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

Introduction: Electronic cigarette (e-cigarette) use is prevalent among young adults, yet cessation treatment options are limited and underutilized.

Methods: Wisconsin residents aged 18 to 24 who had vaped nicotine in the past month (N = 480) completed an online survey assessing vaping initiation, past quit experiences, future quit intentions, and treatment knowledge and preferences. The survey also assessed perceived physical and mental health harms of vaping nicotine and other products (eg, cannabis, cannabidiol).

Results: Most young adults had made a prior e-cigarette quit attempt, commonly motivated by concerns about addiction, cost, and health problems. Though 80% want support to quit, preferred methods of support were highly variable. The same methods (eg, medication, friends/family, health care provider, therapist) that were most endorsed as the form of support young adults were most likely to use were also among the most endorsed forms of support that young adults would not want to use. Nearly 40% of participants reported vaping cannabis and perceived vaping cannabis as significantly less harmful than vaping nicotine or tobacco for physical and mental health.

Conclusions: Vaping cessation resources that are responsive to young adults' needs and preferences are needed. The high variability in treatment preferences suggests that multiple strategies need to be offered; there is no one-size-fits-all approach. Cannabis vaping is prevalent, and an important area for future research is to examine the impact of cannabis vaping on nicotine vaping dependence, cessation, and treatment use. Strategies to reach, motivate, and engage young adults in e-cigarette cessation and cessation treatment should highlight their concerns about addiction, costs, health harms, and desired treatment options.

Introduction: Crusted scabies (Norwegian scabies) is a rare and severe presentation of skin infestation caused by the mite Sarcoptes scabiei in patients with compromised cellular immunity. Kidney transplant patients are maintained on immunosuppressive agents, which induce impaired T cell immune response that can lead to increased risk of crusted scabies.

Case presentation: We report a case of crusted scabies in a kidney transplant patient who presented with a diffuse skin rash. Diagnosis was delayed and misdiagnosed initially, with subsequent skin biopsy leading to an accurate diagnosis and complete recovery with definitive treatment.

Discussion: Unlike classical scabies, crusted scabies can occur in an atypical pattern that can be misdiagnosed as common skin lesions, and a skin biopsy is crucial to obtain an accurate diagnosis to receive definitive treatment.

Conclusions: Transplant recipients are at an increased risk of severe parasitic infections such as crusted scabies due to drug-induced impairment of their cell-mediated immune response, thus maintaining a high index of suspicion for crusted scabies as a differential diagnosis in transplant kidney patients is extremely important. Early histological diagnosis of crusted scabies is essential to prevent delayed or missed diagnosis and avoid unnecessary serious complications. The combination of an oral ivermectin and topical permethrin regimen resulted in excellent clinical outcomes in our case and is recommended as the standard treatment.

Background: Health care agent (HCA) documentation as part of advance care planning (ACP) helps clinicians understand patient care wishes. This project aimed to habituate these conversations and increase documentation rates.

Methods: Workflow redesign and novel educational interventions were implemented. Patients aged 50 and older received an HCA education "blue sheet" at check-in as a discussion prompt.

Results: Of 968 visits, patients in 44% received the intervention and 4% added HCA documentation. Chart audits found that 69% of patients had outdated (older than 5 years) ACP/HCA documentation. Clinician and staff found the process helpful, important to patients, and sustainable.

Discussion: This inexpensive intervention increased HCA documentation and highlighted the need to update old ACP documents.

Introduction: More availability of HIV pre-exposure prophylaxis (PrEP) is needed to end the HIV epidemic, but this means more clinicians will encounter false positive HIV test results. These cases highlight such occurrences and the steps a clinician may take to determine the significance of such results.

Case presentation: We present the case of a 68-year-old male who presented for routine follow-up for HIV PrEP and a 41-year-old transgender male who presented to establish care with a primary care clinician. On labs, both had repeatedly positive HIV antigen/antibody tests with undetectable viral loads.

Discussion: With increasing prescription of HIV PrEP comes a need for accurate interpretation of HIV serologies. HIV PrEP users may have altered stages of seroconversion. Additionally, heterophile antibody interference can lead to false positive or negative results.

Conclusions: The reader should gain an understanding of HIV testing, potential pitfalls, and next steps amidst unclear results.

Introduction: Hypertension is a leading cause of morbidity and mortality worldwide. Although it is often asymptomatic, adequate blood pressure control can help decrease the risk of cardiovascular, renal, and neurologic diseases. Clinical pharmacists can play a critical role in blood pressure management and have been shown to help patients meet their goals. Despite this, patients often disengage from pharmacy services, and reasons for this are not well understood. This study sought to evaluate characteristics of patients who are referred but not engaged in a primary care pharmacy antihypertensive service and explore potential reasons for disengagement.

Methods: Data from the 2023 fiscal year (July 1, 2022 - June 30, 2023) were collected from UW Health's electronic health record. Inclusion criteria were prespecified to include adults referred by their primary care provider to pharmacy services but who did not engage in care. Retrospective chart reviews were performed to gather demographic information on this population, and descriptive statistics were used for data analysis.

Results: Of the 168 individuals who met the inclusion criteria, 66.1% of participants were not currently at their blood pressure goal. The majority of patients did not engage in pharmacist services due to lack of patient interest (n = 114, 67.9%) or being managed by another health care member team (n = 36, 21.4%).

Conclusions: The majority of patients who did not engage with a pharmacist for hypertension medication management despite referral from their primary care provider are not achieving their blood pressure goal.

Introduction: Clinical faculty at academic health centers may benefit from specific mentorship and proficiencies that are distinct from those on research tracks. We describe the creation, activities, and 1-year impact of a faculty development program that included novel professional coaching training (the Clinical Faculty Mentoring Program), which was supplemented by skills- and knowledge-building activities (the Clinical Faculty Development Series).

Methods: The goals and components of the Clinical Faculty Mentoring Program and Clinical Faculty Development Series are described in detail. A mixed methods evaluation plan guided collection of confidential survey and interview data before and after the first year of these activities. We used paired t tests to identify statistically significant changes.

Results: The 43 clinical mentors reported significant gains in job satisfaction, teaching attitudes, knowledge of mentorship competencies, and confidence with coaching skills for mentorship (all P < 0.05). Of mentor respondents, 88% found the coach approach to mentoring program to be "very" or "somewhat" helpful. Coaching behavioral domains with the greatest evidence of improvement were supporting the mentee to integrate new awareness, insight, and learning into their worldview and behaviors (P = 0.0503) and managing time and focus of mentoring sessions (P = 0.022). All 37 mentees had at least 1 meeting with a mentor (100%). Over 9 months, 39 virtual Clinical Faculty Development Series sessions had an average participation of 38 participants (range 22-59). A majority of surveyed faculty (>55%) agreed or strongly agreed the sessions provided valuable opportunities for skills development with teaching, leadership, wellness, diversity, equity, inclusion, and promotion.

Conclusions: Among clinical mentors, our novel coach approach to clinical faculty mentoring and skill-building had favorable effects on job satisfaction, knowledge of mentorship competencies, and confidence in coaching skills. Outcomes from the Clinical Faculty Development series supported the mentoring program outcomes. Longitudinal follow-up is needed to determine how this program will impact mentees.

Background: Increasing attention has been paid to medical racial health disparities, though limited attention has been paid to mitigating these disparities in access to fertility care and reproductive life planning. Workshops previously have been shown to increase physician awareness and practice improvements.

Objective: We sought to develop an education tool to provide structured, case-based learning for physicians to reflect on bias in fertility assessment and treatment and discuss changes in practice.

Methods: Authors created reproductive life planning and infertility management cases and arranged them for review informed by reproductive justice and fertility scholars. The resulting workshop was piloted to a group of 10 residents in person at a single academic institution. The cases were presented in a large group style and participants discussed cases in pairs. At the workshop's conclusion, participants were prompted to provide feedback via a survey.

Results: One hundred percent (10/10) of respondents reported that the workshop helped them think about bias in medicine. Ninety percent (9/10) of respondents reported that after the workshop, they will think differently about how they approach marginalized patients in their practice. Eighty percent (8/10) of participants reported that the workshop gave them tools on how to approach marginalized patients in their practice.

Discussion/conclusions: Participants reported overwhelmingly that they found the workshop valuable and that it assisted them in making goals to change their practice to improve fertility care for racially marginalized patients.

Introduction: There is higher disease incidence and worse outcomes in rural America when compared to urban America. In states like Wisconsin, where 32.9% of the population resides in rural areas, this is particularly worrisome. The Center for Healthcare Quality and Payment Reform found that 30% of rural hospitals in the US are at risk of closing due to financial instability. A substantial cost to rural hospitals is the provision of radiologic services. Thus, the study investigated if a disparity exists in availability of magnetic resonance imaging (MRI) and computed tomography (CT) machines among Wisconsin's urban and rural county hospitals.

Methods: Wisconsin hospitals were asked how many MRI and CT machines were carried at their facility. This information was compiled in a spreadsheet and cross-referenced with the county in which it resided, along with the county's population, urban-rural classification, and land area in square miles.

Results: We found that the state of Wisconsin compared favorably with the national average in terms of the number of persons and square miles per MRI and CT machine. When comparing Wisconsin counties based on their urban-rural classification, a disparity exists in rural counties regarding square mileage per CT and MRI machine.

Conclusions: With distance for service creating a barrier to accessibility, rural county residents would benefit from more in-hospital MRI and CT machines. Based on these findings, further research is warranted to investigate the potential vulnerability of other rural populations regarding accessibility to radiologic resources.

Background: Housing and health care both play crucial roles in overall health. Though housing and health care barriers negatively impact affect health, little is known about the relative influence of each. This study sought to understand the relationship between housing circumstance, barriers to care, and mental health outcomes among low-income, uninsured patients seen at a free clinic in Milwaukee, Wisconsin. This includes investigating the relative impact of risk factors for homelessness, housing barriers, and health care barriers on mental health.

Methods: Surveys were administered to clinic patients (n = 94) from June to December 2023. Surveys assessed patient demographics, housing and health care barriers, and mental health outcomes, primarily measured by the Patient Health Questionnaire-2 (PHQ-2), General Anxiety Disorder-2 (GAD-2) questionnaire, modified loneliness scale, and individuals' subjective mental health rating.

Results: Increased health care barriers and socioenvironmental risk factors for homelessness significantly predicted worse PHQ-2 score, GAD-2 score, loneliness, and mental health rating. Despite significant associations, increased housing barriers did not significantly predict any of the 4 mental health metrics. Furthermore, neither housing barriers nor health care barriers significantly predicted recreational drug use, whereas socioenvironmental risk factors for homelessness were both a significant predictor and response of increased recreational drug use. The most frequently reported mental health care barriers were insurance coverage, financial barriers, and transportation issues. In addition, there was significantly lower patient trust in mental health care providers than in general medical providers, which may reflect increased stigma.

Conclusions: Compared to housing barriers, increased health care barriers significantly predicted worse mental health outcomes. This study emphasizes the importance of addressing health care barriers to improve mental health.