Introduction: In this report, we describe a case of anisocoria following uncomplicated cataract surgery. Clinicians should consider postoperative mechanical and tonic pupils when evaluating patients with anisocoria.
Case presentation: A 69-year-old White female underwent uncomplicated cataract surgery of her left eye. No intraoperative pupil expansion devices were used, and no floppy iris or iris prolapse occurred during the surgery. Postoperatively, she was found to have anisocoria. Pharmacologic pupillary testing confirmed a tonic and mechanical left pupil.
Discussion: There have been no reported causes of anisocoria from a tonic pupil after cataract surgery. Based on reports of tonic pupils following other eye surgeries, our case likely occurred from a combination of parasympathetic dysfunction and mechanical trauma.
Conclusions: To our knowledge, this is the first report of a tonic pupil following cataract surgery, thus expanding the literature of causes of anisocoria that may be underrecognized in the clinical setting.
{"title":"Anisocoria Following Uncomplicated Cataract Surgery.","authors":"Jennifer Larson, Madeline Arzbecker","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>In this report, we describe a case of anisocoria following uncomplicated cataract surgery. Clinicians should consider postoperative mechanical and tonic pupils when evaluating patients with anisocoria.</p><p><strong>Case presentation: </strong>A 69-year-old White female underwent uncomplicated cataract surgery of her left eye. No intraoperative pupil expansion devices were used, and no floppy iris or iris prolapse occurred during the surgery. Postoperatively, she was found to have anisocoria. Pharmacologic pupillary testing confirmed a tonic and mechanical left pupil.</p><p><strong>Discussion: </strong>There have been no reported causes of anisocoria from a tonic pupil after cataract surgery. Based on reports of tonic pupils following other eye surgeries, our case likely occurred from a combination of parasympathetic dysfunction and mechanical trauma.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first report of a tonic pupil following cataract surgery, thus expanding the literature of causes of anisocoria that may be underrecognized in the clinical setting.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725444","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: In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement.
Case presentation: An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection.
Discussion: Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature.
Conclusions: Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.
简介:本报告描述了一例罕见的继发于带状疱疹感染的颅神经VI麻痹病例:在本报告中,我们描述了一例罕见的继发于带状疱疹感染的颅神经VI麻痹病例:一名 82 岁的男性因急性复视到眼科就诊。就诊前 14 天,他被诊断为带状疱疹性眼炎。由于他在出现特征性三叉神经皮疹之前就出现了咽喉痛,因此被怀疑患有带状疱疹多发性神经病,并累及颅神经 IX 和 X。他被诊断为继发于带状疱疹感染的颅神经VI麻痹:讨论:带状疱疹性眼炎的眼部并发症很多,但文献中很少记载继发于带状疱疹感染和带状疱疹多发性神经病的眼外肌麻痹:结论:眼外肌麻痹是带状疱疹感染的罕见并发症。本病例回顾了有关这一病症的最新文献,并讨论了水痘带状疱疹病毒再激活中多神经病变的重要意义。
{"title":"Cranial Nerve VI Palsy Secondary to Herpes Zoster Ophthalmicus: A Case Report and Literature Review.","authors":"Clara V Kuranz, Jennifer Larson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement.</p><p><strong>Case presentation: </strong>An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection.</p><p><strong>Discussion: </strong>Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature.</p><p><strong>Conclusions: </strong>Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725447","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":"Making Space.","authors":"Sophia Neman","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":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725453","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}
Precious Anyanwu, Kavita Naik, Sanjay Bhandari, Pinky Jha, Barbara Slawski
{"title":"Improving Geographical Cohorting of Patients Admitted Under Hospitalist Service.","authors":"Precious Anyanwu, Kavita Naik, Sanjay Bhandari, Pinky Jha, Barbara Slawski","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":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725450","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":"Thriving in Your First Year of Medical Training.","authors":"Fahad Aziz","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":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725463","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}
Amber Brandolino, Terri A deRoon-Cassini, Peter Nguyen, Ramneet Mann, Sydney Timmer-Murillo, Marc de Moya, Basil Karam, Andrew Schramm, Reggie Moore, Kathleen Williams, Alicia Pilarski, Brady McIntosh, David J Milia
Background: Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of "reach." This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized "reach" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence.
Methods: 414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals.
Results: In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods.
Conclusions: 414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.
{"title":"Mapping Milwaukee's Blueprint for Peace: Evaluating the Geospatial Reach of a Cure Violence Implementation, 414LIFE.","authors":"Amber Brandolino, Terri A deRoon-Cassini, Peter Nguyen, Ramneet Mann, Sydney Timmer-Murillo, Marc de Moya, Basil Karam, Andrew Schramm, Reggie Moore, Kathleen Williams, Alicia Pilarski, Brady McIntosh, David J Milia","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of \"reach.\" This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized \"reach\" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence.</p><p><strong>Methods: </strong>414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals.</p><p><strong>Results: </strong>In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods.</p><p><strong>Conclusions: </strong>414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725454","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: Tanning bed use has been directly correlated with increased risk of melanoma and non-melanoma skin cancers with greater duration and frequency of use. Despite this, complete bans for minors accessing indoor tanning devices are active in less than half of the states in the United States.
Case presentation: A 65-year-old female presented to our Mohs surgery clinic with a history of left temporal T2a melanoma, multiple untreated advanced keratinocyte carcinomas, and innumerable smaller untreated keratinocyte carcinomas on her legs, arms, and back after more than 40 years of weekly tanning bed use.
Discussion: Reports from the literature indicate that first exposure under age 35 to tanning devices increases the risk for melanoma and non-melanoma skin cancers. Several programs currently focus on prevention, education, and legislative change surrounding this topic.
Conclusions: Highlighting such severe cases may provide an effective form of education for the public regarding the potential disease burden that results from indoor tanning.
{"title":"The Severe Skin Cancer Consequences of Extended Tanning Bed Use, A Case Report.","authors":"Jacqueline T Cooper, Melanie A Clark","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Tanning bed use has been directly correlated with increased risk of melanoma and non-melanoma skin cancers with greater duration and frequency of use. Despite this, complete bans for minors accessing indoor tanning devices are active in less than half of the states in the United States.</p><p><strong>Case presentation: </strong>A 65-year-old female presented to our Mohs surgery clinic with a history of left temporal T2a melanoma, multiple untreated advanced keratinocyte carcinomas, and innumerable smaller untreated keratinocyte carcinomas on her legs, arms, and back after more than 40 years of weekly tanning bed use.</p><p><strong>Discussion: </strong>Reports from the literature indicate that first exposure under age 35 to tanning devices increases the risk for melanoma and non-melanoma skin cancers. Several programs currently focus on prevention, education, and legislative change surrounding this topic.</p><p><strong>Conclusions: </strong>Highlighting such severe cases may provide an effective form of education for the public regarding the potential disease burden that results from indoor tanning.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725462","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: Chagas disease caused by Trypanosoma cruzi (T cruzi) found in the Americas is often missed during the early stage of infection due to lack of sensitive diagnostic tests. The classic immunological and parasitological tests often fail in the acute phase due to the nonspecific and low antibody level nature of the infection and in the chronic phase due to low levels of trypanosomes in the blood. For successful control strategies, there must be a sensitive and specific diagnostic test.
Objective/methods: We have demonstrated the possibility (proof of concept) of detecting T cruzi-specific repeat DNA via polymerase chain reaction (PCR) by (1) spiking 15 urine samples collected from volunteers free of prior infection with 3 different concentrations of T cruzi (3 strains), Trypanosoma brucei, and Trypanosoma rhodesiense (African strain) genomic DNA and (2) from filtered collected clinical samples from Argentina. Three sets of primers were used.
Results: Our approach detected repeat DNA specific for T cruzi strains from 1 clinical sample by 2 sets of primer and from spiked urine by all 3 sets of primer but not the African species. A serial dilution (spiking) also was performed on T cruzi strains to detect sensitivities of the assay. One set of primers constantly detected satellite DNA for all T cruzi strains from 70 pg/μl to 175 fg/μl.
Conclusions: We were able to demonstrate the feasibility of detecting T cruzi-specific DNA from filtered urine samples by sensitive and specific PCR assay. Besides the evident increased sensitivity and specificity of primers, our approach can be used to explore Chagas prevalence in endemic areas - especially in congenital Chagas newborn screening - and in the acute phase.
导言:在美洲发现的由克鲁斯锥虫(T cruzi)引起的恰加斯病,由于缺乏灵敏的诊断检测,在感染的早期阶段常常被漏诊。在急性期,由于感染的非特异性和低抗体水平,以及在慢性期,由于血液中锥虫水平较低,传统的免疫学和寄生虫学检测常常失效。为了成功实施控制策略,必须有一种敏感而特异的诊断检测方法:我们通过以下方法证明了通过聚合酶链式反应(PCR)检测克鲁兹锥虫特异性重复 DNA 的可能性(概念验证):(1) 在 15 份从没有感染过克鲁兹锥虫(3 株)、布氏锥虫和罗得西亚锥虫(非洲株)的志愿者尿液样本中添加 3 种不同浓度的克鲁兹锥虫基因组 DNA;(2) 从过滤收集的阿根廷临床样本中检测克鲁兹锥虫特异性重复 DNA。使用了三组引物:结果:我们的方法通过两组引物从 1 份临床样本中检测到了特异性克鲁兹锥虫菌株的重复 DNA,通过所有 3 组引物从加标尿液中检测到了特异性克鲁兹锥虫菌株的重复 DNA,但没有检测到非洲菌株。我们还对 T cruzi 菌株进行了序列稀释(加标),以检测检测方法的灵敏度。其中一组引物可持续检测到所有克鲁兹绦虫菌株的卫星 DNA,检测范围从 70 pg/μl 到 175 fg/μl:我们通过灵敏而特异的 PCR 分析证明了从过滤尿液样本中检测 T cruzi 特异性 DNA 的可行性。除了引物的灵敏度和特异性明显提高外,我们的方法还可用于检测恰加斯病流行地区的恰加斯病患病率--尤其是先天性恰加斯病新生儿筛查--以及急性期恰加斯病患病率。
{"title":"Diagnosis of Chagas Disease by Detecting Species-Specific Repetitive Genomic DNA from Filtered Human Urine Samples.","authors":"Miriam Price, Nilanjan Lodh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chagas disease caused by <i>Trypanosoma cruzi (T cruzi)</i> found in the Americas is often missed during the early stage of infection due to lack of sensitive diagnostic tests. The classic immunological and parasitological tests often fail in the acute phase due to the nonspecific and low antibody level nature of the infection and in the chronic phase due to low levels of trypanosomes in the blood. For successful control strategies, there must be a sensitive and specific diagnostic test.</p><p><strong>Objective/methods: </strong>We have demonstrated the possibility (proof of concept) of detecting <i>T cruzi</i>-specific repeat DNA via polymerase chain reaction (PCR) by (1) spiking 15 urine samples collected from volunteers free of prior infection with 3 different concentrations of <i>T cruzi</i> (3 strains), <i>Trypanosoma brucei</i>, and <i>Trypanosoma rhodesiense</i> (African strain) genomic DNA and (2) from filtered collected clinical samples from Argentina. Three sets of primers were used.</p><p><strong>Results: </strong>Our approach detected repeat DNA specific for <i>T cruzi</i> strains from 1 clinical sample by 2 sets of primer and from spiked urine by all 3 sets of primer but not the African species. A serial dilution (spiking) also was performed on <i>T cruzi</i> strains to detect sensitivities of the assay. One set of primers constantly detected satellite DNA for all <i>T cruzi</i> strains from 70 pg/μl to 175 fg/μl.</p><p><strong>Conclusions: </strong>We were able to demonstrate the feasibility of detecting <i>T cruzi</i>-specific DNA from filtered urine samples by sensitive and specific PCR assay. Besides the evident increased sensitivity and specificity of primers, our approach can be used to explore Chagas prevalence in endemic areas - especially in congenital Chagas newborn screening - and in the acute phase.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725448","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":"Integrating Artificial Intelligence Into Radiology Resident Training: A Call to Action.","authors":"Nageen Waseem, Muhammad Saad Farooq","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":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725451","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}
Mary F Henningfield, Alice Yuroff, Lisa Sampson, Paul H Hunter
Introduction: Although shared decision-making is highly valued, its implementation in clinical practice is suboptimal. Shared decision-making was included in the Centers for Disease Control and Prevention (CDC) recommendations for the pneumococcal conjugate vaccine 13 valent for older adults. As a first step to develop and test clinician educational resources to facilitate shared decision-making for pneumococcal vaccines for older adults, we completed a needs assessment to identify knowledge gaps, attitudes, and behaviors.
Methods: Primary care clinicians, pharmacists, and patient care staff completed a questionnaire on shared decision-making and pneumococcal vaccines. After the CDC recommended new pneumococcal vaccines and eliminated the role of shared decision-making, a revised questionnaire was distributed to additional clinicians in an effort to increase the sample size.
Results: Knowledge of pneumococcal vaccine recommendations was high among those who responded to knowledge questions (48 of 75 respondents). Although 96% of respondents believed shared decision-making for use of pneumococcal vaccines in adults 65 years or older was feasible, 25% responded that it would be "somewhat difficult" to explain potential harms and benefits of PCV13.
Discussion: Although shared decision-making was reported to be feasible, challenges implementing it are ongoing. Knowledge gaps regarding pneumococcal vaccines were observed, highlighting the need for ongoing medical education with changing vaccine recommendations.
{"title":"Knowledge, Attitudes, and Behaviors Regarding Pneumococcal Vaccines in Adults 65 Years and Older in Primary Care in Wisconsin.","authors":"Mary F Henningfield, Alice Yuroff, Lisa Sampson, Paul H Hunter","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Although shared decision-making is highly valued, its implementation in clinical practice is suboptimal. Shared decision-making was included in the Centers for Disease Control and Prevention (CDC) recommendations for the pneumococcal conjugate vaccine 13 valent for older adults. As a first step to develop and test clinician educational resources to facilitate shared decision-making for pneumococcal vaccines for older adults, we completed a needs assessment to identify knowledge gaps, attitudes, and behaviors.</p><p><strong>Methods: </strong>Primary care clinicians, pharmacists, and patient care staff completed a questionnaire on shared decision-making and pneumococcal vaccines. After the CDC recommended new pneumococcal vaccines and eliminated the role of shared decision-making, a revised questionnaire was distributed to additional clinicians in an effort to increase the sample size.</p><p><strong>Results: </strong>Knowledge of pneumococcal vaccine recommendations was high among those who responded to knowledge questions (48 of 75 respondents). Although 96% of respondents believed shared decision-making for use of pneumococcal vaccines in adults 65 years or older was feasible, 25% responded that it would be \"somewhat difficult\" to explain potential harms and benefits of PCV13.</p><p><strong>Discussion: </strong>Although shared decision-making was reported to be feasible, challenges implementing it are ongoing. Knowledge gaps regarding pneumococcal vaccines were observed, highlighting the need for ongoing medical education with changing vaccine recommendations.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725452","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}