Focus On...Rural Health

Stoking the Fire

Ben Schumaker

I am 20 years old, one year away from applying to medical school, and consumed by the excitement of my future. My brain is filled with so many ideas regarding my life aspirations that I need to send myself e-mails just to keep them organized. Scrolling through my “inbox” folder, I see titles that say, “Check out MPH program in Puerto Rico,” and, “Talk to advisor about doing senior thesis in Latin America.” A recent e-mail reads, “As you grow older, remember to hang on to your passion!”



Author Affiliations: Mr. Schumaker is an undergraduate zoology major at the University of Wisconsin-Madison. After graduation, he looks forward to working with AIDS patients in Haiti before beginning his medical training

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Focus On...Outcomes Research

Provider education the next step:SMS Medical Outcomes Research Project Asthma Outcomes Study

John Twiggs, MD; Cindy P. Helstad, PhD, RN; Debbie Rickelman, RHIT; Mary Bowers; and the SMS Adult Asthma Toolkit Subcommittee

Introduction We can improve outcomes of care through feedback of process and outcome measures to physicians and educational efforts aimed at providers and patients.”This was the objective of the Adult Asthma Study Group in the summer of 1996. Over the ensuing 3 years the group developed an outcomes survey, defined and surveyed a population of adults diagnosed with asthma, and reported the survey results back to the providers who cared for those patients. Detailed descriptions of the SMS Asthma Outcomes Study were reported previously by Berry et al (Wis Med J. 98:98;3:34-38). In brief, 857 Wisconsin adults, ages 14-50, with the diagnosis of asthma were surveyed in 1997 and 1998 about 8 key indicators of optimal asthma management. While demonstrating that the study could be done in a wide variety of primary care settings, the findings showed that many patients are not fully benefiting from current expert opinion pertaining to the care of patients with asthma.



Author Affiliations: Doctor Twiggs, formerly Chairman of the Department of Allergy, Marshfield Clinic, is retired. Dr. Helstad is Director of the Center for Medical Practice Research and Education at the State Medical Society of Wisconsin (SMS). Ms. Rickelman is Study Coordin

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Focus On...

SMS: 160 years

Raymond C. Zastrow, MD, SMS President

One of the most proudest moments of my life was being sworn in as President of the State Medical Society of Wisconsin.

Author Affiliations: SMS President

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Editorials

As goes Milwaukees health, so goes Wisconsins health

Tom Barrett

Guest editorial from Mayor Barrett

Author Affiliations: Tom Barrett is mayor of the city of Milwaukee. Prior to his mayoral election in 2004, he served five terms in the US House of Representatives.

Corresponding Author: Please address all correspondence to the Mayor office in Milwaukee.

Poverty and human development-A global and local issue

John J. Frey, III, MD, Medical Editor

This past year the Council of Science Editors organized a Global Theme Issue on Poverty and Human Development.
Communications with biomedical journals throughout the world have resulted in 233 journals publishing an entire issue or commenting on the theme in their October 2007 issue. The Wisconsin Medical Journal is proud to join this list of international journals.

Author Affiliations: Medical Editor, Wisconsin Medical Journal

Corresponding Author: Please address correspondence to Wisconsin Medical Society

Original Research

Proceedings from the 2005 Annual Meeting of the American College of Physicians, Wisconsin Chapter

Edited by Kesavan Kutty, MD, MACP

The Wisconsin Chapter of the American College of Physicians held its annual meeting in Madison, Wis, September 8-10, 2005. Internal Medicine residents from each of Wisconsin’s 5 residency programs presented their research and/or unusual clinical experiences via posters and vignettes.

Author Affiliations: The Wisconsin Chapter of the American College of Physicians

Corresponding Author: Address correspondence to Wisconsin Medical Society

Prevalence and Characteristics of Hazardous Drinkers: Results of the Greater Milwaukee Survey

Lisa K. Berger, PhD; Michael Fendrich, PhD; Adam Lippert, MA

At-risk drinking is of particular concern in Wisconsin.

Author Affiliations: Center for Addiction and Behavioral Health Research, Milwaukee, Wis (Berger, Fendrich, Lippert); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wis (Berger, Fendrich)

Corresponding Author: Lisa Berger, PhD, University of Wisconsin-Milwaukee, 2400 E Hartford Ave, END 1183, Milwaukee, WI 53211; phone 414.229.5620; fax 414.229.5311; e-mail lberger@uwm.edu

Urban Community Characteristics
and Adolescent Assault Victims

Marlene D Melzer-Lange, MD; Charis Van Dusen Thatcher, MD; Jingxia Liu, PhD; Shankuan Zhu, MD, PhD

Purpose: To examine the relationship between neighborhood factors and adolescent victimization for low- and high-risk areas of Milwaukee, Wis.

Author Affiliations: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Melzer-Lange, Van Dusen Thatcher); Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis (Liu); Injury Research Center, and Department of Family and Community Medici

Corresponding Author: Marlene D. Melzer-Lange, MD, Medical College of Wisconsin, C550, Children’s Corporate Center, Children’s Hospital of Wisconsin, 999 North 92nd St, Milwaukee, WI 53226; phone 414.266.2647; e-mail mmelzer@mcw.edu

The Milwaukee Homicide Review Commission: An Interagency Collaborative Process to Reduce Homicide

Mallory O’Brien, PhD; Laurie Woods, MS; Ron A. Cisler, PhD

The Milwaukee Homicide Review Commission (MHRC) is a multi-level, multi-disciplinary, and multi-agency homicide review process aimed at reducing the occurrence of homicides in Milwaukee. Based on the public health approach to violence reduction, the MHRC has 3 goals: (1) to gain a better understanding of homicide through strategic problem analysis, (2) to develop innovative, effective responses, and (3) to focus limited enforcement and intervention activities on identifiable risks. The MHRC creates an environment for many disciplines and agencies to share information and work collectively on violence prevention strategies.

Since its inception, the MHRC has reviewed over 150 homicides and developed over 100 recommendations aimed at reducing homicide. These recommendations are based on themes that emerge from case reviews and focus on initiating change at system, agency/organization, and individual levels.

The MHRC has many accomplishments to date, including improved communication between local, state, and federal criminal justice agencies; assistance in immediate investigations; new strategic criminal justice activities; changes in ineffective agency practices; and new cooperative efforts between community service providers. Future plans include the continuation and expansion of initiatives including greater community impact and developing a Center of Excellence in community and public safety serving Milwaukee and the state of Wisconsin.


Author Affiliations: Milwaukee Homicide Review Commission (O’Brien, Woods); Center for Urban Population Health (Cisler); University of Wisconsin-Milwaukee, University of Wisconsin School of Medicine and Public Health and Aurora Health Care, Inc. (Cisler).

Corresponding Author: Mallory O’Brien, PhD, Milwaukee Homicide Review Commission, Milwaukee Police Department, Criminal Investigation Bureau, 3rd Floor, 749 W State St, Milwaukee, WI 53233; phone 414.935.7985; fax 414.935.7987; email Mobrien@hsph.harvard.edu.

Racial and Ethnic Disparities in AIDS Incidence: An Examination of Milwaukee, Wisconsin, 1990-2000

Eric N. Reither, PhD; Sang Lim Lee, MA

Public health agencies have identified the elimination of health disparities as a major policy objective.

Author Affiliations: Department of Sociology, Social Work and
Anthropology, Utah State University (Reither, Lee).

Corresponding Author: Eric Reither, PhD, Utah State University, Department of Sociology, Social Work and Anthropology, Logan UT 84322-0730; phone 435.797.1217; fax 435.797.1240; e-mail eric.reither@usu.edu

Preventable Causes of Death
in Wisconsin, 2004

Peter M. Vila, BS; Bridget C. Booske, PhD; Mark V. Wegner, MD, MPH; Patrick L. Remington, MD, MPH

Introduction: While heart disease, cancer, and injuries are leading proximate causes of death, research has demonstrated that about half of all deaths in the United States are actually due to preventable causes, including tobacco use, poor diet, and physical inactivity. Using state vital statistics data and findings from national studies, we report on the trends in the preventable causes of death in Wisconsin from 1992 to 2004.

Author Affiliations: University of Wisconsin Population Health Institute (Vila, Booske, Remington); Department of Population Health Sciences (Vila, Wegner, Remington); Wisconsin Division of Public Health (Wegner).

Corresponding Author: Patrick Remington, MD, MPH, University of Wisconsin Population Health Institute, Department of Population Health Sciences, 760 WARF Building, 610 Walnut St, Madison, WI 53726; phone 608.263.1745; fax 608.262.6404; e-mail plreming@wisc.edu.

Providing Culturally Sensitive End-of-Life Care for the Latino/a Community

Patricia Tellez-Giron, MD

The Latino population is the fastest-growing population in the United States. This rapid growth has resulted in an increased need for culturally sensitive health and education services, especially at end of life. Terminal illness experiences, beliefs, and expectations are linked to cultural values. Latino culture values end of life and is rich in beliefs, traditions, and rituals related to this important time. This article reflects the author’s clinical and personal experiences as a Latina and reviews the literature
regarding end-of-life issues and Latinos. It also offers suggestions on how to better serve the Latino community, and examples of important traditions, rituals, and beliefs at the end of life.

Author Affiliations: University of Wisconsin, Family Medicine Department, Madison, Wis (Tellez-Giron).

Corresponding Author: Patricia Tellez-Giron, MD, 6134 Sandstone Dr, Madison, WI 53719; phone 608.263.3111; fax 608.263.6663; email ptellez@fammed.wisc.edu.

Health Disparities in Milwaukee by Socioeconomic Status

Peter M. Vila, BS; Geoffrey R. Swain, MD, MPH; Dennis J. Baumgardner, MD; Sarah E. Halsmer, BS; Patrick L. Remington, MD, MPH; Ron A. Cisler, PhD

Background: In 2006, the city of Milwaukee ranked worse than any Wisconsin county for health outcomes and worse than all but 1 county for health determinants.



Author Affiliations: University of Wisconsin-Madison School of Medicine and Public Health (Vila, Swain, Baumgardner, Halsmer, Remington, Cisler); University of Wisconsin Population Health Institute (Vila, Remington); City of Milwaukee Health Department (Swain); Center for Urb

Corresponding Author: Peter Vila, 517 Otto Way, Elkhart Lake, WI 53020; phone 920.876.3083; e-mail pmvila@gmail.com.

The Development and Evaluation of Community Health Competencies for Family Medicine

Marie Wolff, PhD; L. Kevin Hamberger, PhD; Bruce Ambuel, PhD; Syed Ahmed, MD, MPH, DrPH; Geoffrey R. Swain, MD, MPH; Paul Hunter, MD; David Smith, MD

Background: There is an increasing emphasis on teaching community-responsive care and population health in medical education. This focus requires a multidimensional perspective on community health that examines the determinants, ranges, and variations of health status and disease in the community as a whole.

Author Affiliations: Department of Family and Community Medicine, Medical College of Wisconsin (Wolff, Ambuel, Hamberger, Ahmed), Department of Family Medicine, University of Wisconsin School of Medicine and Public Health (Swain), Center for Urban Population Health (Swain), D

Corresponding Author: Marie Wolff, PhD, Associate Professor, Department of Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, phone 414.456.4726, fax 414.456.6524, e-mail mwolff@mcw.edu

Clinical Significance of Common Cold Treatment: Professional Opinions

Bruce Barrett, MD, PhD; Sarah Endrizzi; Philip Andreoli; Shari Barlow; Zhengjun Zhang, PhD

Little is known about professionals’ knowledge and attitudes regarding the clinical significance of treatments for common cold (upper respiratory infection, presumed viral).


Author Affiliations: University of Wisconsin–Madison.


Corresponding Author: Bruce Barrett MD, PhD, Department of Family Medicine, 777 S Mills St, Madison, WI 53715; phone 608.263.2220; fax 608.263-5813; e-mail bruce.barrett@fammed.wisc.edu.

Myocardial Infarction Temporally Related to Ephedra – A Possible Role for the Coronary Microcirculation

Shereif H. Rezkalla, MD; Juan Mesa, MD; Param Sharma, MD; Robert A. Kloner, MD, PhD

Myocardial infarction has been reported with ephedrine and pseudoephedrine use. It has been suggested that these agents may induce coronary artery spasm, hypercoagulable states, or oxygen demand imbalance. We report a 25-year-old male with myocardial infarction after receiving a diet pill containing ephedra. Coronary angiography revealed normal coronary arteries with very slow flow, suggestive of microcirculation abnormalities. The flow responded promptly to intracoronary verapamil.



Author Affiliations: Doctors Rezkalla, Mesa and Sharma are with Marshfield Clinic, Department of Cardiology, Marshfield, WI; Dr. Rezkalla is Director of Cardiovascular Research. Doctor Kloner is the Director of The Heart Institute, Good Samaritan Hospital, Los Angeles, CA.

Corresponding Author: Address correspondence to Shereif Rezkalla, MD, Director of Cardiovascular Research, Department of Cardiology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449; 715.387.5845; e-mail: rezkalls@mfldclin.edu.

False Positive MRI of the Knee A Literature Review Study

Gary N. Guten, MD; Harvey S. Kohn, MD; Donald J. Zoltan, MD

Objective: A retrospective literature review study was performed because our group has seen an increasing number of patients with a “positive MRI” for torn meniscus being referred for arthroscopic surgery yet their clinical signs and symptoms do not fit that of a torn meniscus.

Methods: Fifteen literature articles from 1989 through 1999 were evaluated for MRI studies on asymptomatic volunteers.

Results: Starting in the third decade, there is age- dependent degeneration of the meniscus with increasing MRI signals in the meniscus in asymptomatic patients. By the fourth and fifth decades, significant MRI changes are present, especially in the medial meniscus, yet these patients were asymptomatic. Studies in the literature urge that clinicians match clinical signs and symptoms with magnetic resonance imaging before instituting surgical treatment.

Conclusion: The authors of this paper encourage the MRI report to use the term signal change - 1, 2, 3 rather than describing them as tears. A tear is a clinical-pathological diagnosis.



Author Affiliations: Sports Medicine and Orthopedic Center

Corresponding Author: Address correspondence to: Gary N. Guten, MD, Sports Medicine and Orthopedic Center, 2025 West Oklahoma Ave, Suite 100, Milwaukee, WI 53215; 414.647.0033; fax 414.647.0079.

Your Practice

The primary care physician’s role in treating chronic kidney disease

Jay A. Gold, MD, JD, MPH; Kay Simmons, MA

Twenty million Americans have chronic kidney disease (CKD); another 20 million are considered at risk.

Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. This material was prepared by
MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract with the Centers for Medicare & Medicaid Se

Corresponding Author: Please address all correspondence to MetaStar, Inc.

Partial or full retirement requires careful planning

Kurt G. Krumholz, CFP

For many physicians, partial retirement offers the best of both worlds—enough work to remain on top of their game, enough freedom to enjoy life. What’s stopping them? Money.

Author Affiliations: Kurt G. Krumholz, CFP

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

Your Profession

Efforts to increase health care quality and reduce medical errors must be maintained

Michael J. Dunn, MD

Deans Corner

Author Affiliations: Dean and Executive Vice President, Medical College of Wisconsin

Corresponding Author: Please address correspondence to Wisconsin Medical Society