WMJ : official publication of the State Medical Society of Wisconsin最新文献

Introduction: Human papillomavirus (HPV) infection poses significant public health concerns due to its prevalence and association with various cancers. This study assesses a 2014 quality improvement initiative in Wisconsin's largest health care system. The intervention aimed to improve HPV vaccine initiation and completion among eligible patients and to reduce the gap in vaccination rates between males and females.

Methods: Educational sessions delivered to health care providers and staff at select clinics focused on current HPV vaccination recommendations and strategies for patient communication. Preintervention and postintervention surveys assessed changes in clinician knowledge and attitudes. Clinic-level data on HPV vaccination rates compared intervention and control clinics at 12 and 36 months following the intervention.

Results: Postintervention knowledge and attitudes regarding HPV vaccination improved, and intervention clinics demonstrated notable increases in HPV vaccine initiation and completion rates across various age and sex groups at 12- and 36-month follow-up. The gap between female and male HPV vaccination rates narrowed in some age groups in intervention clinics, but the effect was inconsistent.

Conclusions: This study highlights the potential effectiveness of an in-person educational intervention in improving HPV vaccination rates in a health care system. Clinicians' enhanced understanding of vaccination guidelines, coupled with real-time data feedback, contributed to sustained improvements. To address resource challenges, future interventions may explore cost-effective alternatives. These findings underscore the pivotal role of clinicians in increasing HPV vaccine uptake, emphasizing the importance of aligning interventions with evolving vaccination recommendations to combat HPV-related cancers more effectively.

Introduction: Trigeminal trophic syndrome causes self-injurious lesions secondary to cutaneous dysesthesia following damage of the trigeminal nerve. A similar syndrome, greater auricular trophic syndrome, can result following sacrifice of the greater auricular nerve during a parotidectomy.

Case presentation: A 59-year-old woman presented with ulceration and crusting of her right ear 5 months after parotidectomy. She was determined to have greater auricular trophic syndrome with prurigo nodularis-like histopathologic changes and was successfully treated with topical clobetasol, occlusive dressing, and behavioral modification.

Discussion: Six similar cases have been reported. Mental health disorders were noted in 4 of these cases, and treatment focused on managing psychiatric comorbidities. This case considers treatment of a patient without a prior mental health disorder.

Conclusions: Greater auricular trophic syndrome is a rare complication following a parotidectomy. Occlusive dressing and behavioral modification led to subsequent improvement of the ulceration for this patient.

Introduction: Housing discrimination as one of the main mechanisms for reinforcing racial segregation has persisted historically in the United States through a process known as "redlining." In recent years, researchers across different disciplines have utilized the iconic "residential security maps" created by the Home Owners' Loan Corporation (HOLC) in the 1930s to analyze the structural roots of racial disparities. HOLC maps designated grading of "best" to "still desirable" to "definitely declining" and "hazardous" to urban areas where percentage of African American and foreigners were among the reordered measures.

Objective: Given that sales and marketing of tobacco products also present a historical connection to structural racism in the US, this study examines how historical redlining relates to current geographies of tobacco retailers in Wisconsin.

Methods: Analyses were conducted for 4 cities in Wisconsin with available HOLC maps. We used negative binomial models to account for spatial heterogeneity and overdispersion of retailers, and we controlled for present-day sociodemographic characteristics.

Results: Findings indicated that the hierarchy of HOLC grades are reflected in the present-day retailer density, and areas historically graded as "less desirable" have a higher present-day density of tobacco retailers. The result of the statistical model shows that poverty and percentage minority are also significant factors in distribution of tobacco retailers.

Conclusions: These results highlight that to address the structural roots of health disparities, we need intervention strategies that employ a comprehensive look at the historical legacies of discrimination.

Introduction: Ultrasound use as a procedural guide and diagnostic tool has led many to herald it as the "new stethoscope." Thus, medical schools are seeking to integrate ultrasound training into their longitudinal curricula. While various methods have been trialed, incorporating ultrasound into basic science courses as a supplementary learning tool often offers students their first exposure. This study seeks to identify factors that affected student excitement and perceived value of ultrasound training as part of an anatomy course.

Materials and methods: A brief survey was distributed to first-year medical students after completing ultrasound education in a clinical human anatomy course. This survey gauged student excitement and perceived value of the ultrasound sessions. Through free-response, students expounded on factors that affected their ratings. Qualitative student feedback was organized, coded, and associated with student excitement and perceived value ratings using thematic analysis.

Results: Responses were returned from 26.2% of the surveyed group. Ten and 6 themes were identified in response to students' excitement and perceived value ratings of the sessions, respectively. Clinical relevance/utility was identified consistently as the most influential factor affecting student engagement. In addition, students' personal motivation and incentive, as well as the structure and learning environment of the sessions, were found to impact student engagement.

Conclusions: We identified multiple factors that may impact student engagement with ultrasound sessions that are included as part of an anatomy course. Medical schools seeking to incorporate ultrasound sessions in a similar fashion could consider these factors when designing their own curricula.

Introduction: The use of clinical characteristics to differentiate obstructive lung diseases remains unclear, with limited supporting studies. This study aims to assess the effectiveness of signs and symptoms from clinical questionnaires in diagnosing obstructive lung diseases.

Methods: This prospective cohort study included patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, or asthma-COPD overlap (ACOS) based on spirometry. Clinical symptoms were gathered using questionnaires and incorporated into a multinomial logistic prediction model to evaluate their role in diagnosing obstructive lung diseases.

Results: A total of 1443 patients were analyzed: 177 (12.3%) with COPD, 135 (9.4%) with asthma, 163 (11.3%) with ACOS, and 968 (67.1%) without obstruction. The average age was 64 years (SD 13.23), with COPD patients being older than those with asthma or ACOS. Forced expiratory volume in the first second of expiration/forced vital capacity ratios after bronchodilator use were 61.1 (SD 8.48) for COPD, 78.9 (SD 6.99) for asthma, 57.3 (SD 9.48) for ACOS, and 81.7 (SD 7.15) for non-obstructed patients. The area under the curve for diagnosing COPD was 0.75, for asthma 0.68, and for ACOS 0.78 (all PP  <  0.001).

Conclusions: Clinical variables can identify patients with obstructive lung diseases effectively, offering strong diagnostic performance and precision.