Descriptive analysis of interpreter service mode costs & usage in Northwestern Wisconsin pre and peri COVID-19.

Background: Interpreter service mode (in person, audio, or video) can impact patient experiences and engagement in the healthcare system, but clinics must balance quality with costs and volume to deliver services. Videoconferencing and telephone services provide lower cost options, effective where on site interpreters are scarce, or patients with limited English proficiency (LEP) and/or interpreters are unable to visit healthcare centers. The COVID 19 pandemic generated these conditions in Northwest Wisconsin (NWWI).

Self-efficacy Through Digital Care Plan Participation.

The concept of self-care is a foundational construct of individual health and wellness. Facilitated self-care is the next logical step in society's uptake of technology for previously high-touch clinical activities, such as patient education and frequent biometric data tracking. This retrospective study aimed to assess whether participation in a digital interactive care plan correlated with an increase in participants' perceived self-efficacy as measured by a change in the Shortened Perceived Medical Condition Self-management Scale score from baseline to end-of-care plan.

Impact of pharmacist-led microbiology result follow-up post-discharge for patients undergoing inpatient infectious diseases consultation.

Objective: The primary objective was to determine the rate of clinical actions taken post-discharge on updated microbiology results by an ID pharmacist-led team. Secondary objectives were to describe the microbiology results requiring intervention, characterize interventions by type and severity, and determine time from result to clinical review.

Design: Retrospective cohort study.

Surgical Trends in Chronic Pancreatitis from 2014 Through 2021.

Objectives: We analyzed annual surgical trends for benign chronic pancreatitis (CP), studying specifically mortality, morbidity, and pancreatic fistula rates. We also aimed to identify predictors of pancreatic fistula formation.

Methods: For this analysis, we used data from the American College of Surgeons National Surgical Quality Improvement Program from 2014 through 2021.

Virtual Reality Videos for Symptom Management in Hospice and Palliative Care.

Objective: To learn more about the effect of virtual reality videos on patients' symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most.

Patients And Methods: We conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds.

Addressing menopause symptoms in the primary care setting: opportunity to bridge care delivery gaps.

Objective: Menopause symptoms affect quality of life and financial well-being but are often unaddressed in primary care clinics. Therefore, we evaluated the extent of menopause symptom documentation in electronic health records (EHRs) by primary health care professionals.

Methods: We retrospectively reviewed adult women who reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 1, 2021, through June 30, 2021.

A Virtual Communication Workshop to Increase Confidence Using Telehealth Modalities.

Introduction: COVID-19 ended in-person communication training workshops at our institution, so we sought to provide a way for family medicine residents to hone their telephone and audio-visual skills online.

Methods: We developed a 2-hour online workshop where residents practiced delivering serious news to family members via telephone or videoconferencing call and measured participant confidence via pre-, post-, and 6-month surveys.

Results: Participant confidence in delivering serious news via telephone and videoconferencing increased.

Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19.

Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma").

Central Cord Syndrome After Fall From Inversion Table.

Introduction: Central cord syndrome, the most common incomplete traumatic spinal cord injury, often results in functional impairment with variable recovery.

Case Presentation: Central cord syndrome developed in a 64-year-old man during routine home use of an inversion table.

Discussion: The incidence of central cord syndrome, which occurs most frequently after a fall, is increasing among older persons.

Implementation of an Evidence-Based Medicine Curriculum for Postgraduate Emergency Medicine Physician Assistant and Nurse Practitioner Fellows.

Introduction: Within physician assistant (PA) education, the inclusion of evidence-based medicine (EBM) is mandatory. Despite existing literature on EBM training methodologies for PA students and emergency medicine (EM) physician residents, there exists a dearth of published data concerning EBM instruction within postgraduate PA EM programs. A pilot study is described providing an overview of implementation of an EBM curriculum in a single-institution postgraduate physician assistant and nurse practitioner emergency medicine fellowship.

Amiodarone Pharmacovigilance Through an Intelligent Electronic Health Record Application.

Background: Amiodarone is the most effective and commonly used antiarrhythmic medication. Given its risk of toxicity, routine monitoring is recommended but is challenging to ensure in clinical practice.

Methods: We created an intelligent application, built within our electronic health record, that identified every living patient with an active outpatient prescription by a clinician in our health system.

One Hospital-Five Doors: A Model for Critical Access Hospital Sustainability.

Background: We wanted to assess whether a regional approach to bed management and staffing could improve financial sustainability without reducing services in rural communities.

Methods: Regional approaches to patient placement, hospital throughput, and staffing were coupled with enhanced services at 1 hub hospital and 4 critical access hospitals.

Results: We improved the use of patient beds in the 4 critical access hospitals, increased hub hospital capacity, and improved the health system's financial performance while maintaining or enhancing services at the critical access hospitals.

Automated electronic health record-based application for sedation triage in routine colonoscopy.

Background And Aims: Nearly all routine endoscopy procedures are performed using moderate sedation (MS) or monitored anesthesia care (MAC). In this article, we describe how we improved decision-making and decreased practitioners' cognitive burden for choosing between MAC and MS by using patient data in an automated application within the electronic health record (EHR).

Methods: In our practice, we choose between MS or MAC for routine GI procedures according to written anesthesia-use guidelines and practitioner preferences.

Getting SET for Student Success: Foundations for a Student Education Team.

Background: Family medicine clinical education poses logistic issues that we sought to address with the Student Education Team model.

Methods: The model combined team-based, patient-centered care with student experiences in a sustainable precepting model. Four learners successfully underwent precepting simultaneously.

Collaborative Rooming: An Innovative Pilot Project to Overcome Primary Care Challenges.

Background: Primary care physicians are overburdened with growing complexities and increasing expectations for primary care visits. To meet expectations, primary care physicians must multitask during visits and spend extra hours in the office for charting, billing, and documentation. This impacts the physician's quality of life and may affect the quality of patient care.

Number of Patient Encounters in Emergency Medicine Residency Does Not Correlate with In-Training Exam Domain Scores.

Introduction: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain.

Patient Understanding of Chemotherapy and Goals of Care as Provided by Different Care Team Members.

Chemotherapy can be challenging and overwhelming for patients, but when patients are knowledgeable about chemotherapy, their comfort level, overall satisfaction, and coping improve. It is currently unknown whether patients prefer information about chemotherapy to be provided by specific care team members and whether demographic characteristics affect learning preferences. We developed a 31-question questionnaire that asked patients when chemotherapy information was discussed and who they wanted that information to come from.

A Need for Digitally Inclusive Health Care Service in the United States: Recommendations for Clinicians and Health Care Systems.

The COVID-19 pandemic led to digital health service expansion that widened the existing digital divide. Residing in areas of limited broadband internet connectivity, lacking access to smart devices, and/or having low digital health literacy (ease, comfort, and skills to use technology) pose barriers to receiving health care remotely. This unequal access to health care is further exacerbated for older adults, those with lower income and less education, racial and ethnic minorities, and those who do not speak English.

Development and Implementation of a Virtual Clinical Skills Examination in General Psychiatry.

Objective: During the COVID-19 pandemic, psychiatry programs have administered the Clinical Skills Evaluation (CSE) through videoconferencing. The authors evaluated the feasibility and appropriateness of administering virtual CSEs.

Methods: Virtual CSEs were administered to 11 general psychiatry residents on March 16, 2021.

Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record.

Objective: After a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders.

Materials And Methods: A reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants.

Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.

Purpose: To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making.

Methods: In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid.