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

Background: Opioids prescribed for postoperative pain have exceeded patient need in the United States, playing a significant role in the opioid epidemic. In the preintervention phase of this project (September 2018 - March 2019), a chart review and patient survey revealed that patients were prescribed double the number of opioids they consumed following gynecologic surgery.

Objective: To ascertain whether an educational intervention recommending opiate prescriptions based on postoperative opioid use decreases gynecologic surgeons' opiate prescriptions.

Methods: An educational intervention implemented in January 2021 communicated the discrepancy between patient need and medications prescribed and made prescribing recommendations for common gynecologic procedures. A postintervention (February 2021 - April 2021) retrospective chart review ascertained postoperative opioid prescribing practices. Residents were surveyed about their prescribing practices in June 2021. Descriptive statistics compared each phase.

Results: For laparoscopic hysterectomy, the median morphine milligram equivalent (MME) was 150 (IQR 112.5-166.9) for preintervention and 150 (IQR 112.5-150) postintervention. For vaginal hysterectomy, median MME declined from 150 (IQR 112.5-225) to 112.5 (IQR 112.5-150). For laparoscopic surgery without hysterectomy, the median MME was 75 for both preintervention (IQR 75-120) and postintervention (IQR 60-80). For vaginal surgery without hysterectomy median MME went from 75 (IQR 75-142.5) to 54 (IQR 22.5-112.5). Median MME for hysteroscopy and dilation and curettage was 0 for both phases. When surveyed, residents reported prescribing lower amounts than actual prescribing practices.

Conclusions: Despite education informing gynecologic surgeons that their opioid prescribing exceeded patient need, prescribing practices did not change. The difference between actual and resident-reported prescribing practices warrants further investigation.

Introduction: Rh D alloimmunization is the serologic response that occurs when Rh D-negative patients are exposed to Rh D-positive blood. Rh D blood typing is recommended in pregnancy to prevent alloimmunization.

Case presentation: A 27-year-old gravida 3, para 2012 (G3P2012) previously Rh D-negative female presented with discordant and weakly positive Rh D blood typing results. Confirmatory genetic testing revealed weak D phenotype that can be treated clinically as Rh D-positive.

Discussion: Genetic variants of Rh D can cause varied blood typing results depending on the hospital reporting protocol utilized. If labeled as Rh D-negative, this could lead to unnecessary administration of Rh D immunoglobulin in pregnancy. Genetic variants should be suspected when patients are noted to have blood typing results that are discordant or weakly positive.

Conclusions: Rh D genotyping should be considered when discordant or weakly positive Rh D blood type results are noted in order to confirm and classify genetic subtype.

Background: Given the need for a diverse health care workforce, efforts must be made early in their education to support underrepresented minorities in medicine and the science, technology, engineering, and mathematics (STEM) fields.

Methods: The Eyes on the Future program introduces underrepresented minority 8th grade students to science and medicine via interactive science-based programming and mentorship by medical and graduate students. Program impact was evaluated using pre- and post-program surveys.

Results: Of 25 participating students, 24 and 22 responded to pre- and post-program surveys, respectively. Students showed strong interest in science concepts and STEM careers, with high, positively correlated, and statistically similar pre- and post-program survey responses.

Discussion: The Eyes on the Future program was well-received and represents a step towards addressing barriers to STEM careers faced by underrepresented minority students.

Introduction: Acute pancreatitis is a common cause of hospitalizations in the United States, causing approximately 230 000 to 275 000 annual admissions We present the case of a patient with acute pancreatitis likely due to doxycycline.

Case presentation: A 64-year-old male was admitted after developing acute epigastric pain radiating to his back, a lipase of 6611 (units/L), and a computed tomography scan showing moderate peripancreatic inflammation. He had no recent alcohol use, his gallbladder was surgically absent, and he had no gallbladder pathology on evaluation; however, he had been started on doxycycline 10 days prior. While hospitalized, he was treated with pain medications, fluids, and antibiotics for aspiration pneumonia. His acute symptoms resolved, except for minor intermittent abdominal pain 2 months after discharge.

Discussion: Doxycycline-induced pancreatitis has been reported within 3 to 17 days of medication initiation. Given the temporal correlation and lack of other inciting etiologies, we determined the most likely etiology was doxycycline.

Conclusions: Further study is needed to understand the pathophysiology and incidence of doxycycline-induced pancreatitis.

Introduction: Pediatric hospitalized patients often are discharged before all lab tests are completed. Given the risk of medical errors related to inadequate test follow-up, we piloted a collaborative initiative to address tests pending at discharge (TPAD) within our pediatric hospital medicine section. Our objectives were to delineate the responsibilities of case managers and pediatric hospital medicine clinicians in addressing these tests and to establish a communication process.

Methods: We formed an interprofessional team and performed a current state assessment, including a survey to pediatric hospital medicine clinicians to assess time spent following up TPAD and confidence that results were followed up in a timely and appropriate manner. We obtained a list of 1450 individual TPAD for the previous 9 months using an electronic health record data query, from which a list of 26 common and straightforward labs were identified for case manager follow-up. A shared case manager Epic Inbasket for TPAD was created and was checked twice daily. We developed a phased approach to establish a workflow for follow-up.

Discussion: The case manager partnership was launched in 4 phases for the duration of the 6-month pilot. However, due to duplication of work and less value of case managers addressing straightforward labs, the pilot was stopped. A more effective and mutually beneficial role for pediatric hospital medicine attendings and case managers may be to have the case managers address complex TPAD and communicate with primary care clinicians and families.

Background: Obstructive sleep apnea complicates 10% to 32% or greater of pregnancies, however, reports on long-term effects on the children of pregnancies affected by obstructive sleep apnea are limited.

Objective: We sought to test the hypothesis that the children of pregnant people with symptoms of obstructive sleep apnea during pregnancy have an increased incidence of autism spectrum disorder.

Methods: This was a case-control study comparing the pregnancies of people whose children were later diagnosed with autism spectrum disorder without a known associated genetic condition to those whose children were diagnosed with autism spectrum disorder with a known associated genetic condition.

Results: Of the 51 total parents who were eligible and consented to participate, 4 had a child with autism associated with a known genetic condition, and 47 had a child with autism with no known genetic condition. The prevalence of any snoring (50.0% and 36.2%, respectively) and daytime tiredness (75.0% and 89.4%, respectively) were similar between both groups.

Conclusions: In this study, the prevalence of any snoring and falling asleep while driving during pregnancy was higher in the sampled population than typically reported in pregnant people. While the sample size for this study was small, our preliminary results suggest that parents of children with autism have a high prevalence of sleep-related concerns during their pregnancies, which indicates the need for further investigation - especially for obstructive sleep apnea. Future studies exploring the neurodevelopmental outcomes of children of a cohort of pregnant people with known presence or absence of obstructive sleep apnea during pregnancy is warranted.

Introduction: The goal of this study is to describe the change in utilization of mental health services by trainees at a private medical college in Wisconsin after specific interventions were instituted by the administration.

Methods: Multiphase interventions designed to increase access to care were instituted at the student behavioral health clinic. These interventions were based on the findings of online wellness surveys distributed to the Medical College of Wisconsin during the 2016-2017 school year. The authors collected annual utilization reports of student use of mental health services at the Medical College of Wisconsin and plotted them along a timeline of specific administrative interventions.

Results: Since the 2016-2017 academic year, medical students have used an average of 1274 mental health service visits per year compared to 637 visits annually during the academic years 2010-2011 through 2015-2016. The number of mental health visits increased significantly during 2016-2017 versus the average number of visits in previous years (P < 001; Cohen's d  = 4.39).

Discussion: Similar to results shown worldwide, medical students in Wisconsin experience diminished mental health relative to their nonmedical peers. Recommendations have been made to provide additional administrative support to provide increased mental health resources to medical trainees. The findings in this report imply that incorporation of recommendations from the stakeholder medical trainees may be a key feature in the successful design and implementation of these supports.