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

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: Rural-based health care systems face unique concerns, including the struggle to recruit and retain quality clinicians. We evaluated health care providers' perceptions of their service line directors (SLDs) in the Marshfield Clinic Health System to understand how these perceptions affect job satisfaction in a rural health care setting.

Methods: Utilizing quantitative and qualitative methods, we reached out to providers within the health system, excluding SLDs to prevent bias. The survey, with a 43% response rate, encompassed 14 questions focusing on 8 domains of engagement. Data analyses included chi-squared tests, t tests, analysis of variance, and correlation matrices. To delve deeper into perceptions, a qualitative approach was employed, analyzing open-ended feedback.

Results: Of the 457 respondents, 70% reported satisfaction with their SLDs. High meeting frequencies with SLDs were positively correlated with satisfaction. The majority acknowledged the positive attributes of SLDs in domains like availability, recognition, and feedback. However, significant variations in perceptions arose between physicians and advanced practice clinicians and between surgeon and non-surgeon SLDs. Qualitative feedback elucidated themes including engagement, communication, and advocacy. Positive attributes, such as competence and proactivity, were mentioned frequently, while negatives highlighted disconnectedness and being uninformed.

Conclusions: The quality of interactions with SLDs significantly influences clinician satisfaction. Regular, meaningful interactions - especially recognizing and providing feedback - enhance satisfaction. However, certain groups like advanced practice clinicians under surgeon SLDs felt less engaged. Our findings underscore the importance of tailored leadership training for SLDs and suggest organizational strategies to boost satisfaction, potentially affecting recruitment and retention in rural health care settings.

Introduction: Tick-borne relapsing fever is a zoonotic infection caused by members of the Borrelia genus of spirochetes found predominantly in the southwestern United States.

Case presentation: A 65-year-old woman presented to a Wisconsin emergency department with a 2-day history of fevers and altered mental status after returning from a 5-week stay in Colorado. Initial labs were notable for elevated transaminases, thrombocytopenia, mild hyponatremia, mild hypokalemia, and elevated procalcitonin.

Discussion: Rapid identification of patients with tick-borne relapsing fever is essential to minimize morbidity and mortality. Peripheral blood smear - especially during a febrile episode - can serve as a quick and accurate way to diagnose the illness with direct visualization of spirochetes.

Conclusions: Early analysis of a peripheral blood smear can lead to a swift diagnosis of tick-borne relapsing fever, particularly in nonendemic states such as Wisconsin.

Introduction: Epidural lipomatosis is a relatively rare condition resulting in the accumulation of unencapsulated fatty tissue within the epidural space. Steroids, either exogenous or endogenous, have been reported as a cause for this accumulation. The diagnosis is confirmed by computed tomography or magnetic resonance imaging. Symptomatic epidural lipomatosis has been reported to present with radiculopathy, myelopathy, claudication, cauda equina syndrome, or paraplegia. It is usually managed conservatively, including weight loss and avoidance of steroids.

Case presentation: We report the case of a patient with sarcoidosis on oral prednisone who was referred for low back and leg pain of multifactorial origin. After addressing his low back pain, a fluoroscopically guided lumbar epidural steroid injection was performed for his neurogenic claudication. This provided 3 months of complete pain relief. But the patient also developed unilateral foot drop, possibly secondary to worsening epidural lipomatosis.

Conclusions: Epidural lipomatosis may result in complications that include neurological deficits. Although various disease states may cause it, prudence is advised in the use of exogenous steroids.

Introduction: Electronic cigarettes (e-cigarettes) are the most common tobacco product used by adolescents, yet no evidence-based cessation treatment for adolescents exists.

Methods: Wisconsin residents aged 13 to 17 (N = 227) completed an online survey assessing e-cigarette use, knowledge, motivations around using and quitting, and recommendations for cessation intervention content.

Results: Most of our sample never vaped (76.2%), reporting concerns with health effects and addiction as motivations preventing initiation. Among adolescents who used e-cigarettes, friend use was the main motivation for initiation, and mental health symptoms promoted ongoing use. Motivations for quitting included health harms, cost, and addiction.

Conclusions: This study identified various topics that motivate and demotivate e-cigarette use among adolescents. This information can be incorporated into prevention and treatment strategies tailored to adolescents.

Introduction: Efficient discharges lead to decreased length of stay and improved hospital flow. An efficient discharge requires timely recognition of medical readiness for discharge (MRD) and effective preparation. The objective of this study was to better understand pediatric hospital medicine discharges by (1) analyzing the time of MRD and discharge throughout the day, (2) assessing the time from MRD to discharge, and (3) categorizing commonly identified discharge delays.

Methods: A retrospective chart review of pediatric hospital medicine patients with the diagnoses of asthma, "brief resolved unexplained event," hyperbilirubinemia, or "rule out sepsis neonates" was completed. MRD was determined by reviewing the patient's chart for completion of diagnosis-specific discharge criteria. MRD was compared to the time of discharge order and discharge. Delayed discharges were reviewed further to identify reasons for the delay.

Results: One hundred discharge events were analyzed - 25 from each of the 4 selected diagnoses. MRD occurred throughout the day (33% morning, 43% afternoon, 14% evening, and 10% night). The median time from MRD to discharge was 1.7 hours (0.5 hours from MRD to discharge order and 0.9 hours from order to discharge), with the longest MRD to discharge time in asthma patients. Forty percent of patients had a delayed discharge, and identified reasons for delays were further categorized.

Conclusions: MRD occurred throughout the day, suggesting the MRD to discharge time may be an informative metric of discharge efficiency. Next steps include developing forward-facing electronic health record alerts noting MRD for improved tracking and real-time communication and targeted interventions to address reasons for discharge delays.

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.

Background: Individuals who donate their bodies to academic, whole-body donation programs support health science education, training, and research. This is the first report on Wisconsin whole-body donor demographics and the extent to which donors represent the state population.

Methods: Donor demographic data from 2016 through 2021 were collected from death certificate worksheets and compared with Wisconsin population data from the US Census Bureau and state health statistics.

Results: Most donors were non-Hispanic White individuals, did not have a college degree, and did not work in health care. The median age at death was 86 years. Twenty-eight percent of donors served in the armed forces. Donors were not representative of the Wisconsin population in age, race, ethnicity, or military service.

Discussion: Whole-body donors provide an invaluable resource for health science education and research. Understanding donor demographics is an important first step in examining diversity and representation within Wisconsin's body donation programs.