医患沟通方面的积极变化。青年辅导员还报告说,在参与该计划9个月后,他们在劳动力和青年发展方面发生了显著变化。讨论:这些结果显示了青年驱动的倡议在加强当地青少年患者-临床医生沟通方面的良好效果,以及对参与青年的影响。
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引用次数: 0
Does a Change in Physician Compensation Lead to Changes in Care Delivery in Family Medicine Clinics? 医生报酬的变化会导致全科诊所医疗服务的变化吗?
Q3 Medicine Pub Date : 2022-12-01
Jennifer Lochner, Jen Birstler, Maureen A Smith, Paul Rathouz, Brian Arndt, Mark Micek, Elizabeth Trowbridge, Elizabeth Trowbridge, Sandra Kamnetz, Nancy Pandhi

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.

背景与目标:许多高度按人头付费的系统仍根据相对价值单位(RVU)向医生支付报酬,这可能会导致过多的门诊量。我们审查了家庭医学诊所小组成员(97 名医生和 42 名住院医师)的电子健康记录,以确定从相对价值单位到基于小组的补偿是否会影响医疗服务的提供,具体定义为小组成员每月的门诊次数和电话联系次数:我们对 4 家住院医师培训诊所、10 家社区诊所和 4 家地区诊所的患者电子健康记录进行了回顾性分析。我们评估了各诊所的面对面医疗服务提供情况和电话呼叫量,以及从变更前 1 年到变更后至少 1 年期间按诊所类型汇总的诊所的面对面医疗服务提供情况和电话呼叫量:结果:按诊所类别汇总后发现,医生报酬的变化并未对每位小组成员每月的门诊量或电话通话量产生影响。在个别诊所中发现了一些明显的影响,但没有发现诊所规模或类型的明显模式:结论:医生报酬的变化并不是家庭医学诊所医疗服务提供的主要驱动因素。要了解医疗服务的变化,可能需要考虑系统、医生和患者等一系列因素。
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引用次数: 0
Missing Out: Underutilization of Primary Care by Wisconsin Patients Who Smoke and Its Implications for Tobacco Treatment Access. 错过:威斯康星州吸烟患者对初级保健的利用不足及其对烟草治疗机会的影响》(Missing Out: Underutilization of Primary Care by Wisconsin Patients Who Smoke and Its Implications for Tobacco Treatment Access.
Q3 Medicine Pub Date : 2022-12-01
Margaret Nolan, Alexandra Spicer, Patrick Remington, Kristen Malecki, Danielle McCarthy

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.

简介烟草依赖治疗通常在基层医疗机构提供。然而,如果许多吸烟患者无法获得初级保健服务,那么戒烟干预措施可能会错过那些最需要的人。本研究描述了威斯康星州成年人按吸烟状况划分的医疗保健使用情况:本研究分析了参加威斯康星州居民跨部门健康调查(2014-2016 年)的 1726 人的数据。使用针对复杂调查设计加权的沃尔德卡方检验比较不同吸烟状态的人口统计学特征。使用多变量逻辑回归模型计算了比值比:在 1726 名受访者中,15.3% 表示目前正在吸烟,25.4% 曾经吸烟,59.4% 从未吸烟。与以前吸烟或从不吸烟的受访者相比,目前吸烟的受访者更有可能称急诊室是他们 "生病时常去的地方"(12% 对 3%),或称他们 "生病时没有地方可去"(16% 对 7%)。在过去一年中,吸烟者到急诊室就诊的次数(平均 = 1.4 次)也多于其他人(平均 = 0.4 次,PPP 结论:这些研究结果表明,威斯康星州有超过四分之一的吸烟成年人没有每年接受初级保健,与从不吸烟或已戒烟的人相比,他们更经常推迟接受保健或到急诊室就诊。因此,这些人可能会错过循证戒烟治疗。
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引用次数: 0
Analysis and Incidence Calculation of Snowmobile Injuries Identified in a Rural Wisconsin Health Care System Over Five Years. 威斯康星州农村医疗保健系统五年来雪地摩托伤害的分析和发生率计算。
Q3 Medicine Pub Date : 2022-12-01
Jennifer P King, Oluwatosin Olaiya, Daniel C Cullinane

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.

背景:目前对雪地摩托相关伤害的估计主要基于创伤中心的住院患者数据。这些中心照顾严重受伤的患者,可能无法捕捉到与雪地摩托相关的轻微伤害的治疗信息和结果,因此低估了它们的数量,高估了患者的敏锐度。方法:采用国际疾病分类外因代码和关键词文本搜索的分层方法,回顾性地从威斯康星州中北部卫生系统的住院和门诊记录中识别医疗救护的雪地摩托伤害。手动审查病历收集的有关患者特征、事故详细信息和临床信息的信息。描述性分析,住院和非住院病例之间的比较,并计算季节性发病率。结果:2013年11月1日至2018年4月30日,共发生1013例雪地摩托相关伤害,住院264例(26%),门诊749例(74%)。仅文字搜索就能识别61%的事件和大约四分之一(26%)的住院事件。住院患者年龄较大,戴头盔的比例较高,持续多系统创伤,持续骨折,更多器官损伤,需要更高的手术和重症监护。死亡率为1%。年平均伤害发生率为每10万辆注册雪地车中有313人受伤。结论:目前对雪地摩托相关伤害的研究低估了它们的数量和负担。结合来自州卫生系统的数据集和全州范围内在治疗前死亡病例的死亡率记录的研究,可以阐明威斯康星州雪地摩托相关伤害在全州范围内的全部影响,从而更好地评估农村创伤系统的预防工作和人员配备。
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引用次数: 0
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Wisconsin Medical Journal
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