INTRODUCTION:Chronic medical conditions affect approximately 129 million Americans. The complexities of chronic illness, coupled with limited health care resources and clinician time, can complicate treatment management, and contribute to poor health outcomes. The effect of group medical visits (GMVs) on patient wellness has not been well established. METHODS:Mixed-methods approach using both quantitative and qualitative data was used to evaluate wellness following completion of GMV programs. Patients completed pre- and post-GMV assessments using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. GMV programs included Yoga for Cancer, Stress Reduction and Resiliency, Mindful Eco-Wellness, and Mindfulness for Your Health from 2017 to 2024. The PROMIS-29 is a validated health questionnaire that assesses 7 domains: anxiety, depression, fatigue, sleep disturbance, participation in social roles, pain, and physical function. Clinicians and patients also participated in qualitative interviews regarding their GMV experiences. RESULTS:Among 76 participants who completed pre- and post-GMV PROMIS-29 assessments, fatigue scores improved and participation in social roles increased significantly. Improvements were also observed in anxiety, depression, sleep disturbance, and physical function, although these changes were not statistically significant. Themes identified from interviews with 15 clinicians and 10 patients included patient empowerment, sense of community, patient satisfaction, integrative care, and trust. DISCUSSION:Improvements in PROMIS-29 domains suggest that GMVs may have the potential to enhance patient health and wellness. The themes discovered portray a positive outlook on GMVs, with mindfulness practices and the sense of community that is cultivated within a group setting highlighted as especially important. CONCLUSIONS:GMVs were associated with improvements in fatigue and participation in social roles and were viewed favorably by patients and clinicians. Although additional controlled studies are needed, GMVs may represent a promising approach to supporting wellness among patients living with chronic conditions.
INTRODUCTION:The body of literature surrounding transgender health care primarily focuses on metropolitan populations and resource-rich areas. This qualitative study examines the perspectives of transgender patients in northcentral Wisconsin to identify recommendations for more comprehensive, inclusive health care practices. METHODS:A series of semistructured interviews was conducted with recipients of gender-affirming care residing in northcentral Wisconsin. A mixed deductive-inductive approach was used for qualitative thematic analysis. RESULTS:A total of 10 interviews were completed. Qualitative analysis revealed 3 key themes contributing to positive and negative experiences with health care providers: education, cultural competency, and access. DISCUSSION:Patients reported feeling supported by health care providers but not always that providers were well equipped to address their specific health needs. The attitudes of all members of the health care team contributed to participants' feelings of acceptance and comfort in the health care environment. Participants living in rural areas cited transportation challenges and provider scarcity as barriers to gender-affirming care. CONCLUSIONS:Health care providers play an important role in mitigating health disparities among transgender patients. Experience providing gender-affirming care, nonjudgmental attitudes, and visible displays of allyship are associated with positive clinician-patient relationships.
INTRODUCTION:Patients undergoing infertility evaluation and treatment frequently experience anxiety and depressive symptoms. Easily available and highly accessible online mental health tools have not previously been evaluated using validated screening measures in this population. The objective of this study was to assess whether SilverCloud, an online, self-guided mental health program, is associated with reductions in anxiety and depressive symptom scores among patients experiencing infertility. METHODS:A retrospective cohort study was conducted among female patients undergoing an initial infertility consultation at a single academic center. Patients completed Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires and were offered enrollment in SilverCloud at their initial infertility consultation. Baseline PHQ-9 and GAD-7 scores from initial consultations were compared between patients who enrolled in SilverCloud and those who did not. For patients who engaged in SilverCloud, Wilcoxon signed-rank tests were used to compare PHQ-9 and GAD-7 scores before and after completion of SilverCloud modules. RESULTS:A total of 354 patients were included in the analysis. Fifty-two patients enrolled in SilverCloud, and 32 completed at least 1 module. Baseline data demonstrated that patients who enrolled in SilverCloud had significantly higher GAD-7 scores (0.5 vs 0; P = .006). Among patients who completed at least 1 SilverCloud module, PHQ-9 and GAD-7 scores decreased significantly decreased after engagement (PHQ-9: 8.0 vs 6.5; P 7lt; .04; GAD-7: 12.5 vs 9.5; P = .02). CONCLUSIONS:Patients experiencing infertility who utilized SilverCloud experienced significant decreases in PHQ-9 and GAD-7 scores, suggesting improvement in anxiety and depression symptoms.
INTRODUCTION:An intra-right ventricular course of the left anterior descending (LAD) artery is a rare coronary anomaly with uncertain clinical and procedural significance. We describe the use of multimodality imaging to characterize this variant in a patient with ventricular tachycardia and to guide the safe performance of catheter ablation. CASE PRESENTATION:A 46-year-old White woman presented with ventricular tachycardia and was found on coronary computed tomography angiography to have an intraventricular course of the mid LAD through the right ventricular cavity. Multimodality imaging, including coronary computed tomography angiography and stress cardiac magnetic resonance imaging, demonstrated no evidence of obstructive coronary artery disease, myocardial ischemia, structural heart disease, or myocardial scar. She was ultimately diagnosed with idiopathic right ventricular outflow tract ventricular tachycardia and underwent successful catheter ablation. DISCUSSION:An intra-right ventricular course of the LAD is a rare coronary variant. In a large coronary computed tomography angiography study, this anomaly was identified in less than 1% of patients. Although its clinical significance is not well understood, this anatomic variant can have important procedural implications for ventricular tachycardia ablation. CONCLUSIONS:Multimodality imaging is vital in assessing the clinical significance of an anomalous coronary artery and ensuring the procedural safety of ventricular tachycardia ablation.
INTRODUCTION:Genomic advances have launched medicine into a new frontier of preventive and personalized care, driving increased demand for services amid a recognized provider shortage. We aimed to highlight perspectives of clinical geneticists to support growth and sustain genetics care for patients in Wisconsin in the face of rising demand. METHODS:A literature review informed the development of interview questions for appreciative inquiry-guided interviews. University of Wisconsin-affiliated geneticists were interviewed in the summer of 2024 about their experiences and insights. Transcripts were analyzed using an open inductive process, and hierarchical qualitative analyses were conducted to identify themes and opportunities to increase interest in genetics as a career. RESULTS:Regarding their profession, 92% of respondents identified "problem-solving" as a favorite aspect, highlighted the benefits of interprofessional collaboration, and identified diagnostic improvements as the most notable change over their careers. Regarding the future of genetics, 75% expressed excitement about improving treatments, anticipated a shift in their roles from diagnostics to management, and encouraged trainees across health professions to engage in genomic medicine learning opportunities. CONCLUSIONS:Clinical geneticists expressed strong enthusiasm for their careers, noting problem-solving, continuity of care, and patient diversity as key highlights. Their roles provide opportunities to lead interdisciplinary teams, collaborate across specialties, and engage in lifelong learning. Their experiences offer insight into future diagnostic and treatment advances, which will require innovative care delivery approaches, including greater delegation and expanded training for the broader health care workforce. These perspectives may help foster interest in clinical genetics among health care trainees.
INTRODUCTION:Prion diseases are rare neurodegenerative disorders characterized by abnormal folding of prion proteins in the brain. Creutzfeldt-Jakob disease (CJD), is the most common prion disease in humans, typically presenting with neuropsychiatric manifestations, including dementia, behavioral abnormalities, and motor dysfunction. Diagnosis can be challenging because its nonspecific presentation overlaps with numerous other potential causes. CASE PRESENTATION:A 60-year-old man presented with altered mental status and progressive neurologic decline. After an extensive diagnostic evaluation, he was diagnosed with probably CJD. Management was primarily supportive and focused on symptom relief and patient comfort. The patient died shortly after the diagnosis was confirmed. CONCLUSIONS:This case highlights the challenges of diagnosing CJD and underscores the value of System 1 and System 2 reasoning in navigating a broad differential diagnosis in patients presenting with altered mental status and rapidly progressive neurologic symptoms.
BACKGROUND:Sputum cultures are essential for guiding targeted antibiotic therapy; however, they are often underutilized. This quality improvement initiative aimed to enhance sputum culture ordering through an antimicrobial stewardship pharmacist-led intervention. METHODS:A retrospective review of pneumonia hospitalizations from January 2021 through December 2022 evaluated the impact of a policy change allowing antimicrobial stewardship pharmacists to order sputum cultures. Statistical analyses compared preintervention and postintervention sputum culture ordering rates, adjusting for patient demographics, hospital admission location, and other covariates. RESULTS:Sputum culture orders increased from 36% before the intervention to 50% after the intervention, with a 29% higher likelihood of sputum culture ordering after the intervention (risk ratio, 1.29; 95% CI, 1.19-1.38; P < .001). CONCLUSIONS:This intervention demonstrates the potential for antimicrobial stewardship programs to improve adherence to guideline-based practices through pharmacist-led initiatives.
INTRODUCTION:Severe hypercholesterolemia in children is commonly caused by familial hypercholesterolemia (FH); however, sitosterolemia, a rare autosomal recessive disorder, should be considered when FH genetic testing is negative. CASE PRESENTATION:A 4-year-old boy presented with xanthomas on his knees. His total cholesterol was 561 mg/dL. Initially, homozygous FH was suspected, and rosuvastatin was started; however, genetic testing was negative. Subsequent genetic testing identified a homozygous ABCG8 variant, consistent with sitosterolemia. Rosuvastatin was discontinued, and ezetimibe and dietary plant sterol restriction were initiated, resulting in significant improvement in cholesterol levels and resolution of xanthomas. DISCUSSION:Sitosterolemia results from impaired ABCG5/8 transporter function, leading to plant sterol accumulation, which can cause hypercholesterolemia, xanthomas, and hematologic abnormalities. Diagnosis is established by demonstrating elevated plant sterol levels or through genetic testing. Treatment involves dietary plant sterol restriction and ezetimibe. CONCLUSIONS:Sitosterolemia, though rare, should be considered in severe hypercholesterolemia when FH genetic testing is negative. This case demonstrates a typical presentation and favorable response to treatment with ezetimibe and dietary modification.
BACKGROUND:Skin cancer is the most common malignancy in the United States, underscoring the need for effective prevention strategies. The Community Sun Protection Program (CSPP), a medical student-run initiative, aims to improve access to sunscreen through the provision of free sunscreen dispensers. OBJECTIVES:This study evaluated the impact of a sunscreen dispenser initiative and identified factors that may inform future community sunscreen dispenser programs. METHODS:The CSPP provided 13 sunscreen dispensers to 8 community partners in Milwaukee County, Wisconsin. After at least 1 summer of dispenser use, community site managers were interviewed, and responses were transcribed for thematic analysis. RESULTS:Community site managers identified 3 primary themes: improved accessibility, positive community engagement, and increased educational opportunities related to sun safety. CONCLUSIONS:These findings highlight the value of a collaborative public health intervention aimed at improving sun safety awareness and access to preventive resources.
INTRODUCTION:Overdoses due to novel potent opioids continue to increase across the United States. The availability of colored fentanyl products that may appeal to younger patients is concerning. CASE PRESENTATION:We present the case of an adult male with an unknown ingestion subsequently identified as purple fentanyl. Brorphine is a common component of purple fentanyl and is considered an emerging novel potent opioid. DISCUSSION:Only limited number of case reports describing brorphine exposure are available, and many clinicians remain unfamiliar with this substance. It is a potent opioid with a presumed long half-life. Clinical presentation is similar to that of other opioid toxidromes, including respiratory depression, miosis, and sedation, and is managed similarly. Patients may require extended monitoring after exposure to brorphine. CONCLUSIONS:Awareness of emerging substances of abuse will enable clinicians to diagnose and treat affected patients more readily.
INTRODUCTION:Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by impaired mucociliary clearance. To our knowledge, no cases of lung adenocarcinoma in patients with PCD have been previously reported. CASE PRESENTATION:A 43-year-old White man with PCD presented with persistent cough and dysphonia. Chest imaging revealed a 4-cm mass in the left upper lobe, and positron emission tomography/computed tomography (PET/CT) demonstrated increased uptake in the mass, hilar lymph nodes, and sternum, suggesting metastatic disease. Biopsy of the lung mass confirmed adenocarcinoma, and magnetic resonance imaging of the brain identified a metastatic lesion. He was treated initially with pembrolizumab and stereotactic radiation therapy for a brain metastasis and had a mixed response. Consequently, chemotherapy with carboplatin and pemetrexed was added, resulting in complete response, with no fluorodeoxyglucose-avid lesions on follow-up PET imaging. DISCUSSION:With only 8 reported cases of lung cancer in patients with PCD, this is, to our knowledge, the first report of lung adenocarcinoma in a patient with PCD successfully treated with chemoimmunotherapy. CONCLUSIONS:Although rare, clinicians should consider lung cancer in patients with PCD who present with persistent symptoms refractory to standard treatment.
INTRODUCTION:Rat bite fever is a rare zoonotic illness that presents with nonspecific symptoms. Rapid identification and treatment are essential to reduce morbidity or mortality. CASE PRESENTATION:A 39-year-old male presented to the emergency department with severe headache and arthralgias. His history was notable for multiple bites and scratches from pet rats. He was admitted for further evaluation after meeting systemic inflammatory response syndrome (SIRS) criteria for sepsis. A meningitis workup was unrevealing. He was treated for presumed rat bite fever with amoxicillin and discharged in improved condition. Several days later, his blood culture grew Streptobacillus moniliformis. His symptoms resolved with appropriate antibiotic therapy. DISCUSSION:Prompt recognition and management are necessary to avoid complications of rat bite fever. A thorough history is crucial to identify uncommon exposures when initial workup is unrevealing. CONCLUSIONS:This report describes a rare, culture-confirmed case of rat bite fever. Because this disease is not nationally reportable, it may be more prevalent than currently recognized and should remain in the differential diagnosis for patients with nonspecific symptoms and known rodent exposure.
INTRODUCTION:Isolated vertebral osseous sarcoidosis is a rare form of sarcoidosis that may mimic malignancy or infection and can be difficult to diagnose in the absence of systemic symptoms. CASE PRESENTATION:A 70-year-old African American woman presented with lower back pain, 5 years after an initial evaluation of incidental vertebral lesions identified on positron emission tomography imaging. Repeat imaging showed a lesion in the T4 vertebra. Computed tomography-guided biopsy and thorough evaluation excluded infection and malignancy, confirming vertebral sarcoidosis. DISCUSSION:Few cases of vertebral sarcoidosis have been reported, usually presenting with localized pain and lytic or sclerotic vertebral lesions. Diagnosis requires histopathologic confirmation and exclusion of alternative etiologies. Early recognition is important, as corticosteroid treatment often improves outcomes. CONCLUSIONS:Sarcoidosis should be considered in the differential diagnoses of vertebral lesions, even in the absence of systemic involvement.
INTRODUCTION:Emergency services professionals (eg, emergency medical technicians, paramedics, and emergency department registered nurses) work in high-stress, low-resource environments and are consequently vulnerable to burnout. Additionally, many lack opportunities to learn patient outcomes, which may contribute to dissatisfaction or uncertainty regarding their role in the patient care. OBJECTIVES:TThis study evaluated the feasibility, acceptability, appropriateness and estimated the effect size of a patient follow-up program implemented in a rural Wisconsin service area among both prehospital and emergency department-based emergency services professionals on burnout, compassion satisfaction, secondary traumatic stress, and job satisfaction. METHODS:Participants were provided follow-up summaries for patients they cared for over a 12-week period. Feasibility, acceptability, and appropriateness were measured using a validated instrument and free-text responses analyzed via content analysis after the intervention. Burnout, compassion satisfaction, and secondary traumatic stress were measured using the Professional Quality of Life Scale, and job satisfaction was measured using 2 items from the Satisfaction of Employees in Health Care survey, administered before and after the intervention. RESULTS:Forty-one participants enrolled in the study. They rated feasibility, acceptability, and appropriateness highly. The majority reported that patient follow-up summaries were valuable and provided clinically useful information that supported their practice. CONCLUSIONS:Patient follow-up summaries are valued by emergency services professionals and provide opportunities to learn from patient outcomes.
INTRODUCTION:Invasive cervical cancer continues to disproportionately affect racially and ethnically minoritized populations and individuals living in rural areas. We analyzed trends in cervical cancer incidence by race, ethnicity, and geography in Wisconsin from 1998 through 2022. METHODS:Cervical cancer incidence rates (per 100 000 individuals with a cervix) were analyzed by race/ethnicity and county using data from the Wisconsin Cancer Reporting System. RESULTS:Overall incidence declined 28%, from 8.2 to 5.9 cases per 100 000, but declines were not evenly distributed across populations. Compared with non-Hispanic White individuals, non-Hispanic Black individuals had nearly twice the incidence rate throughout the study period. Although Hispanic individuals experienced the largest relative decline (40.8%, 15.7 to 9.3 per 100 000), incidence remained higher among non-Hispanic White individuals. Milwaukee County, Wisconsin's most socially vulnerable county, had among the highest incidence rates and slowest decline over time (19.8%). DISCUSSION:Because cervical cancer is largely preventable, the persistence of substantial disparities in Wisconsin highlights structural inequities that warrant urgent attention.
INTRODUCTION:Human papillomavirus (HPV) is the most common sexually transmitted infection globally, with high-risk strains contributing to cancers of the cervix, penis, anus, vulva, vagina, and oropharynx. Despite the availability of an effective vaccine (Gardasil-9) and broad support from public health organizations, vaccination rates remain suboptimal due to parental hesitancy and misinformation. This study assessed the impact of an educational intervention on HPV knowledge and vaccination intent among parents and guardians of children aged 8 to 17 years. METHODS:Pharmacy students conducted virtual educational sessions via Zoom for parents of children aged 8 to 17 years. Sessions covered HPV transmission, associated risks, and benefits of Gardasil-9. Participants completed presession and postsession surveys assessing knowledge and willingness to vaccinate. RESULTS:A total of 50 participants attended the sessions; 48 completed the presurvey and 39 completed the postsurvey. Knowledge improved significantly following the intervention (53% vs 90% correct; P<.001). Willingness to vaccinate daughters increased from 68% to 89% reporting "very willing," while willingness to vaccinate sons increased from 70% to 91%. Parents were 1.2 times more likely to report being "very willing" to vaccinate their children against HPV after the intervention. CONCLUSIONS:A virtual educational intervention significantly improved parental knowledge and positively influenced their intent to vaccinate against HPV. Addressing vaccine hesitancy through structured, accessible educational programs may help increase HPV vaccination rates and reduce the burden of HPV-related cancers.
