Digital Commons Network^™

Defining Patient-Oriented Research For The Average Person (And Potential Research Partner), Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In this introduction to the first issue of 2019, the editor-in-chief of Journal of Patient-Centered Research and Reviews offers additional context to the findings of Kaur and Pluye (p. 7), who methodically formalized an operational definition of patient-oriented research for the purposes of searching bibliographic databases. A possible succinct, lay definition of patient-oriented research for the average “person on the street” is proposed.

Patient Self-Management: Tools And Barriers, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In his issue introduction, the editor-in-chief of the Journal of Patient-Centered Research and Reviews comments on the theme of patient self-management of chronic diseases and the related articles published therein. Illnesses such as cardiovascular disease, diabetes, epilepsy, arthritis, asthma, and obesity often require patients to administer their own medication daily or adhere to strict dietary restrictions. Progress is being made on the process of implementation and evaluation of patient self-management tools in primary care practices. Barriers to self-management tool implementations in clinics, as well as their use by individual patients, must be understood and addressed.

Limiting Antibiotic Use In Acute Sinusitis: Partly A Matter Of Vocabulary?, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In his issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on an included article that describes the successful use of an electronic medical record best practice alert to reduce the rate of antibiotic prescription for acute sinusitis. Various methods previously tried to improve antibiotic stewardship in this illness are briefly reviewed. Borrowing on the model of acute bronchitis, it is suggested that a change in conveyed diagnostic vocabulary to “sinus cold” when describing acute sinusitis may help limit antibiotics for this predominantly viral infection.

Use Of Urine Antigen Testing For Blastomyces In An Integrated Health System, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Purpose: Blastomycosis, an endemic fungal infection, mimics many other diseases. We explored the use of Blastomyces urine antigen (BuAg), reportedly the most sensitive noninvasive test, in clinical practice and compared it to other noninvasive tests.

Methods: A total of 836 BuAg tests performed on unique patients (first test only) at one large integrated health system from June 2013 to May 2016 were retrospectively reviewed to examine test characteristics and demographic features. Of these, 100 cases from 2015, a year containing a large local blastomycosis outbreak, were randomly selected for detailed analysis.

Results: Demographics for the BuAg-tested population: mean age 54.9 …

Uncertainty And Competing Priorities In Shared Clinical Decision-Making, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews observes that a connecting thread among the articles published therein is an element of uncertainty among patients and clinicians. Competing priorities for the patient also may be present. Several approaches to overcoming these prevalent conflicts to delivery of better health care have been proposed, the most important of which may be clinicians embracing a will to practice shared decision-making.

The Lifestyle Initiative: An Innovative Coaching-Based Quality Improvement Study To Improve The Health Of Aurora Health Care Caregivers And Family Members, Tiffany A. Mullen, Jessica J.F. Kram, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans.

Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members.

Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of …

Every Word, Every Gesture, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Two nonverbal patients teach a novice clinician the power and often hidden impact of the physician-patient relationship.

Improving Obstetrics In Family Medicine Residency Clinics: A Quality Improvement Study, Garima Chawla, Jessica J.F. Kram, Bonnie Bobot, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care.

Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB.

Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at …

Did You Hear What I Meant To Say?, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

The author introduces Volume 4, Issue 1 of Journal of Patient-Centered Research and Reviews by acknowledging the importance of communication between patient and caregiver in the clinical setting. Failure to communicate effectively can have a negative impact on a patient's well-being, therefore efforts to improve communication skills among clinicians, researchers and health practice administrators should be undertaken with regularity.

Health Care Transitions For Adolescents And Young Adults With Special Health Care Needs: Where Are We Now?, Nicole Mubanga, Dennis J. Baumgardner, Jessica J. F. Kram

Dennis J. Baumgardner, MD

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to …

Fungal Infections From Human And Animal Contact, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America. Other human-acquired and zoonotic fungal infections also are discussed in brief.

Freshwater Fungal Infections, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Fungal infections as a result of freshwater exposure or trauma are fortunately rare. Etiologic agents are varied, but commonly include filamentous fungi and Candida. This narrative review describes various sources of potential freshwater fungal exposure and the diseases that may result, including fungal keratitis, acute otitis externa and tinea pedis, as well as rare deep soft tissue or bone infections and pulmonary or central nervous system infections following traumatic freshwater exposure during natural disasters or near-drowning episodes. Fungal etiology should be suspected in appropriate scenarios when bacterial cultures or molecular tests are normal or when the infection worsens or fails …

Blastomyces: Why Be Dimorphic?, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In introducing the infectious disease focus for this edition of the Journal of Patient-Centered Research and Reviews, the author describes the unsolved mysteries surrounding the dimorphic fungus Blastomyces and the related pathogenesis of pulmonary blastomycosis.

Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Purpose

Community-acquired pneumonia (CAP) is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP), i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP.

Methods

We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not improve …

Geodemographic Features Of Human Blastomycosis In Eastern Wisconsin, Megan E. Huber, Dennis J. Baumgardner, Jessica J. F. Kram, Melissa A. Lemke

Dennis J. Baumgardner, MD

Purpose

Blastomycosis is an endemic fungal infection. In rural northern Wisconsin, blastomycosis cases are associated with certain environmental features including close proximity to waterways. Other studies have associated blastomycosis with particular soil chemicals. However, blastomycosis also occurs in urban and suburban regions. We explored the geodemographic associations of blastomycosis cases in the more urban/suburban landscape of eastern Wisconsin.

Methods

We conducted a retrospective study of 193 laboratory-identified blastomycosis cases in a single eastern Wisconsin health system, 2007–2015. Controls were 250 randomly selected cases of community-diagnosed pneumonia from a similar time period. Geographic features of home addresses were explored using Google …

Disease-Causing Fungi In Homes And Yards In The Midwestern United States, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

A number of fungal pathogens that may result in a variety of human diseases are found in residential homes and yards. The growth of these microscopic fungi is often favored by particular characteristics of the dwelling and nearby outdoor environment. Evolved virulence factors or increased ability of specific fungi to grow in diverse, and sometimes harsh, microenvironments presented by the domestic environment may promote growth and pathogenesis. Infection may occur by inhalation or direct inoculation and include endemic fungi in addition to opportunistic or emerging species. Systemic or locally aggressive fungal infections are particularly likely and may be life-threatening in …

Geographic Distribution Of Maternal Group B Streptococcus Colonization And Infant Death During Birth Hospitalization: Eastern Wisconsin, Jessica J. F. Kram, Dennis J. Baumgardner, Kiley B. Vander Wyst, Melissa A. Lemke

Dennis J. Baumgardner, MD

Purpose

Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization.

Methods

We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed.

Results

Study population (N = 99,305) had …

Β-Thujaplicin: A Soil Antifungal, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: β-thujaplicin (β-Th), also known as hinokitiol, naturally occurs in cedar mulch, is found in personal care products and has in vitro antitumor activities. It is antibacterial and antifungal, but has not been tested on soil. Scedosporium apiospermum (Sce) is an emerging “extremophile” fungal pathogen found in built outdoor environments. Purpose: Pilot β-Th as “natural” soil antimicrobial or for isolation of extremophiles, and to explore β-Th resistance as selective advantage to Sce in mulched landscape. Methods: A variety of outdoor and indoor environments were used for 2 sets of 24 paired soil samples. Soil/H20 slurry (0.1 ml) was spread on …

Disease-Management In Family Medicine Clinics Through The Addition Of A Health Coach: A Pilot Study, Crystal Y. Cichon, Jessica J.F. Kram, Tiffany A. Mullen, Pamela Voelkers, Kristin J. Magliocco, Kiley A. Bernhard, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: In the United States, more than 80% of health care spending is focused on the management of chronic illnesses such as hypertension, diabetes and hyperlipidemia. Controlling these chronic diseases can lead to better health outcomes and decrease the number of preventable deaths. Patient self-management has shown to improve clinical outcomes. In a primary care setting, a multidisciplinary approach can more effectively educate patients on improving their health. Purpose: To assess the impact of a health coach in a primary care setting as it relates to clinical outcomes. Methods: Patients from two Aurora family medicine clinics were referred to a …

Assessing The Effectiveness Of Implementation Of Unified Workflow In Improvement Of Medication Reconciliation For Aurora St. Luke’S Family Medicine Residency Outpatients, Katherine Meyers, Jessica Konarske, Jessica J.F. Kram, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Background: Medication errors are the most common errors occurring in hospitals. Preventable adverse drug events are linked with 1 in 5 injuries or deaths; 23% of medication errors in primary care occur due to inaccuracies in the medication list. Quality improvement projects designed to improve accuracy of outpatient medication reconciliations may decrease the number of medication errors and increase patient safety by preventing adverse drug events. Purpose: To determine whether a unified workflow for medication reconciliation improves the accuracy of ambulatory, electronic medical record (EMR)-based patient medication records. Methods: Retrospective study of random sample of patients from Aurora Family Medicine …

Primary Care For Melanoma: Should We Be Screaming For Screening?, Dennis J. Baumgardner, Alexandria Rogers

Dennis J. Baumgardner, MD

The incidence of cutaneous malignant melanoma continues to rise in the United States. This deadly disease is potentially curable if caught at an early stage, however screening programs remain controversial. The United States Preventive Services Task Force cites insufficient evidence to recommend screening, by total-body skin examination (TBSE), for early detection of cutaneous melanoma. While definitive studies may be cost-prohibitive in the United States, more recent evidence suggests that organized programs to increase TBSE reduce mortality from melanoma. The positive impact of TBSE, and education regarding risk reduction and skin self-examination, is most likely to be cost-effective in high-risk patients …

One Final Goodbye, Dennis Baumgardner

Dennis J. Baumgardner, MD

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Pulmonary Blastomycosis In Vilas County, Wisconsin: Weather, Exposures And Symptoms, Dennis J. Baumgardner, Kiley A. Bernhard, Gina Egan

Dennis J. Baumgardner, MD

Purpose Blastomycosis is a serious fungal infection contracted by inhalation of Blastomyces spores from the environment. Case occurrence in dogs in Vilas County, Wisconsin, has been associated with antecedent weather. We aimed to explore the effects of weather on the occurrence of human pulmonary blastomycosis in this area, and update exposure factors and symptoms since last published reports. Methods Mandatory case reports were reviewed. Chi-square test was used for categorical data of exposures, comparing 1979–1996 (n=101) versus 1997–June 2013 (n=95). Linear regression was used to model local weather data (available 1990–2013; n=126); Southern Oscillation Index (SOI), North Atlantic Oscillation Index …

Clinical Guidelines: Where Environment Meets Medicine, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

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