Editorials

A little something for everyone

Thomas C. Meyer, MD, Medical Editor, WMJ

The first issue of the journal that was to become the Wisconsin Medical Journal was published early in 1904, so your Editorial Board deemed it appropriate that we mark the centennial year in a way that may be of interest to the readership. We will be publishing a centennial issue later this year, but before that we are launching a new feature that borrows from JAMA: “Looking Back.” In each issue of the Journal we will reprint an article that first appeared in one of those early issues. This issue’s selection is on page 80, reprinted exactly 100 years since it was first published. Both patients and doctors were pretty tough in those days!

Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Commentaries

HIPAA liability: Beware the secondary enforcers

Daniel L. Icenogle, MD, JD

HIPAA compliance is upon us. Having passed the long awaited April 14, 2003 enforcement date, we have all become familiar with the notices of privacy practices and other manifestations of compliance with HIPAA, the Health Insurance Portability and Accountability Act of 1996. Some time in the next few months, we will also begin to see examples of HIPAA enforcement. There will be HIPAA complaints and investigations; there will be enforcement actions by the Office of Civil Rights (OCR), the HIPAA enforcement agency. But there will also be innovative efforts by plaintiff’s attorneys to obtain judgments against physicians and hospitals based on HIPAA violations, something obviously not envisioned by HIPAA.

Author Affiliations: Doctor Icenogle is an emergency medicine physician, as well as a health law attorney with Icenogle and Associates, LLC

Corresponding Author: S7563 Riley Rd, Readstown, WI 54658; phone 608.675.3000; e-mail dicenogle@icenogle.net

Original Research

What’s new in clinical pharmacology and therapeutics

Paramjith S. Chawla, MD; Mahendr S. Kochar, MD, MS

New drugs are being constantly introduced to treat diseases more effectively or with less side effects. Advances in molecular biology and genetics have led to the development of several of these new agents. They tend to have names that are difficult to pronounce, but the trade names are easier to remember. We have described here newer drugs pertaining to several body systems.



Author Affiliations: Doctor Chawla is a hospitalist with St. Joseph’s Regional Medical Center in Milwaukee, Wis. Doctor Kochar is professor of medicine and pharmacology and toxicology and senior associate dean of graduate medical education at the Medical College of Wisc

Corresponding Author: Mahendr S. Kochar, MD, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.456.4575; fax 414.456.6528; e-mail kochar@mcw.edu.

Health care personnel delivery system: Another doctor draft?

COL Roger A. Lalich, MC, WIARNG

The recent mobilization of large numbers of reserve soldiers may have caused public concern about the adequacy of the number of personnel in the military. There is a perception that a military draft may have to be instituted. Although the United States military may be deployed around the world, the Secretary of Defense has indicated “a conventional draft of untrained manpower is not necessary for the war on terrorism or any likely contingency.” However, the Department of Defense has stated that what most likely will be needed is a “special skills draft, especially health care, within a 90-day time frame.” In other words, there may be another “Doctor Draft.” The Health Care Personnel Delivery System (HCPDS) is the mechanism that the Selective Service System (SSS) will employ to obtain trained health care personnel for the military.



Author Affiliations: Doctor Lalich is the Wisconsin Army National Guard State Surgeon. He is also a board certified obstetrician/gynecologist with Women’s Health Care, S.C. in Waukesha, Wis.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Risk communication, risk perception, and public health

Eric Aakko, MS

The September 11 terrorist attacks and subsequent destruction of the World Trade Center towers caused significant environmental contamination. Environmental fallout in the form of toxic dust covered much of downtown New York City. There was widespread uncertainty, fear, and anxiety about terrorism, but also of the toxic dust. Initial attempts by the government failed to reassure the public about the dust’s safety. A specialized form of communication, known as risk communication, was needed to address questions raised by the public during this complex public health emergency. Wisconsin public health officials also raised the question, “How can we effectively communicate after a disaster or terrorist event occurs?” The ability to communicate effectively about risks is emerging as a high priority for public health officials. This article briefly defines risk communication and risk perception, and highlights a Wisconsin study involving local public health officials and their risk perceptions regarding terrorism occurring in or near Wisconsin.



Author Affiliations: Aakko conducted risk communication for the Health Hazard Evaluation Section, Bureau of Environmental Health, Wisconsin Department of Health and Family Services. He currently coordinates bioterrorism training for the Montana Department of Public Health and

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Licensed athletic trainers: A traditional, unique, and proactive approach in Wisconsin sports medicine

Daniel Trampf, LAT, CSCS; Jeff Oliphant, MS, LAT

As the sports medicine world continues to evolve with new advances and philosophies, one constant key element continues to provide knowledge to a wealth of resources. The field of athletic training and the certified athletic trainer (ATC) is part of the sports medicine and complete health care team. The profession of athletic training got its start in the early 1900s when it was recognized that there was a need for someone, other than a coach, to take care of injuries that were being suffered in college football. In fact, the number of deaths and severe injuries were so high in this era that President Theodore Roosevelt threatened to abolish football on college campuses. Hence the National Collegiate Athletic Association (NCAA) was born, and larger colleges and universities across the country slowly began hiring athletic trainers.



Author Affiliations: Mr Trampf is a Licensed Athletic Trainer and Certified Strength and Conditioning Specialist. He is the Industrial Rehabilitation Coordinator at Ripon Medical Center and Chair of the Wisconsin Athletic Trainers’ Association Reimbursement Committee. M

Corresponding Author: 330 E. Lakeside St Madison, WI 53715

Effectiveness of Acetylcysteine on Preventing Renal Dysfunction in Patients Undergoing Coronary Procedures

Shereif H. Rezkalla, MD; Michele Benz, CMA

Objective: Experimental studies have shown that acetylcysteine is beneficial in preserving kidney function during coronary procedures. However, its role in routine clinical practice is not known.

Methods: We studied 75 consecutive patients undergoing coronary procedures who received acetylcysteine, and compared them with 56 consecutive similar patients who served as control. All patients had renal dysfunction, and a single operator did all procedures.

Results: Patients in the acetylcysteine group had a decrease in serum creatinine of 0.1 ± 0.3 mg/dl versus a rise of 0.2 ± 0.6 mg/dl in the control group (P<0.001). When the benefit in the active drug group was correlated with baseline creatinine, it occurred in all patients, regardless of the degree of kidney dysfunction.

Conclusion: We conclude that in patients with varying degrees of renal dysfunction who undergo coronary procedures, acetylcysteine should be used in addition to hydration. It should be an accepted clinical practice that should be adopted routinely in the cardiac catheterization laboratory.



Author Affiliations: Both Dr Rezkalla and Ms Benz are with Marshfield Clinic, Department of Cardiology, Marshfield, Wis. Doctor Rezkalla is Director of Cardiovascular Research. Ms Benz is a Medical Assistant.

Corresponding Author: Shereif Rezkalla, MD, Director of Cardiovascular Research, Department of Cardiology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.387.5845; fax 715.389.3808; e-mail rezkalla.shereif@ marshfieldclinic.org.

Functional Fitness, Disease and Independence in Community-Dwelling Older Adults in Western Wisconsin

Karolyn Collins, BS; Brenda L. Rooney, PhD; Kathy J. Smalley, BA; Sarah Havens, BS

Objective: Older adults are at higher risk for developing chronic conditions such as diabetes, heart disease, or arthritis. Despite the aging process, maintaining independence is a major goal for older adults. Functional fitness has been found to be predictive of one’s ability to perform necessary everyday activities needed to maintain independence. We conducted functional fitness assessments with community-dwelling older adults and correlated the findings to other participant characteristics.

Methods: Participants completed 6 functional fitness tests and a health-screening questionnaire. Test performance was compared across demographic, behavioral, chronic illness, and activities of daily living categories.

Results: One hundred sixty nine adults over age 50 completed the tests. Thirty-seven percent performed at or above the population norm on all tests. There was a significant positive correlation between test performance and activities of daily living (r=0.3520, P=0.0001). In multivariate analysis, the best model to predict test performance included education, self-rated health, obesity, diabetes, and activities of daily living.

Conclusions: An objective test, such as the one reported here, may be helpful in predicting loss of independence. However, health care providers, using a few questions based on this study’s key findings, may be able to screen for patients with poor functional status that are at risk of losing independence.



Author Affiliations: This work was supported by Gundersen Lutheran Health System and the Gundersen Lutheran Medical Foundation. All authors are with Gundersen Lutheran Health System, La Crosse, Wis.

Corresponding Author: Brenda Rooney, PhD, Gundersen Lutheran, 1900 South Ave, La Crosse, WI 54601; phone 608.775.2152; fax 608.775.5887; e-mail blrooney@gundluth.org

An Approach to the Evaluation of a Patient for Seizures and Epilepsy

S. Nizam Ahmed, MD, FRCPC; Susan S. Spencer, MD

Epilepsy affects approximately 1 percent of the population and is characterized by recurrent unprovoked seizures. A careful clinical history is often helpful in diagnosis, classification of seizure and epilepsy types, selection of appropriate ancillary studies, selection of anti-epileptic drugs, and formulation of a long-term management plan. This article provides directions and guidelines both for the family practice physician and the specialist in evaluating this patient population in the clinics.

Author Affiliations: Doctor Ahmed is the Director of the Comprehensive Adult Epilepsy Program at the University of Alberta and an Assistant Professor in Neurology. He completed his epilepsy fellowship at the Yale University School of Medicine and his neurololgy residency at t

Corresponding Author: S. Nizam Ahmed, MD, FRCPC, 2E3.12, University of Alberta Hospital, 8440-112 St, Edmonton, Alberta T6G 2B7, Canada; phone 780.407.8068.

Design Elements for a Primary Care Medical Error Reporting System

John W. Beasley, MD; Kamisha Hamilton Escoto, MS; Ben-Tzion Karsh, PhD

Problem considered: State and federal initiatives to develop medical error reporting systems are being proposed. For these to lead to an effective error reporting system to improve primary care, the needs of primary care professionals must be understood. Methods: This study was based on the answers to key questions directed at primary care physicians and clinical assistants. A series of focus groups was held to determine what elements need to be included in the design of a medical error reporting system for ambulatory care. Results: Participants addressed the purposes of an error reporting system, the barriers and motivators to the use of a system, the types of events that should be reported, how the reporting should be done, and how the data should be analyzed and used. During the sessions, 87 different themes emerged that were distilled down to the general principles and operating design elements deemed most important. Conclusions: The participating physicians and clinical assistants supported a primary care medical error reporting system designed to provide useful information to improve health care. The system should not be punitive.



Author Affiliations: Authors are with the University of Wisconsin. Doctor Beasley is Professor Emeritus in the Department of Family Medicine; Ms Escoto is a graduate student in the Department of Industrial Engineering; and Dr Karsh is an Assistant Professor in the Department

Corresponding Author: John Beasley, MD, UW Department of Family Medicine, 777 S Mills St, Madison, WI 53715; e-mail jbeasley@fammed.wisc.edu.

The Adult Screening Physical Examination: What Physicians Do

Troy Wildes, MD; Ruric (Andy) Anderson, MD

Background: Patients expect a thorough physical examination. However, there is debate on the utility of the physical examination, and students are deficient in many common maneuvers.

Purposes: (1) To estimate physician perceived utility of physical examination maneuvers in a routine adult screening examination. (2) To promote teaching of core physical examination competencies in student and resident education. Methods: Primary care physicians at 2 academic medical centers were surveyed. Using a 5-category frequency scale, physicians estimated how often they perform and document 90 common physical examination maneuvers in a routine adult screening examination.

Results: Survey response rate was 56%. Physicians reported significant variation in frequency of use for individual physical examination maneuvers. Both common (blood pressure) and rarely performed (visual acuity) maneuvers were identified.

Conclusion: This study helps define the adult screening physical examination by estimating which individual physical examination maneuvers physicians typically utilize. Educational resources and clinical research should focus on identifying an evidence-based approach to the physical examination.



Author Affiliations: Doctor Wildes is a resident at St. John’s Mercy Medical Center, St. Louis, Mo. Doctor Anderson is an associate professor of medicine at the Medical College of Wisconsin

Corresponding Author: Ruric (Andy) Anderson, MD, Medical College of Wisconsin, Froedtert East Clinic Building, Suite 4100, 9200 W Wisconsin Ave, Milwaukee, WI 53226; phone 414.456.6856; fax 414.456.6212; e-mail randerso@mail.mcw.edu

Your Practice

ACE inhibitors vs. angiotensin II receptor blockers in acute myocardial infarction and heart failure

Jay A. Gold, MD, JD, MPH; Peter S. Rahko, MD, FACC

Recent studies have led physicians to wonder whether angiotensin II receptor blockers (ARBs) now may be considered equivalent to ACE inhibitors as first-line treatment for post-infarct and heart failure patients. The short answer is probably not yet, except in a limited number of cases.



Author Affiliations: Doctor Gold is Senior Vice President of MetaStar. Doctor Rahko is a professor of cardiology at the University of Wisconsin, Wisconsin’s Governor of the American College of Cardiology (ACC), and serves on the ACC’s heart failure guidelines comm

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Planning for life’s little and not-so-little financial surprises

Kurt G. Krumholz, CFP, President of SVA Planners, Inc., Registered Investment Advisor

Whether you realize it or not, you are already taking steps to manage future financial hardships. Auto insurance, health insurance, homeowner’s insurance—all of these are investments you are making to protect yourself and your family.



Author Affiliations: Based in Madison, Wis, Kurt G. Krumholz is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. Well-respected in the wealth management industry, Kurt has been named to Mutual Funds list of “100 Great Financial Plan

Corresponding Author: Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810.

Your Profession

Welcoming incremental, measurable change

Philip M. Farrell, MD, PhD

first became fully aware of the importance of occupational health in Wisconsin some four years ago in a conversation with Tom Hefty, then chief executive officer of Blue Cross and Blue Shield United of Wisconsin. He was wondering if a portion of the Blue Cross gift could potentially be used to create innovative statewide programs to improve occupational health.

Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, Wi 53715

Eau Claire physician’s thoughts conveyed in The Other Side

Russell Lewis, MD

In The Other Side, retired Eau Claire surgeon Ralph Hudson, MD, draws on his experiences as a surgeon and a patient to convey his philosophies of life.

Author Affiliations: Doctor Lewis is a retired OB-GYN from Marshfield

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, Wi 53715

Your Society

Nominees for Society Offices

Wisconsin Medical Society

Nominees

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

2003 Foundation Donors

Wisconsin Medical Society Foundation

The mission of the Wisconsin Medical Society Foundation is to advance the health of the people of Wisconsin by supporting medical and health education. The individuals and organizations named below made contributions to the Wisconsin Medical Society Foundation from January 1, 2003 to December 31, 2003. We are deeply grateful to these donors for their support.

Author Affiliations: Wisconsin Medical Society Foundation

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

An Interesting Case of Nasal Deformity Corrected by the Paraffine Method

Wisconsin Medical Journal, February, 1904 Henry B. Hitz, MD, Milwaukee

So rich and fruitful has been the progress of modern medical science, that but a comparatively few of the discoveries have received the mead of praise that is justly their due. Of these none has been more fruitful of beneficial results than the discovery of the value of subcutaneous injections of paraffine (sic).


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715