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

Introduction: Calcium channel blockers (CCBs) antagonize L-type calcium channels, primarily in the cardiovascular system. In overdose, the pancreas also is affected, which prevents the release of insulin leading to hyperglycemia. We sought to determine the incidence of hyperglycemia in CCB exposures reported to US poison centers and to compare the incidence of hyperglycemia with severe medical outcomes.

Methods: We performed a retrospective chart review of CCB exposures using data from the National Poison Database System from January 1, 2007, through December 31, 2017. Exposures with co-ingestions were excluded. Statistical analysis was performed to determine incidence of hyperglycemia and associated medical effects. Statistical analyses on age and intentionality of exposure also were performed.

Results: There were a total of 49 576 CCB exposures included in the study; 626 exposures (1.2%) had reported hyperglycemia. The relative risk of a severe medical outcome in cases with hyperglycemia compared to cases without hyperglycemia was 21.8 (95% CI, 19.6-24.4). Exposures in cases of people older than age 20 had a relative risk of hyperglycemia of 8.6 (95% CI, 6.8-10.9) and a relative risk of a severe medical outcome of 5.6 (95% CI, 4.9-6.5). In intentional exposures, the relative risk of hyperglycemia was 11.3 (95% CI, 9.6-13.3), and the relative risk of death or a severe medical outcome was 12.1 (95% CI, 10.8-13.7).

Conclusions: In this large retrospective review of CCB exposures, hyperglycemia was an uncommon event. When present, hyperglycemia was associated with a severe medical outcome. Intentional exposures and exposures in people older than age 20 years also were associated with increased incidence of hyperglycemia and a severe medical outcome.

Introduction: To improve inferior vena cava (IVC) filter retrieval rates, an electronic health record prompt for scheduling retrieval before patient discharge was implemented.

Methods: This retrospective comparative cohort study was conducted in a single Midwestern tertiary care medical center. Adult patients with IVC filters placed for a medical (Medical subgroup) or trauma (Trauma subgroup) indication before and after protocol implementation and who had follow-up documented in the electronic health record were included. IVC filter retrieval attempt rates both overall and by indication for placement before and after protocol implementation were compared.

Results: Three hundred eighty-five patients met eligibility criteria: 223 before implementation (Before group) and 162 after implementation (After group). The attempted retrieval rate for the After group was 11.4% higher than the Before group (P = .012). Attempted retrieval rates in the Medical Before and After subgroups were 56.2% and 76.0%, respectively (P = .001). The Trauma subgroups' rates were similar to each other (P = .594). Time to retrieval attempt was significantly shorter in the Medical After subgroup than in the Medical Before subgroup (P = .018) but similar in the Trauma subgroups.

Conclusions: Attempted retrieval rates were significantly higher in the After group and Medical After subgroup. Trauma subgroup rates were similar, likely because a previous intervention to increase retrieval in trauma patients was in place during the pre-implementation period of our study. Findings suggest that using an automated electronic health record-based prompt to facilitate IVC filter retrieval scheduling could greatly improve retrieval rates and patient safety.

Introduction: Chlamydia trachomatis and Neisseria gonorrhoeae are the two most reported bacterial infections in the United States, with over 1.5 million and 500 000 cases reported in 2019, respectively. The number of infections continues to rise, with significant disparities at the national level in the rate of infection between age, race, and sex demographic classifications. Although the disparities in chlamydia and gonorrhea infections have been well described in the US, little research has been done on a smaller community scale, such as La Crosse County, Wisconsin.

Methods: We accessed data from La Crosse County, Wisconsin; the State of Wisconsin; and the United States for gonorrhea and chlamydia cases from 2001 through 2020 and completed both descriptive analysis and inferential statistical analysis.

Results: Gonorrhea and chlamydia rates have risen at the local, state, and national levels. Demographic analysis of the cases in La Crosse County conveyed that females and Black populations having higher rates of infection. Additionally, the 25- to 39-year age group had a marked increase in gonorrhea rates at the county and state levels.

Conclusions: We were able to show demographic differences in chlamydia and gonorrhea incidence rates. The authors recommend that the 25- to 39-year-old group should undergo more regular comprehensive screening for all sexually transmitted infections.

Introduction: Endometrial cancer is the most common gynecologic cancer in the United States, and endometrial cancer staging historically has included lymph node assessment to inform prognosis and guide recommendations for adjuvant treatment. This study sought to determine the incidence of lymph node involvement in patients undergoing hysterectomy with sentinel lymph node dissection for a preoperative diagnosis of endometrial intraepithelial neoplasia (EIN) to allow for risk stratification and management by general gynecology and gynecologic oncology.

Methods: We performed a retrospective chart review of patients diagnosed with EIN who underwent hysterectomy from January 2018 through July 2021. We collected and analyzed patient characteristics, perioperative metrics, and postoperative data. Incidence of lymph node positivity on final pathology was the primary outcome of interest. We analyzed clinical and histologic risk factors for correlation with a final diagnosis of endometrial carcinoma. Chi-square, Fisher exact, and t tests were used for comparisons.

Results: One hundred patients met inclusion criteria, 40 of whom had an underlying endometrial cancer. The majority were stage IA grade 1 endometrioid carcinomas (95%). Per institutional protocol, all patients were recommended sentinel lymph node dissection, of which 84 (84%) patients ultimately underwent lymph node dissection. One patient was found to have a positive sentinel lymph node on final pathology (1.2%). Increasing endometrial stripe thickness was positively associated with risk of endometrial carcinoma on final pathology (22.39 mm ± 31.87 vs 11.78 mm ± 5.17, P = 0.023).

Conclusions: The incidence of lymph node involvement in patients with a preoperative diagnosis of EIN is low. Sentinel lymph node dissection is unlikely to affect adjuvant treatment recommendations following surgical staging. Standardized risk assessment methods are warranted for patients with a preoperative diagnosis of EIN to delineate the utility of lymph node assessment in this population.

Introduction: Female physicians experience high rates of infertility and report barriers to accessing treatment, including lack of health insurance coverage and limited knowledge of available benefits. Given the extended duration of training, medical school may be an optimal time for fertility preservation or treatment. However, whether medical schools provide information or coverage for these services in unclear. This study aimed to assess (1) whether US medical school websites provide information on health insurance coverage for fertility preservation and treatment and (2) whether medical schools offer health insurance coverage for these services.

Methods: Accredited allopathic and osteopathic medical school websites were reviewed for information on fertility coverage available. Summary-of-benefits documents were examined for coverage of in vitro fertilization (IVF), intrauterine insemination (IUI), elective oocyte cryopreservation, fertility medications, and infertility evaluation. Chi-squared tests assessed differences by school type, funding source, and geographic region.

Results: Of 108 medical school websites reviewed, 48.2% provided information on elective fertility preservation and 52.7% on IVF coverage. Osteopathic schools more frequently provided information on IVF coverage (48.71% vs 24.51%; P  = .006) and fertility preservation coverage (43.58% vs 22.58%; P  = .014). Only 8.33% of schools offered coverage for IVF or elective fertility preservation. Publicly funded schools more often offered coverage for IUI (23.3% vs 3.57%; P  = .027), fertility medications (23.33 % vs 0%; P   = .005), and infertility evaluation (31.03% vs 3.57%; P   = .006). Schools in the Northeast most frequently offered coverage for these services.

Conclusions: US medical schools provide limited information and health insurance coverage for fertility preservation and treatment. Publicly funded and Northeastern schools more frequently offer coverage, which may influence prospective students' decisions.

Background: Exercise offers multiple health benefits, and improving adherence may positively influence community health. Thus, improving exercise adherence is likely to have a positive impact on community health. The YMCA, a longstanding community resource, provides exercise opportunities ranging from individual workouts to large-group classes. Group cohesion may enhance adherence; however, the effect of group size on cohesion is not well understood.

Methods: This study at the Greater Green Bay YMCA examined the impact of individual, small-group (< 12 participants), and large-group (≥ 12 participants) exercise on adherence, frequency, satisfaction, confidence in safe exercise, and self-perceived health. An online survey distributed via the YMCA newsletter collected data on exercise preferences, membership duration, and related factors.

Results: Fifty-six members completed the survey: 14 exercised exclusively in large groups, four in small groups, 20 individually, and 18 used multiple methods. Large-group participants reported the highest satisfaction (8.8/10) and exercised most frequently, with 64% attending three or more times per week. Large-group and individual exercisers reported the highest confidence in safety (8.3/10). Combination exercisers had the highest self-perceived health (7.9/10). Among long-term members, 73% participated in some form of group exercise.

Discussion/conclusions: Exercising in groups of at least 12 participants was associated with greater satisfaction and more frequent exercise compared with smaller groups or exercising alone. Participation in any group exercise was linked to higher self-perceived health. These findings suggest that group cohesion may influence adherence and health perceptions, providing a foundation for future research and program development.

Introduction: Despite the negative health effects of adverse childhood experiences, few pediatricians regularly screen for them. We sought to investigate clinician and trainee knowledge and practices regarding adverse childhood experiences in Wisconsin clinics.

Methods: We undertook a sequential mixed methods study. We administered a cross-sectional, web-based survey to medical trainees and clinicians associated with the University of Wisconsin-Madison or subscribing to the Wisconsin chapter of the American Academy of Pediatrics. The survey was developed and pretested by experts in medical education and survey methodology. Data were analyzed descriptively and categorically. We then conducted semistructured interviews using thematic analysis and inductive and deductive coding to characterize facilitators and barriers to screening.

Results: Survey respondents included 110 medical students, 103 attending physicians, 51 residents, and 10 advanced practice providers. Respondents were familiar with adverse childhood experiences, yet only 26% had adequate knowledge to impact their clinical practice. More residents (69%) and medical students (50%) received education about adverse childhood experiences than attending physicians (20%). Few respondents (13%) regularly screen for adverse childhood experiences, but the majority (80%) expressed interest in screening. Nine respondents completed interviews, revealing 3 themes: (1) knowledge is not enough; (2) demand for a multilevel approach; and (3) impact of systems of oppression.

Conclusions: Wisconsin trainees and clinicians have limited experience with adverse childhood experiences resulting in low screening rates but express a strong desire to learn more. Increasing screening practice will require targeted efforts to enhance clinician experiential learning, minimize systemic barriers, and address systems of oppression.