Michael C Fiore, Karen L Conner, Lorraine S Lathen, Hasmeena Kathuria, Megan E Piper, Timothy B Baker
{"title":"Helping Black Patients in Wisconsin Quit Smoking: A Call for Clinical Action.","authors":"Michael C Fiore, Karen L Conner, Lorraine S Lathen, Hasmeena Kathuria, Megan E Piper, Timothy B Baker","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305377","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}
{"title":"Driving in Cars with Viral Transport Medium.","authors":"Maureen D Goss","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305374","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}
Introduction: Tropical myositis - also known as pyomyositis - is a subacute, primary infection of skeletal muscle. Long considered a diagnosis exclusive to tropical climates, recently it has been reported increasingly in historically nontropical climates. We present a case of tropical myositis in Madison, Wisconsin, occurring in a febrile type 1 diabetic patient without travel or known exposure.
Case presentation: A 35-year-old male with a history of von Willebrand disease, type 1 diabetes, and financial insecurity resulting in insulin rationing presented with 2 weeks of generalized weakness. On exam, he had a multitude of large, erythematous "bumps" across his body, which had been increasing in size for more than 2 weeks. His blood glucose was 518, with leukocytosis and labs supportive of diabetic ketoacidosis. Computed tomography revealed extensive intramuscular and subcutaneous abscesses of the left chest, bilateral erector spinae, right gluteal muscles, bilateral thighs, left leg, and left upper and lower arm. Broad-spectrum antibiotics were initiated, as was treatment for diabetic ketoacidosis. Blood and urine cultures revealed oxacillin-susceptible Staphylococcus aureus. After clinical stabilization, he underwent initial incision and drainage of the abscesses. His condition would require 14 more operative incision and drainage procedures and wound closure attempts before he was discharged to a rehab facility after more than a month-long hospitalization.
Discussion: Severe tropical myositis is associated with high morbidity and high use of health care resources. The exponential rise in cases in the United States in recent years risks further stressing an already-burdened health care system. We explore potential causes of the increase in cases of tropical myositis in nontropical regions, including increasing rates of diabetes and poverty and climate change. Recent data suggest that the large majority of tropical myositis cases are caused by Panton-Valentine leukocidin toxin-producing Staphylococcus aureus strains. There is a theoretical mitigation of disease severity when patients receive early protein synthesis inhibitor antibiotic treatment, though these findings are limited to case reports and observational studies and lack controlled clinical trials. This case highlights the need for early identification, antibiotic administration, and surgical source control in suspected cases of tropical myositis.
{"title":"Tropical Myositis: A Not-So-Tropical Diagnosis in a Febrile Type 1 Diabetic Patient.","authors":"Jack Bullis, Kenneth Fiala, Nicole Werner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Tropical myositis - also known as pyomyositis - is a subacute, primary infection of skeletal muscle. Long considered a diagnosis exclusive to tropical climates, recently it has been reported increasingly in historically nontropical climates. We present a case of tropical myositis in Madison, Wisconsin, occurring in a febrile type 1 diabetic patient without travel or known exposure.</p><p><strong>Case presentation: </strong>A 35-year-old male with a history of von Willebrand disease, type 1 diabetes, and financial insecurity resulting in insulin rationing presented with 2 weeks of generalized weakness. On exam, he had a multitude of large, erythematous \"bumps\" across his body, which had been increasing in size for more than 2 weeks. His blood glucose was 518, with leukocytosis and labs supportive of diabetic ketoacidosis. Computed tomography revealed extensive intramuscular and subcutaneous abscesses of the left chest, bilateral erector spinae, right gluteal muscles, bilateral thighs, left leg, and left upper and lower arm. Broad-spectrum antibiotics were initiated, as was treatment for diabetic ketoacidosis. Blood and urine cultures revealed oxacillin-susceptible <i>Staphylococcus aureus</i>. After clinical stabilization, he underwent initial incision and drainage of the abscesses. His condition would require 14 more operative incision and drainage procedures and wound closure attempts before he was discharged to a rehab facility after more than a month-long hospitalization.</p><p><strong>Discussion: </strong>Severe tropical myositis is associated with high morbidity and high use of health care resources. The exponential rise in cases in the United States in recent years risks further stressing an already-burdened health care system. We explore potential causes of the increase in cases of tropical myositis in nontropical regions, including increasing rates of diabetes and poverty and climate change. Recent data suggest that the large majority of tropical myositis cases are caused by Panton-Valentine leukocidin toxin-producing <i>Staphylococcus aureus</i> strains. There is a theoretical mitigation of disease severity when patients receive early protein synthesis inhibitor antibiotic treatment, though these findings are limited to case reports and observational studies and lack controlled clinical trials. This case highlights the need for early identification, antibiotic administration, and surgical source control in suspected cases of tropical myositis.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305390","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}
Isabel Breyer, Didier Mandelbrot, Sharon M Bartosh, Sandesh Parajuli
{"title":"Reflecting on the Past and Looking Toward the Future: A Brief History of University of Wisconsin Transplant Program.","authors":"Isabel Breyer, Didier Mandelbrot, Sharon M Bartosh, Sandesh Parajuli","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305385","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}
Madeline K Moureau, Nicole B Schmuhl, Zooey B Shultz, Cathryn P Phouybanhdyt, Heidi W Brown
Background: This study sought to assess the perceived value of in-person and online implementation of a community-based continence promotion program among Wisconsin community agencies serving older adults.
Methods: Electronic surveys were administered to representatives of organizations that serve older adults and assessed their preferences and perceptions of disseminating and implementing a continence promotion program to members of their organization.
Results: Among 101 participants, most (68%) reported an online program would appeal to their organization, while fewer noted the appeal of an in-person program. Many considered technology a barrier but indicated the online format could improve program reach and provide privacy to women with incontinence.
Conclusions: Community organizations perceived incontinence as a prevalent and important issue and see advantages of in-person and online program implementation.
{"title":"Community Agency Preferences for and Perceptions of Disseminating and Implementing a Continence Promotion Program.","authors":"Madeline K Moureau, Nicole B Schmuhl, Zooey B Shultz, Cathryn P Phouybanhdyt, Heidi W Brown","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This study sought to assess the perceived value of in-person and online implementation of a community-based continence promotion program among Wisconsin community agencies serving older adults.</p><p><strong>Methods: </strong>Electronic surveys were administered to representatives of organizations that serve older adults and assessed their preferences and perceptions of disseminating and implementing a continence promotion program to members of their organization.</p><p><strong>Results: </strong>Among 101 participants, most (68%) reported an online program would appeal to their organization, while fewer noted the appeal of an in-person program. Many considered technology a barrier but indicated the online format could improve program reach and provide privacy to women with incontinence.</p><p><strong>Conclusions: </strong>Community organizations perceived incontinence as a prevalent and important issue and see advantages of in-person and online program implementation.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305372","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}
{"title":"Experience as IMGs Applying for US Clinical Experience.","authors":"Rabbia Irfan, Shamayel Safdar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305375","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}
Cibele B Carroll, Amye J Tevaarwerk, Mary F Henningfield, Alice S Yuroff, Cathy Bolan, Katy Geiger, Earlise C Ward, Sarina Schrager
Introduction: Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital.
Methods: We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively.
Findings: Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%).
Conclusions: Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.
引言生活在农村地区的妇女比城市妇女更容易被诊断为晚期乳腺癌。晚期诊断可能是乳房 X 光筛查率较低的原因。我们旨在阐明影响威斯康星州农村地区妇女乳房 X 线照相筛查决策的因素:我们进行了一项观察性横断面混合方法研究,使用 3 种方法从不同来源收集数据。从 2021 年 9 月到 2022 年 2 月,我们对医院员工进行了虚拟访谈,对社区成员进行了虚拟焦点小组讨论,并对 40 岁及以上的妇女进行了调查。定性数据按乳房 X 光筛查的促进因素和障碍主题进行整理。对调查问卷的答复进行了描述性报告:受访的 11 名医院员工和参加了 3 个虚拟焦点小组中的 1 个小组的 21 名社区成员对乳房 X 光检查的促进因素和障碍表达了相似的看法。促进因素包括临床医生的推荐,而保险问题则是主要障碍。在调查对象(N = 282)中,平均年龄为 58.7 岁,98% 的人自认为是白人,91% 的人在过去一年中看过医疗服务提供者。首次接受乳房 X 光检查的首要原因是医生建议(70%)、家族史(19%)和个人决定(18%)。她们没有至少每年进行一次乳房 X 光检查的主要原因是拖延(23%)、缺乏问题(17%)以及与大流行相关的原因(15%):结论:加强对患者的教育并支持临床医生提供筛查建议可提高筛查的适当性。未来的研究应重点关注未参与医疗系统的妇女。
{"title":"Identifying Local Facilitators and Barriers to Screening Mammography Within a Rural Acute Care Hospital Service Area.","authors":"Cibele B Carroll, Amye J Tevaarwerk, Mary F Henningfield, Alice S Yuroff, Cathy Bolan, Katy Geiger, Earlise C Ward, Sarina Schrager","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital.</p><p><strong>Methods: </strong>We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively.</p><p><strong>Findings: </strong>Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%).</p><p><strong>Conclusions: </strong>Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305378","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}
{"title":"Statistical Thinking Part 2: Relative Risk, Absolute Risk, and Number Needed to Treat.","authors":"Robert A Calder, Jayshil J Patel","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305387","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}
Introduction: "Delta-8," or delta-8 tetrahydrocannabinol (delta-8 THC), is a cannabinoid product that is growing in popularity for recreational use across the nation. This report aims to characterize the clinical presentation of acute delta-8 ingestions presenting to the emergency department.
Case series: This is a case series of 6 patients who presented to a regional network of small- and medium-volume emergency departments in northwest Wisconsin. Patient histories confirmed that all patients had delta-8 exposure. Patient ages ranged from 5 to 57 years old. Amounts ingested and routes of ingestions varied from patient to patient. The most common symptoms reported were respiratory depression, unresponsiveness, altered mental status, tachycardia, and chest pressure.
Conclusions: This case series is a snapshot of the burden experienced by emergency departments because of delta-8 availability. Clinicians should maintain a high index of suspicion for delta-8 use, especially in patients with altered mental status, anxiety, or cardiac.
{"title":"Delta-8 Tetrahydrocannabinol in the Emergency Department: A Case Series.","authors":"Kyle Gibbons, Jacob Morris","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>\"Delta-8,\" or delta-8 tetrahydrocannabinol (delta-8 THC), is a cannabinoid product that is growing in popularity for recreational use across the nation. This report aims to characterize the clinical presentation of acute delta-8 ingestions presenting to the emergency department.</p><p><strong>Case series: </strong>This is a case series of 6 patients who presented to a regional network of small- and medium-volume emergency departments in northwest Wisconsin. Patient histories confirmed that all patients had delta-8 exposure. Patient ages ranged from 5 to 57 years old. Amounts ingested and routes of ingestions varied from patient to patient. The most common symptoms reported were respiratory depression, unresponsiveness, altered mental status, tachycardia, and chest pressure.</p><p><strong>Conclusions: </strong>This case series is a snapshot of the burden experienced by emergency departments because of delta-8 availability. Clinicians should maintain a high index of suspicion for delta-8 use, especially in patients with altered mental status, anxiety, or cardiac.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305373","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}
Saim Mahmood Khan, Jawairya Muhammad Hussain, Iman Azam
{"title":"Promoting the Effectiveness of Low-Carbohydrate/ Time-Restricted Diets in the Management of Diabetes.","authors":"Saim Mahmood Khan, Jawairya Muhammad Hussain, Iman Azam","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305384","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}