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

Background: Alcohol use is increasing in Wisconsin. We aimed to improve a state public health campaign around youth drinking to increase awareness of alcohol as a carcinogen.

Methods: The campaign was expanded and distributed via targeted social media advertisements and a directed campaign in a Wisconsin county with high rates of alcohol consumption.

Results: The media campaign outperformed benchmarks by 23.6%, delivering 1.65 million impressions. Total billboard impressions exceeded expectations by 46%. Across all digital tactics, there was a collective click-through rate of 0.42%. Facebook had the largest audience with over 128 000 total impressions, exceeding expectations by 28%. Cancer-specific related messaging engaged slightly higher click-through rates among Facebook audiences than impact messaging (0.47% vs 0.36%).

Discussion: Adding cancer-related messaging was effective in this expanded Wisconsin state youth drinking campaign.

Introduction: Causes of nipple pain include trauma, vasospasm, malignancy, Paget's disease, inflammation secondary to blockage of the ducts, infection, and medications. Raynaud's phenomenon (RP) of the nipple is reported more often in women and typically presents bilaterally.

Case presentation: A 63-year-old man presented with episodic, stabbing pain and blanching of the left nipple, worsening over 3 years. Symptoms began insidiously during military service. Examination revealed no abnormalities, but blanching was observed during a painful episode. Laboratory and imaging studies were unremarkable. Conservative measures and pharmacologic agents, including nitroglycerin ointment and amlodipine, provided minimal relief. Intercostal nerve blocks and cervical sympathetic blocks did not provide lasting relief. Ultrasound-guided paravertebral sympathetic block with local anesthetic provided temporary relief lasting week. Botulinum toxin injection around the areola resulted in sustained pain relief lasting more than month.

Discussion: The patient's presentation is consistent with primary RP of the nipple, a rare and underrecognized condition. While it typically affects distal extremities, it can involve other areas, including the nipple. Diagnosis is clinical, often requiring documentation during episodes. Management is challenging and largely anecdotal. Botulinum toxin has shown promise in RP, though evidence remains mixed.

Conclusions: This case highlights a rare presentation of unilateral, vasospastic nipple pain resembling primary RP, with partial response to botulinum toxin injection.

Introduction: Academic medicine literature has reported hesitation from clinical teaching physicians to use questions when teaching medical students due to its negative connotation of "pimping." However, newer literature suggests that most students prefer questions, while only a small minority are less welcoming. Some teaching physicians, however, have concerns about using questions due to the risk of humiliating or embarrassing medical students in clinical settings.

Methods: Medical students who completed core clerkship rotations at a public medical school in the Midwest were invited to participate in 1 of 4 virtual focus groups. Students were asked to reflect on 3 clinical teaching vignettes. Inductive thematic qualitative analysis was performed to create a codebook. The transcripts were coded by 2 independent coders for emerging themes.

Results: Twenty-six students participated across 4 groups. Four major themes were identified that demonstrate positive student reception of teaching physicians and their questions: teaching physicians (1) engaging students, (2) setting clear expectations, (3) empathizing with the medical student experience, and (4) asking questions to teach rather than evaluate. Thematic coding of the 3 vignettes resulted in initial intercoder reliabilities of 85.4%, 87%, and 79%, prior to achieving 100% consensus. Students described the ideal teaching physician to be patient, engaged, and respectful.

Conclusions: By engaging medical students, setting clear expectations early on, empathizing with the medical student experience, and asking questions with the purpose of teaching, teaching physicians can be less hesitant about upsetting medical students when utilizing questions as a teaching tool.

Background: Justice-involved individuals are disproportionately affected by hepatitis C virus (HCV) infection. Wisconsin's viral hepatitis elimination plan prioritizes this population, yet little is known about jail capacity for testing and treatment.

Methods: A 10-item survey was emailed to administrators of 71 county jails and 1 Tribal detention facility to assess HCV testing and treatment practices and barriers. Responses were analyzed descriptively.

Results: Thirty facilities (41.7%) responded. Ten jails (33.3%) offered HCV testing; 15 (51.7%) provided treatment. Common barriers to testing included lack of contracted services (40%) and staffing constraints (23.3%). Barriers to treatment included financial restrictions (66.7%) and short incarceration periods (33.3%).

Discussion: Limited testing and treatment capacity persists despite Medicaid coverage and effective therapies.

Conclusions: Partnerships with local health agencies and policy changes addressing cost and contractual limitations are essential to expand HCV services in Wisconsin jails.

Introduction: By removing the intrinsic source of pain, total pancreatectomy offers patients with chronic pancreatitis a definitive surgical treatment. However, pancreatectomy results in labile diabetes. Specialized centers perform total pancreatectomy and islet autotransplantation (TP-IAT) to prevent labile diabetes and restore insulin independence after pancreatectomy.

Objective: The objective of this retrospective study was to describe current indications and outcomes of TP-IAT performed at the University of Wisconsin (UW)-Madison, the sole center in the state offering this procedure.

Methods: We reviewed the records of 19 TP-IAT procedures performed at our center from 2014 to 2023 for chronic and relapsing pancreatitis. All were nondiabetic and 89% required narcotics for pain. We report surgical outcomes as well as outcomes related to postoperative control of pain and diabetes, including narcotic usage, islet graft function (measured by detectable fasting serum C-peptide levels), and insulin independence.

Results: The UW experience with TP-IAT demonstrates durable pain alleviation in 79% of patients. One year post-procedure, 80% of patients exhibited islet graft function; 32% remained insulin-independent.

Conclusions: In selected nondiabetic patients with chronic pancreatitis, TP-IAT is associated with durable reductions in narcotic pain medication requirements, improved quality of life measures, islet function, and mitigation of insulin dependence. Despite the advantages of TP-IAT, the procedure is still underutilized in the United States. Our data indicate that nondiabetic patients with chronic pain syndromes due to pancreatitis should be referred for possible TP-IAT to specialized centers before they lose islet function, develop significant fibrosis/calcifications, or have other major pancreatic surgical procedures.

Introduction: Atraumatic splenic rupture is an extremely rare but serious complication of infectious mononucleosis.

Case presentation: We present the case of an 18-year-old female who presented with atraumatic splenic rupture in the setting of infectious mononucleosis. Her past medical history was significant for postural orthostatic tachycardia syndrome, and she has a sister who was diagnosed with Ehlers-Danlos syndrome. Given her presentation and unique background, she was followed closely by surgery and hematology. The decision was made to pursue conservative management, and she was discharged home 4 days after admission with a 6-week physical activity restriction.

Discussion/conclusions: This patient's medical and family history warranted unique clinical considerations and multidisciplinary collaboration throughout in-patient management and follow-up. The lessons learned from nonoperative management of pediatric splenic injuries may be applied successfully to medical organ rupture, working in close partnership with hematologists to understand the time course and endpoints for the underlying inflammatory condition.

Introduction: Wisconsin's influenza immunization rates are below public health goals, with only 38% of residents vaccinated during the 2022-2023 season. Rates vary by race, sex, ethnicity, and geography. The COVID-19 pandemic demonstrated that pharmacists are well-positioned to address vaccine rates and disparities. Similar efforts are needed to address influenza, another respiratory disease associated with substantial morbidity and mortality.

Methods: Influenza vaccination data for the 2022-2023 season were obtained from the Wisconsin Immunization Registry and analyzed by demographic and geographic subgroups to determine the proportion of immunizations administered at pharmacies. Three focus groups assessed factors affecting pharmacies' role in promoting influenza vaccine equity. Qualitative data were analyzed using thematic content analysis.

Results: Of the 38% of Wisconsin residents vaccinated, 30.6% received their immunization at a pharmacy. Vaccination rates were higher among females than males (44% v 34%), with similar proportions vaccinated at a pharmacy (29.5% females v 29.4% males). Residents aged 18 to 49 years and 50 to 64 years had lower vaccination rates than those aged > 65 (26.7%, 39.6%, and 81.1%, respectively) and lower proportions vaccinated at a pharmacy (7.1%, 13.2%, and 35.8%, respectively). Differences in vaccination rates and pharmacy use were observed across racial and ethnic groups, with most groups showing lower rates compared to White residents. Qualitative results identified barriers such as vaccine burnout, billing and insurance issues, red tape and staffing shortages; promotors included trusted messengers and improved access/outreach.

Conclusions: Discrepancies in influenza vaccination rates by sex, age, and race/ethnicity persist in Wisconsin. Identifying barriers and promotors at the patient and immunizer levels can inform actionable recommendations to improve vaccine rates and promote equity.