Patient care, public health, and a pandemic: adapting educational experiences in the clinical years.

The University of Wisconsin Madison School of Medicine and Public Health rapidly adapted its four-year, three-phase medical doctorate clinical curriculum at the onset of the COVID-19 in Spring 2020. Medical students in clinical rotations, our Phase 2 and 3 of the ForWard curriculum, temporarily stopped face to face care of patients, transitioning instead to online learning. For Phase 2 students, this single 12- week interim course included didactic content from all required integrated blocks and the creation of a new content which taught public health principles in the context of historical pandemics. Phase 3 students were rescheduled into online electives, which course directors had offered in the past and agreed to offer again during this time. All Phase 3 students participated in a Public Health Preparedness course after its rapid redesign for online delivery and scaling for an entire class. Phase 2 students returned in July 2020 to abbreviated 8-week integrated blocks that retained approximately 83% of the clinical time students would have received in the intended 12-week integrated blocks. This was possible through the frontloading of teaching sessions to the interim course and creative scheduling of clinical experiences. The 2015 curricular redesign to the integrated curriculum facilitated effective coordination and teamwork that enabled these thoughtful, rapid adjustments to the curriculum.

A systematic review of prolotherapy for chronic musculoskeletal pain.

OBJECTIVE: Prolotherapy, an injection-based treatment of chronic musculoskeletal pain, has grown in popularity and has received significant recent attention. The objective of this review is to determine the effectiveness of prolotherapy for treatment of chronic musculoskeletal pain. DATA SOURCES: We searched Medline, PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search strategies using all current and historical names for prolotherapy and injectants. Reference sections of included articles were scanned, and content area specialists were consulted. STUDY SELECTION: All published studies involving human subjects and assessing prolotherapy were included. MAIN RESULTS: Data from 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations. CONCLUSIONS: There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandomized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with noninjection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy.

Bloodstream infections in a community hospital: a 25-year follow-up.

OBJECTIVE: To examine the current status of bloodstream infections (BSIs) in a community hospital as part of a 25-year longitudinal study. DESIGN: Retrospective descriptive epidemiologic study. SETTING: Community teaching hospital. PATIENTS: All inpatients in 1998 with a positive blood culture who met the CDC NNIS System case definition of BSI. METHODS: Cases were stratified by underlying illness category using case mix adjustment categories (after McCabe) and reviewed for associations among mortality, underlying illness severity, and multiple clinical and laboratory parameters. RESULTS: Of 19,289 patients discharged in 1998, 185 had an episode of infection documented by blood culture (96 cases per 10,000 inpatients). BSI was twice as frequent in patients 65 years and older compared with younger patients. BSIs caused or contributed to the deaths of 22 patients for an overall case-fatality rate of 11.9% compared with 20.7% in 1982 (P = .02). Striking decreases were noted for in-hospital patient mortality in 1998 for BSIs with ultimately and rapidly fatal underlying illnesses (P = .02 and P < .10, respectively). Primary bacteremia decreased compared with 1982. Antibiotic use was vigorous, but resistance was modest in both nosocomial and community-acquired organisms and had changed little from 1982 and 1987. CONCLUSIONS: Compared with previous studies, case-fatality rates in patients with BSI were substantially lower in rapidly fatal and ultimately fatal underlying illness categories. Antibiotic use was extensive but prompt and appropriate. Microorganism resistance to antibiotics changed little from the 1980s.