Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 103, Issue 2 (2004)

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Thomas C. Meyer, MD, Medical Editor, WMJ
Tales, history, and science tell their significance
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Before I focus on what is in this issue of the Journal, I would like to address something that is not. Staffing cuts mean we are no longer able to prepare the obituaries that have been included for many years. Instead, the abbreviated “In Remembrance” box on page 5 replaces the longer obituaries, and will appear from time to time in future issues of the Journal. While we regret that we cannot expand on the many interesting facets of our deceased colleagues’ lives, we do wish to acknowledge their passing and salute them, albeit briefly.

William Cayley, MD
I just want my pills…
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“I just want my thyroid pills and my hormones.” So said the patient seated in front of me–a late middle–aged woman who was in the clinic for her first visit in over a year. We had never met, but her chart showed a pattern. She would visit the clinic yearly for refills and the occasional TSH, always declining any further health services. No physical exams, no screenings for cholesterol, colon cancer, or breast cancer. Just periodic visits for refills and a TSH.

Peter M. Cham
Enhancing cultural education through service learning: A medical student’s perspective
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In a recent survey of medical education programs in the United States, about 100 schools were found to include instruction on cultural diversity, with a mean of 15 hours of instruction. The approaches to cross-cultural education in medical schools differ and can include formal lectures, role-playing, small group discussions, videos, patient interviews, and immersion experiences. These curriculums were assessed recently, and were found to have varied levels of success.

Original Research

Alexandra Adams, MD, PhD; Nancy Miller-Korth, RN, MSN; David Brown, PhD
Learning to Work Together: Developing Academic and Community Research Partnerships
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Background: Community-based participatory research (CBPR) has been promoted as an important collaborative methodology for addressing local health concerns. However, academic physicians and researchers usually are not trained to work with communities as partners.

Methods: Key characteristics of effective community-academic partnerships are examined based on experiences with 2 CBPR projects in Wisconsin.

Results: These 2 projects increasingly have involved the respective communities and researchers in a collaboration. The steps they have taken illustrate the qualities of successful CBPR partnerships: ongoing development of joint community and researcher analysis, communication, and mobilization to search for relevant solutions to important community health problems. To sustain this kind of partnership, it is critical for researchers using the CBPR approach to understand how their academic-scientific perspective differs as well as converges with the community members’ practical-experiential perspective.

Conclusions: Health care researchers can effectively make use of partnerships with communities by following defined CBPR steps for developing mutually agreed upon research agendas, timelines, and goals. This, in turn, builds the capacity of communities to initiate and engage in future collaborative research projects concerning health issues.

Jon Gould, MD; Michael Garren, MD; James Starling, MD
Bariatric Surgery
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Bariatric surgery has evolved since its introduction in the 1950s. The original surgical procedure designed specifically to address morbid obesity was the jejuno-ileal bypass (JIB). Although associated with excellent and sustained weight loss, the JIB was eventually abandoned by all surgeons (and removed from the American College of Surgeons procedure list) due to a high incidence of complications and an unacceptable mortality rate. In 1967, Dr Edward Mason at the University of Iowa developed the gastric bypass after observing that females who had undergone gastric resections for peptic ulcer disease tended to lose weight that was difficult to regain after surgery. The gastric bypass has since become the preferred bariatric surgical procedure in the United States. Since Mason’s original description, several important technical modifications have been made, and results are well described. In general, morbidly obese patients may expect to lose about 60%-70% of their excess weight. In most cases, this is more than 100 pounds. This weight loss has also proven to be durable, with more than 10 years follow-up in some series. In 1994, Wittgrove and colleagues first introduced the laparoscopic approach to gastric bypass. Results of contemporary series demonstrate weight loss comparable to that of open gastric bypass, and acceptable complication rates.

Jennifer L. Erickson, BA; Patrick L. Remington, MD, MPH; Paul E. Peppard, PhD
Trends in Bariatric Surgery for Morbid Obesity in Wisconsin
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Background: Obesity is a national epidemic with rates in Wisconsin and the United States doubling over the past decade. Research of available treatments for morbid obesity (body mass index >40 kg/m2) suggests that bariatric surgery may be the only modality that provides any significant long term weight loss. Methods: Using the data from Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, we analyzed self-reported information on body weight and height among adults in Wisconsin. We used the WITHIN database for inpatient hospitalization and surgeries in Wisconsin to evaluate trends in gastric bypass surgery. Finally, we surveyed bariatric surgeons in Wisconsin to assess trends in bariatric surgery in the state. Results: In Wisconsin, the percentage of the adults considered to be obese increased from 11% in 1990 to 22% in 2001. In 1999-2001, approximately 80,000 adults (2% of the population) were morbidly obese. The number of gastric bypass surgeries performed in Wisconsin more than doubled in 1 year, from 182 in 2001 to 426 in 2002. According to bariatric surgeons, gastric bypass accounts for approximately 90% of bariatric surgeries performed in Wisconsin. Thus, in 2002, there was roughly 1 bariatric surgery for every 200 morbidly obese Wisconsin adults. Most (84%) bariatric surgeons are planning to increase the number of procedures they perform, and 24% plan on adding an additional bariatric surgeon to their group. Summary: Bariatric surgery rates are increasing in Wisconsin, yet the demand for surgery far exceeds current capacity of surgeons in the state.

Victoria L. Vande Zande, MD; Joseph J. Mazza, MD; Steven H. Yale, MD
Hematologic and Metabolic Abnormalities in a Patient with Anorexia Nervosa
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Anorexia nervosa is a common problem in young adults that may present with a variety of metabolic and hematologic abnormalities, as well as weight loss and psychological disturbances. We present a young man with a long history of anorexia nervosa who developed pancytopenia associated with decreased bone marrow cellularity and abnormal architecture and marrow infiltration with an amorphous, gelatinous substance characteristic of anorexia nervosa. The patient also developed osteopenia with evidence of excessive calcium excretion. The pancytopenia and marrow function reverted to normal with therapeutic and dietary intervention. The effects of eating disorders can result in serious consequences with respect to an individual’s health and well-being. A host of hematologic abnormalities that are associated with anorexia nervosa have the potential of increasing the risk of infection and bleeding. Additionally, because of the insidious development of anemia in some patients, decreased performance status and chronic fatigue can pose significant compromises in one’s daily activities and work effort. Anorexia nervosa is a chronic illness that is distinctly more common in females than in males (ratio of 10 to 1), but can affect males in an equally debilitating manner, requiring multiple modalities of therapeutic intervention and consultation.1-4 We present the case of a male referred to the hematology department because of pancytopenia, chronic fatigue, and back pain. A diagnosis of anorexia nervosa had been made 10 years prior at the age of 18 years.

Review Articles

Phiroze Hansotia, MD
The Rowley family of physicians—A glimpse of medical practice in Wisconsin from frontier to early modern times
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This review describes Wisconsin in its days as a territory and after statehood in 1848. Early settlers often brought infectious diseases with them that affected both American Indians and other European settlers in the region. Medical care in the 19th century was empirical and rudimentary. By the early 20th century, scientific advances and public health began to dramatically change medical practice, preparing it for the modern era. The record of three physicians in the Rowley family covers the more than 100-year period from 1854 to 1956, offering an unusual observation of the changes in medical practice from pioneer to modern times as experienced by a single family of Wisconsin physicians.

Joseph J. Mazza, MD
Hypercoagulability and Venous Thromboembolism: A Review
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This review addresses the numerous factors that predispose individuals for venous thromboembolic events (VTE). Both acquired and genetically inherited factors are reviewed with their approximate relative risk of developing VTE. Oral contraceptive use and hormone replacement therapy, as well as the prevalence of VTE associated with pregnancy, are also addressed. Particular attention is directed to the frequency of more than 1 predisposing factor being present, further increasing the risk of VTE or its recurrence.

Your Profession

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin
Reform is only cure for ailing medical liability system
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Physicians attuned to the current state of the medical liability insurance system may consider themselves fortunate to call Wisconsin home. Wisconsin is one of only six states deemed stable by the American Medical Association (AMA) in terms of the burden that the cost of malpractice insurance is placing on clinicians.

Your Society

Wisconsin Medical Journal, 1904;2:630-631 Arthur J. Patek, AB, MD, Editor
Editorial Comment “Graft”
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At a recent meeting of the Physicians’ Club of Chicago the subject of “Graft” was under discussion, and Mr. Clarence Darrow, a well-known lawyer, defined graft as follows: “The effort of any human being to take from society or from another human being or animal more than he really gives to society in return.” Graft is a subject which is receiving widespread attention at the present time.