Faculty Bibliography

Opioid use disorder (OUD) is highly prevalent among jail and prison populations in the United States, including in Wisconsin. Medications for opioid use disorder (MOUD), including long-acting injectable naltrexone, are crucial in the treatment of OUD. These medications are especially important for individuals transitioning out of jail or prison and back into the community. Unfortunately, few individuals who were formerly incarcerated continue MOUD after reentry due to a variety of barriers. Wisconsin community pharmacists are highly accessible and uniquely positioned to provide care for this population, specifically by administering injectable naltrexone. However, community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated has not been previously explored. As a first step, this legislative and regulatory review aimed to identify Wisconsin statutes and administrative codes that may impact these services for this population. Two legal databases were searched to identify relevant Wisconsin statute and administrative code subsections. Overall, 24 statute subsections (from 7 chapters) and 31 administrative code subsections (from 12 chapters) were identified that (1) highlighted a need or potential role of community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated or (2) served as a potential barrier or facilitator to the availability, access, or use of these services. Future work should focus on helping community pharmacists leverage available resources and overcome existing legal barriers to providing or supporting MOUD services. Importantly, work should be done to ensure that individuals who were formerly incarcerated can be linked to these services upon reentry.

Artificial intelligence makes strides in specialized diagnostics but faces challenges in complex clinical scenarios, such as rare disease diagnosis and emergency condition identification. To address these limitations, we develop Meta General Practitioner (MetaGP), a 32-billion-parameter generative foundation model trained on extensive datasets, including over 8 million electronic health records, biomedical literature, and medical textbooks. MetaGP demonstrates robust diagnostic capabilities, achieving accuracy comparable to experienced clinicians. In rare disease cases, it achieves an average diagnostic score of 1.57, surpassing GPT-4's 0.93. For emergency conditions, it improves diagnostic accuracy for junior and mid-level clinicians by 53% and 46%, respectively. MetaGP also excels in generating medical imaging reports, producing high-quality outputs for chest X-rays and computed tomography, often rated comparable to or superior to physician-authored reports. These findings highlight MetaGP's potential to transform clinical decision-making across diverse medical contexts.

The endoscopic transsphenoidal approach (ETSA) is a commonly used technique that allows for the minimally invasive removal of sellar and parasellar lesions. Augmented reality (AR) applications in ETSA are hypothesized to enhance intraoperative visualization by integrating a 3D-reconstructed model into the operative field. This study describes the workflow and surgical outcomes associated with the Endoscopic Surgical Navigation Advanced Platform (EndoSNAP, Surgical Theater, Cleveland, OH, USA), an AR platform designed for surgical planning and intraoperative navigation in ETSA for sellar and parasellar lesions. We analyzed a cohort of patients who underwent ETSA tumor resection using EndoSNAP. Preoperative MRI and CT scans were reconstructed and merged into a single 360° AR model using the Surgical Rehearsal Platform software. The model was then imported into EndoSNAP, which was integrated with the endoscope and neuronavigation system for real-time intraoperative use. Patient demographics, tumor characteristics, extent of resection (EOR), and endocrinologic and neurologic outcomes were recorded. Eighteen adult patients with newly diagnosed (83%) and recurrent (17%) tumors were included. Pathologies consisted of pituitary adenoma (72%), craniopharyngioma (11%), meningioma (11%), and chordoma (6%). Optic compression was present in 56% of patients, with preoperative visual deficits in 70% of them. Cavernous sinus invasion was observed in 17% of tumors. Preoperative hormonal excess and insufficiency were noted in 56% and 28% of cases, respectively. The mean preoperative tumor volume was 21.4 ± 17 cm³, which decreased to 0.4 ± 0.3 cm³ postoperatively. The mean EOR was 93.6 ± 3.6%. Postoperative complications included CSF leaks requiring surgical repair (17%), seizures related to pre-existing hemispheric trauma (6%), pulmonary embolism (6%), deep venous thrombosis (6%), and sinusitis (6%). These findings suggest that AR-enhanced visualization through EndoSNAP is a feasible and potentially beneficial adjunct in ETSA for sellar and parasellar tumor resection.

This article presents a case of a patient whose treatment for irritable bowel syndrome (IBS) involved a modification of gut-directed hypnotherapy (GDH). It was delivered in a nonstandard schedule and integrated concepts from other therapeutic modalities, primarily mindfulness meditation and narrative therapy. A review of the literature on GDH and prior modifications, as well as other iterations of integrative hypnosis, will be provided. Along with describing the case, a rationale for the treatment and examples of the modification will be presented.

BACKGROUND:Minimally invasive surgery (MIS) for patients undergoing inguinal hernia repair (IHR) after prostatectomy has been considered a challenging procedure due to the presence of scar tissue and adhesions. We aimed to compare the outcomes of open and MIS IHR outcomes in post-prostatectomy patients through a systematic review and proportional meta-analysis. MATERIAL & METHODS/METHODS:PubMed/MEDLINE, Embase, Cochrane, and Web of Science were searched for studies on open and MIS IHR after prostatectomy. Outcomes such as recurrence, complications, seroma, hematoma, SSI, and conversion rates were analyzed, with subgroup analyses conducted for open, TEP, and TAPP procedures. RESULTS:Among 402 screened studies, 18 met the inclusion criteria, covering 8,668 open IHR (64.6%) and 4,761 MIS IHR (35.4%) patients. The rate per 100 events for intraoperative complications was 0.19 (95% CI [0.00; 0.76]; I2 = 71%;), 5.22 per 100 for seroma (95% CI [2.86; 9.34]; I2 = 92%), 0.83 per 100 for SSI (95% CI [0.39; 1.75]; I2 = 48%), 3.16 per 100 for hematoma (95% CI [1.16; 8.31]; I2 = 84%), 3.02 per 100 patients for chronic pain (95% CI [2.53; 3.62]; I2 = 13%), and 0.02 per 100 for recurrence (95% CI [0; 0.16]; I2 = 10%). The conversion rate for MIS was 1.66 per 100 (95% CI [0.89; 3.06]; I2 = 0%). Subgroup analysis revealed no significant difference between TEP and TAPP in intraoperative complications (p = 0.70), but a lower seroma rate in TAPP compared to TEP (5.29 vs. 20 per 100; P = 0.01). MIS had significant reduction in SSI (0.08 vs. 0.34 per 100; P < 0.01), hematoma (1.29 vs. 17.86; p < 0.01), and recurrence (0.08 vs. 0.37; p = 0.04) compared to open, with no difference in seroma rates. Funnel plots revealed no evidence of publication bias. CONCLUSIONS:In experienced hands, MIS IHR is a safe and effective option for post-prostatectomy patients, with lower complication rates compared to open IHR, although high-quality comparative studies are needed to establish definitive conclusions. PROSPERO REGISTRATION/UNASSIGNED:July 7, 2024 (ID CRD42024562863).