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

Background: Health care settings are not immune to workplace violence, and emergency department workers are especially susceptible. In 2021, Wisconsin Act 209 made it a felony to "intentionally cause bodily harm or threaten to cause bodily harm to a person who works in a health care facility." We conducted a study of emergency department workers to assess their experiences with violence and the perceived effects of Act 209.

Methods: We developed a survey for health care workers (nurses, physicians, and advanced practice providers) who were currently practicing in a Wisconsin emergency department. The reporting timeframe was March 23, 2022, through June 30, 2023.

Results: A total of 194 Wisconsin emergency department workers responded; 70.6% reported experiencing bodily harm, threats of bodily harm, or both. The median number of bodily harm incidents was 2, and 51.4% did not report these incidents. The median number of threats reported was 4, and 66.7% did not report them. Nurses experienced more threats of bodily harm than physicians. Overall, 40.2% of respondents were unaware of Act 209, and 67.6% indicated that abuse toward health care workers occurred at the same rate after its enactment as before. The most frequent barrier to reporting was "Person has a medical condition that might complicate application of the law."

Discussion: Most workers reported experiencing bodily harm or threats, and most did not report these incidents. Beyond clinical factors and time constraints, limited law enforcement bandwidth and perceptions of law enforcement as obstructive were the next most cited barriers. Only 1.2% of respondents reported feeling "definitely safer" after Act 209.

Conclusions: Violence against health care workers has become an expected consequence of working in the field. Legislative action is one tool to attempt to curb this trend. Further efforts to identify strategies that ensure the safety and wellness of health care workers should be a priority.

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.

Introduction: Candida auris (C auris), a multidrug-resistant fungus, was declared by the Centers for Disease Control and Prevention as a serious global health threat in 2016. It is hard to identify, resistant to standard antifungal treatments, and spreads within health care settings, resulting in high morbidity and mortality in critically ill patients.

Case presentation: We report the case of a 60-year-old immunocompetent male with a protracted course of prosthetic knee joint infections. He received medical care at several health care facilities across 2 Midwestern states culminating in wound dehiscence and C auris infection necessitating prolonged antimicrobial treatment.

Discussion: C auris has been a pathogen of increasing nosocomial transmission with particular concern for multidrug resistance. Treatment is with prompt irrigation and debridement and polyethylene exchange and systemic antifungal treatment. Local treatment with antimicrobial impregnated cement can be used to reduce treatment duration and mitigate resistance.

Conclusions: With emerging concerns and the prevalence of infection with C auris, there should be greater vigilance in evaluating patients with repeat surgeries and health care contacts for fungal infection.

Introduction: Climate change is the greatest global public health threat of this century, increasing respiratory, cardiovascular, and vector-borne diseases; mental health effects; and premature deaths. The US health care sector is responsible for 8% to 10% of the nation's greenhouse gas emissions; therefore, engaging health care systems in emissions reduction could improve health for all communities.

Methods: A 10-question survey was emailed to a convenience sample consisting of 211 faculty physicians, nurse practitioners, and physician assistants and an unknown number of other staff employed at 21 UW Health family medicine clinics. The survey measured knowledge of health care greenhouse gas emissions and included 2 open-ended questions to solicit opinions on sustainability priorities and barriers to waste reduction. Each clinic also received a 15-minute presentation on health care climate impact during one of their regularly scheduled meetings.

Results: Of the 130 survey respondents, 34% knew the health care sector is responsible for 8% to 10% of the US carbon emissions and 9% of non-greenhouse air pollutants. Only 26% knew that most of these emissions come from purchasing and transportation. However, 92% thought environmental sustainability should be incorporated into all clinical operations, and 74% wanted to know how to affect purchasing to reduce emissions. Top priorities were identified as investing in renewable energy, increasing recycling, and reducing waste (eg, single-use instruments). Top barriers to waste reduction were thought to be cost, complacency, and time.

Conclusions: Despite lack of knowledge of the health care sector's contribution to US greenhouse gas emissions, most surveyed health care workers wanted their health care system to incorporate environmental sustainability into all clinic operations. Additional research identifying knowledge gaps and soliciting opinions of other medical specialties and health care systems on health care greenhouse gas emissions may increase awareness of health care emissions, inform health care leaders, and lead to emissions reduction.

Introduction: While prostatic abscess formation is often mitigated by initiating antibiotics for prostatitis, early recognition and treatment are important to avoid risk of sepsis and death.

Case presentation: A 79-year-old male presented with milky-white penile discharge during bowel movements. He had no fever, dysuria, or perineal pain. The discharge culture grew multidrug resistant Escherichia coli. Computed tomography of abdomen/pelvis showed a heterogenous, enlarged prostate leading to diagnosis of a prostatic abscess. The abscess was treated successfully with cystourethroscopy, transurethral unroofing, and a course of intravenous ertapenem.

Discussion: Previous research shows patients with prostatic abscesses present with perineal pain, dysuria, and fever. This case demonstrates the importance of considering a prostatic abscess in a patient with penile discharge alone.

Conclusions: We report a unique presentation of prostate abscess to educate and improve clinical suspicion of a rare, yet potentially fatal urological complication.