Editorials

What we mean when we talk about "conflict of interest"

John J. Frey, III, MD Medical Editor, Wisconsin Medical Journal

In the 1970s, partly stimulated by the infusion of money from the National Institute of Health (NIH) and the rapid rise in the number of faculty members in US medical schools, the volume of biomedical publications also increased dramatically. Pressure to publish results also increased, partly to help investigators with promotion but also to improve their chances for additional funding from NIH or other sources. Any time money and pressure to obtain more of it exist there are opportunities to stretch the boundaries of ethics, creating problems ranging from outright fraudulent research to taking credit where credit exists only in the eyes of the one taking it.

Author Affiliations: Wisconsin Medical Journal

Corresponding Author: John J. Frey, III, MD Medical Editor, Wisconsin Medical Journal

Commentaries

As I See It: Paying for population health care: The link between reimbursement models and quality health care

Marc Tumerman, MD

The Department of Family Medicine at the University of Wisconsin is beginning to look at the issue of paying for performance within its physician faculty compensation formula in a different way. The concept of paying for quality performance over the traditional model of compensation that pays for “activity” as measured by patient visits, charges, and/or “RVUs” (relative value units) is gaining momentum as the industry looks at the incredible amount of money we invest in our health care system, while concerns about errors and poor outcomes grow.

Author Affiliations: Franciscan Skemp Healthcare, Sparta

Corresponding Author: Marc Tumerman, MD, Franciscan Skemp Healthcare - Mayo Health System, 310 W Main St, Sparta, WI 54656-2170.

As I See It: 2006 Summer Fellowships in Government and Community Service

Wisconsin Medical Society

The Summer Fellowship in Government and Community Service Program is an initiative of the Wisconsin Medical Society Foundation and is available to medical students attending either the Medical College of Wisconsin or the University of Wisconsin School of Medicine and Public Health.

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society

Original Research

Calories from Newspaper Dessert Recipes are Associated with Community Obesity Rates

Catherine A. McCarty, PhD, MPH, RD; Daniel J. McCarty, PhD; Annie C. Wetter, PhD, CSCS

Introduction: The purpose of this study was to determine if the nutrient content of recipes available in newspapers is related to community obesity rates. Methods: All recipes published in the major newspapers for 3 cities with populations of 400,000 or more from 4 geographic areas within the United States the last week of August 2000 were accessed. The recipes were grouped as entrée, dessert, accompaniment, snack, appetizer, or beverage, and the nutrient content per serving for each recipe was calculated. The nutrient content was correlated with data on self-reported obesity rates in these same cities. Results: Total mean kcalories per dessert serving ranged from 180.0 to 599.0 (mean=315.5) and total mean kcalories per entrée serving ranged from 265.4 to 567.3 (mean=436.7). Obesity rates for the 12 cities ranged from 16.8% to 28.2% (mean=21.1%). The average total caloric content of dessert recipes was significantly associated with the percent obese in the metropolitan cities (correlation=0.76, P-value=0.011). The total caloric content of entrée recipes was not significantly associated with the obesity rate (P=0.59). Discussion: While these data cannot be interpreted as causal, they are intriguing and suggest that newspapers may play a greater role in promoting or preventing obesity than previously recognized.

Author Affiliations: Marshfield Clinic Research Foundation (McCarty, McCarty); University of Wisconsin – Stevens Point (Wetter)

Corresponding Author: Catherine A. McCarty, PhD, MPH, Interim Director and Senior Research Scientist, Marshfield Clinic Research Foundation, Center for Human Genetics, 1000 N Oak Ave (ML1), Marshfield, WI 54449; Phone 715.389.3120; fax 715.389.4950; e-mail mccarty.catherine@mc

An Assessment of Emergency Preparedness in Western Wisconsin

Gary D. Gilmore, MPH, PhD; William R. Schwan, PhD; Mary K. McLaughlin, PhD

Background: Emergency preparedness is important for our national defense. Preparedness has been prioritized in Wisconsin, but little has been done to gauge the knowledge, training, and resource gaps that remain—especially those that are necessary for a coordinated community response. Objective: To determine the emergency preparedness knowledge, training, and resource needs of community-based professionals in Western Wisconsin, an assessment was conducted during 2004-2005, centering around a coordinated community response training exercise involving more than 100 civilian and military personnel. Methods: The assessment used questionnaires, observation, and interviews to gather data. The target population was comprised of 10 professional cohorts: physicians, nurses, public health and mental health professionals, health educators, veterinarians, pharmacists, dental professionals, law enforcement, and emergency/fire personnel. The survey was delimited to 7 Western Wisconsin counties. Results: The findings revealed that training needs existed across all cohorts, with the most acute training needs being decontamination procedures and communication. The highest awareness and knowledge levels occurred with physicians, nurses, and public health professionals. On-site coordination and communication systems were the weakest aspects of coordinated community response. Conclusion: Overall, the findings indicate a need for more drills and exercises in short intervals, augmented by additional informational and fiscal resources.

Author Affiliations: Graduate Community Health Programs, University of Wisconsin-La Crosse (Gilmore); Department of Microbiology, University of Wisconsin-La Crosse (Schwan); Western Technical College (McLaughlin).

Corresponding Author: Gary D. Gilmore, MPH, PhD, Professor and Director, Graduate Community Health Programs, University of Wisconsin-La Crosse, 201 Mitchell Hall, 1725 State St, La Crosse, WI 54601; phone 608.785.8163; fax 608.785.6792; e-mail gilmore.gary@uwlax.edu.

Impact of a Child Care Educational Intervention on Parent Knowledge about Appropriate Antibiotic Use

Donita R. Croft, MD, MS; Mary Jo Knobloch, MPH; Po-Huang Chyou, PhD; Darcy Vanden Elzen; Carolyn Janette, MEd; Jeffrey P. Davis, MD; Richard E. Besser, MD; Edward A. Belongia, MD

Background: Parent education is an integral component to promoting judicious antibiotic use. Opportunities to educate parents directly are limited. Child care providers are in a position to relay information to parents. Methods: A group-randomized trial assessed the impact of a child care center staff intervention on parental knowledge and attitudes regarding appropriate antibiotic use. A 9-point knowledge score and 3 attitude items were measured. Results: Surveys were returned by 151 (51%) of 298 intervention center parents and 150 (42%) of 361 control center parents. Intervention center respondents were significantly more likely than control center respondents to be college graduates, non-Hispanic white, and insured. Among college graduates, the median knowledge score was 7.0 at intervention centers and 6.5 at control centers (P<0.01). No significant differences were found in knowledge scores among noncollege educated parents (P=0.11). After adjusting for clustering within child care centers, multivariate analysis demonstrated high knowledge score was associated with white race (P=0.02), being a college graduate (P=0.02), and being in the intervention group (P=0.06). Conclusion: An appropriate antibiotic use program for child care providers promotes better knowledge among parents of children aged <5 years, particularly among highly educated parents.

Author Affiliations: Epidemic Intelligence Service assigned to the Wisconsin Division of Public Health, Centers for Disease Control and Prevention, Atlanta, Ga (Croft); Bureau of Communicable Diseases and Prevention, Wisconsin Division of Public Health, Madison, Wis (Croft, D

Corresponding Author: Donita R. Croft, MD, MS, 600 Highland Ave #9988, Madison, WI 53792; e-mail dc2@@medicine.wisc.edu.

Review Articles

Primary-Open Glaucoma and Myopia: A Narrative Review

Nilsa I. Loyo-Berríos, PhD; Joseph N. Blustein, MD, MPH

Refractive errors and primary open-angle glaucoma are common eye conditions in the United States. The identification and quantification of risk factors for primary open-angle glaucoma is critical to understanding and managing the disease process from both individual and public health perspectives. This narrative review was conducted to present the epidemiology of primary open-angle glaucoma and to summarize epidemiologic findings on myopia as a risk factor. Epidemiologic evidence suggests an increasing prevalence of primary open-angle glaucoma over the last decade in the United States. It has been documented that primary open-angle glaucoma prevalence increases with age, and that African Americans tend to have the highest estimates. Epidemiologic data, however, are not as clear with respect to gender differences. Other factors that have been identified are increased intraocular pressure and the use of steroids. The evidence for increased risk of primary open-angle glaucoma among myopies is stronger for moderate and severe myopia and not as clear for mild myopia. The association between primary open-angle glaucoma and its multiple risk factors is complex.

Author Affiliations: Food and Drug Administration, Rockville, MD (Loyo-Berríos); Medical consultant and private practice, Madison, Wis (Blustein).

Corresponding Author: Nilsa Loyo-Berríos, PhD, Epidemiology Branch, Division of Post-Market Surveillance, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, 1350 Piccard Dr, HFZ-541, Rockville, MD 20850; phone 240.2

Case Reports

FoxHollow Atherectomy as a Treatment Modality for Common Femoral Artery Occlusion

Robert S. Dieter, MD, RVT; John P. Pacanowski, Jr, MD; M. Habeeb Ahmed, MD, RVT; Pat Mannebach, MD; Sohail Ikram, MD; Aravinda Nanjundappa, MD, RVT

Common femoral artery occlusions are usually treated with open vascular surgical repair. We present a case of common femoral artery occlusion that was successfully treated with the FoxHollow SilverHawk atherectomy catheter. The use of this device obviated the need for adjunctive balloon angioplasty and stenting. The patient was discharged without complications after 1 day.

Author Affiliations: Loyola University (Dieter); Medical College of Wisconsin (Mannebach); Brody School of Medicine (Nanjundappa); Endovascular Solutions (Pacanowski); San Jose, CA (Ahmed); University of Louisville (Ikram

Corresponding Author: Robert S. Dieter, MD, RVT, Division of Cardiology Vascular & Endovascular Medicine, Interventional Cardiology, Loyola University, 2160 South First Ave, Maywood, IL 60153

Cocaine-induced Fatal Acute Eosinophilic Pneumonia: A Case Report

Michael McCormick, MD; Todd Nelson, MD

We present a case of fatal acute eosinophilic pneumonia clinically simulating acute respiratory distress syndrome in a 32-year-old man. Clinical, radiographic, and histologic features of this entity are discussed along with a review of the literature.

Author Affiliations: Holy Family Memorial Medical Center, Manitowoc, Wis (McCormick, Nelson); University of Wisconsin (Nelson).

Corresponding Author: Michael McCormick, MD, Holy Family Memorial, Department of Pathology, 2300 Western Ave, Manitowoc, WI 54220.

The National Children’s Study: Waukesha County, Wisconsin Vanguard Center

Jeanne B. Hewitt, PhD; Steven R. Leuthner, MD, MA; Marianne Weiss, DNSc; David Whelan, MSW; Leslie Athey, MS; Jane A. McElroy, PhD; Maureen S. Durkin, PhD, DrPH; Christine E. Cronk, ScD

The National Children’s Study (NCS) is a large, long-term study designed to detect environmental influences on the health and development of children. Waukesha County, Wisconsin, was selected as 1 of 7 “Vanguard Centers” currently funded to finalize and lead the implementation of the study protocol. The authors provide an overview of key design and planning processes that will be used at all NCS Vanguard locations, the specific approaches to be used in the NCS Waukesha County Vanguard Center, and information about how Wisconsin physicians and other health care professionals can become involved in working with the NCS.



Author Affiliations: This project has been funded in whole or in part with Federal funds from the National Institute of Child Health and Human Development, National Institutes of Health, under Contract Number HHSN275200503396C. The content of this publication does not necessa

Corresponding Author: Jeanne B. Hewitt, PhD, Marine and Freshwater Biomedical Sciences Center and Institute of Environmental Health, University of Wisconsin, 1921 E Hartford Ave, Milwaukee, WI 53211; phone 414.229.5463; fax 414.229.5504; e-mail jbhewitt@uwm.edu.

Your Practice

Crucial aspects of the hiring process

Stephen A. DiTullio, JD

Attracting and evaluating job applicants, and retaining qualified applicants as employees, is crucial to any organization’s success, including a medial practice, clinic, or hospital. Effective, lawful documents prepared so as to reduce the risk of discrimination and/or contract claims against the practice, clinic, or hospital are equally crucial. These documents will set the tone for the employment relationship, potentially protect the employer from liability, and reinforce any desired employment-at-will relationship.

Author Affiliations: DeWitt Ross & Stevens, S.C.

Corresponding Author: Stephen A. DiTullio, JD, DeWitt Ross & Stevens S.C.,2 E Mifflin St, Ste 600, Madison, WI 53703-2865; phone 608.283.5516; fax 608.252.9243; e-mail sad@dewittross.net

Medical malpractice insurance tests the mettle of insurance companies

A. Derrill Crowe, MD

Everyone knows history repeats itself, and that may be a scary thought for physicians who remember the malpractice crises that have occurred in each of the last 3 decades.

Author Affiliations: A. Derrill Crowe, MD, is Chair of ProAssurance and its subsidiary PIC WISCONSIN. He retired from his practice of urology in the mid-‘90s to devote his full-time efforts to the company. Doctor Crowe helped found ProAssurance’s predecessor in the first malp

Corresponding Author: For more information, contact Wisconsin Medical Society Insurance and Financial Services, Inc., at 866.442.3810.

Rebalancing: Effectively managing risk and market volatility

Debbie Oswald, Financial Consultant, SVA Planners, Inc., Registered Investment Advisor

As time goes by, and the markets go up and down, your portfolio commonly experiences gains in some areas and losses in others. Over time, this fluctuation can throw your asset allocation out of sync and increase your overall risk. When this happens, it’s time to rebalance.



Author Affiliations: Based in Madison, Debbie Oswald is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. Debbie provides a full spectrum of services from creating financial plans and providing investment consulting to asset management. Sh

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

Your Profession

Looking back, looking forward

Robert N. Golden, MD

Academic year 2007-2008 will be a very exciting time for the University of Wisconsin School of Medicine and Public Health. We will celebrate our 100th anniversary and look back with pride and appreciation on all the people at our school who have made such innovative contributions to medical education, research, and patient care.

Author Affiliations: Dean, University of Wisconsin School of Medicine and Public Health; Vice Chancellor for Medical Affairs, University of Wisconsin-Madison

Corresponding Author: Robert N. Golder, MD

Your Society

The Wisconsin Medical Society’s Standard Benefit Plan

Wisconsin Medical Society Standard Benefit Plan Committee

In 1992, the Wisconsin Medical Society (Society) published Wisconsin Care, the Society’s recommendations for health care reform. Published during a time when both the US Congress and the President were debating major changes in the health care system, Wisconsin Care envisioned a market-based system for health care service delivery with a strong government role to set the “rules of competition.”

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society Standard Benefit Plan Committee

Other

Letters to the Editor: Reviews should be comprehensive and non-biased; Caribbean clinic seeks volunteers

John K Brendel, MD, Rice Lake, Wis; Nick Akgulian, MD

Letter to Editor

Author Affiliations: John K Brendel, MD, Rice Lake, Wis; Nick Akgulian, MD

Corresponding Author: Brendel