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

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.

Introduction: Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytic multisystem disorder, deriving from mononuclear phagocytic cells. It is notoriously challenging to diagnose. Here we present a case of a patient with multisystem ECD.

Case presentation: A 76-year-old female with a history of Hashimoto's thyroiditis who presented with persistent leukocytosis was found to have bilateral renal enlargement with a perinephric mass, a recurrent pericardial effusion, and bilateral pleural effusions. Following biopsies of several sites of involvement, a diagnosis of ECD was made.

Discussion: The existing literature on ECD is sparse, and no diagnostic criteria have been put forward due to widely differing presentations, although the most common is skeletal. Definitive diagnosis requires a tissue sample.

Conclusions: In presenting our clinical reasoning and approach, we hope to contribute to the existing body of literature on ECD, with the aim of ultimately having sufficient data to compile a diagnostic framework for other clinicians who encounter ECD.

Background: We investigated patient experience with abortion for fetal anomaly, about which little is known.

Methods: This qualitative, longitudinal pilot study surveyed 7 patients twice after abortion for fetal anomaly, initially 4 to 5 days after the abortion and a follow-up 3 months post-abortion, at a single Wisconsin hospital from July 2012 to February 2014.

Results: Patients indicated that having a choice to have an abortion and choose the modality is imperative, and they remained certain in their decision-making over time. They also described initially strong, then lacking, social support; processed grief; and identified resource constraints.

Discussion: Patients emphasized the importance of having the choice to choose abortion and the abortion modality, remaining confident in their decision-making over time. This qualitative pilot study provides areas for future intervention to improve care for people undergoing abortion for fetal anomaly.

Understanding youth and young adult mental health and well-being is critical to addressing rates of suicide among this population. This qualitative study sought to gather additional perspectives of students across Wisconsin using photovoice methods to enhance understanding of their experiences and to inform future policies and programs. A total of 11 youth and young adults ages 14 to 26 participated by taking pictures in response to given prompts and then discussing those pictures within a virtual focus group. Spanning the social-ecological framework, 4 themes emerged from the photographs and discussion: (1) individual-level factors drive mental health and well-being; (2) the support of interpersonal relationships is crucial; (3) school-related factors are predominant sources of stress; (4) policies, culture, and systems influence well-being. This study highlights the unique experiences of youth and young adults and underscores the impact of systems and structures on their mental health and well-being.

Introduction: More young adults (age 18-24 years) in rural areas versus urban areas use electronic nicotine delivery systems (ENDS) - also known as e-cigarettes. Little is known about young adults' perceptions toward ENDS use and cessation. The objective of this study was to examine barriers and facilitators to ENDS use cessation among young adults living in rural areas, as well as their perceptions about ENDS use and cessation and to determine implications for future cessation studies.

Methods: We administered cross-sectional online surveys to young adults living in rural Midwestern counties. A total of 100 individuals responded to the surveys. Descriptive statistics were used to report their perceptions of ENDS use as well as barriers and facilitators to ENDS use cessation. The content analysis method was used to analyze the answers to an open-ended question regarding perceptions about the ENDS use cessation in the context of rural areas.

Results: Barriers to ENDS use cessation included perceived advantages to ENDS use, high nicotine dependence, and the perception that ENDS use was less harmful cigarettes. Facilitators to ENDS use cessation included cost of ENDS use, perceived harm, and high confidence in ability to quit. Participants' perceptions about ENDS use cessation in the context of rural areas were conceptualized under the themes of (1) exposure to and initiation of ENDS use, (2) continuation of ENDS use, and (3) prevention and cessation of ENDS use.

Conclusions: Health care providers, tobacco control researchers, and public health advocates should be aware of barriers and facilitators to ENDS use cessation among young adults for future cessation intervention studies relevant specifically to rural areas.

Introduction: Acute myelomonocytic leukemia is a type of acute myeloid leukemia with monocytic expansion. Both the disease and its treatment can be immunocompromising. Immunocompromised patients are more susceptible to infections, such as Fournier's gangrene, a rare necrotizing infection of the groin.

Case presentation: A 56-year-old male presented to the emergency department with abdominal pain, leukocytosis, and perineal ecchymosis. Overnight, his perineal discoloration and tenderness worsened. He underwent irrigation and debridement for Fournier's gangrene and received broad-spectrum antimicrobial therapy. Subsequent workup revealed acute myeloid leukemia with leukemia cutis and central nervous system involvement, necessitating chemotherapy initiation prior to complete wound healing.

Discussion/conclusions: This case highlights the challenges in the diagnosis and management of acute leukemia in the setting of a concomitant life-threatening soft tissue infection, as both the hematologic disease and treatment thereof can exacerbate infectious complications.

Hypokalemia is a common disorder in clinical practice. The underlying pathophysiology can be attributed to 3 main mechanisms: insufficient potassium intake, excessive urinary or gastrointestinal losses, and transcellular shift. Renal loss is the most common cause of hypokalemia. Renal loss of potassium can occur due to diuretics, mineralocorticoid excess or hypercortisolism (Cushing syndrome). Among patients with Cushing syndrome, ectopic adrenocorticotropic hormone (ACTH) is the most frequent cause. We present a case of hypokalemia and hypertension due to ectopic ACTH production leading to Cushing syndrome.

A 33-year-old man presented with suprapubic abdominal pain and small vesicular lesions on the foreskin of the penis. Based on the presentation, he was empirically treated for genital herpes, although the herpes simplex virus swab was negative. He returned to the emergency department 4 months after his initial presentation with worsening symptoms that were consistent with balanoposthitis and cystitis. He was tachycardic and febrile on presentation. He denied any sexual contact for the last 3 months, with previous negative screening tests for sexually transmitted infections. Syphilis was eventually diagnosed during this admission. The incidence rates of syphilis have increased in recent years, and the infection is often undiagnosed given atypical manifestations. Here we present an atypical manifestation of syphilis that was initially misdiagnosed as herpes simplex virus.