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

Background: Probiotics are synthetic oral supplements containing live bacterial and fungal species hypothesized to help with various gastrointestinal conditions. However, they can cause infection if the organism spreads outside of the gastrointestinal tract. The aim of this study was to identify and describe patients who experienced systemic infections caused by probiotic use.

Methods: This study was a retrospective chart review of pediatric and adult patients at academic medical centers who received probiotics and subsequently developed positive cultures from a sterile site for probiotic-related species. Two individuals completed the chart reviews to determine if the probiotic was the true cause of the infection.

Results: Lactobacillus, Bifidobacterium, and Saccharomyces cultures were reviewed, with a total of 71, 8, and 2 cultures isolated from sterile sites for each organism, respectively. Further review revealed 23 Lactobacillus cultures from 13 unique patients who were taking Lactobacillus-containing probiotics. Four patients without gastrointestinal tract compromise were included in the final analysis, including 1 patient whose culture was confirmed as identical to the probiotic. Types of infections included meningitis and bacteremia. Targeted antimicrobial therapy included ampicillin, ampicillin-sulbactam, and piperacillin-tazobactam, with total durations of therapy ranging from 10 to 22 days. No patients had mortality attributed to Lactobacillus infection.

Conclusions: Probiotics are not harmless supplements as they come with risk of serious infection as demonstrated in this review. Before use, the risks of probiotics should be considered carefully for each individual patient. Clinicians should consider avoiding probiotics in hospitalized patients, especially those with vascular or extra-ventricular access devices.

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.

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.

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.

Background: Depression is a common concern for patients seeking medical care. The Patient Health Questionnaire-9 (PHQ-9) is a tool used to diagnose and manage depression. Tracking individual symptom scores rather than the sum of multiple symptom scores has been found to be more predictive of depression treatment response.

Methods: The records of 30 patients who had a follow-up visit in primary care were reviewed. We discuss 3 patient scenarios and present their PHQ-9 data as individual symptom scores, in the form of a color-coded heat map.

Results: In the cases presented, medication side effects, anxiety, a thyroid disorder, and fibromyalgia were identified as possible influencers of the PHQ-9 survey scores.

Dsicussion: A heat map helped clinicians understand the patient's clinical status in an efficient manner. We encourage the development of a PHQ-9 heat map in electronic medical record systems.