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Volume 106, Issue 2 (April 2007)


 
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Editorial

John J. Frey, III, MD Medical Editor, Wisconsin Medical Journal
What we mean when we talk about “conflict of interest”
(full text PDF)

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.

Commentary

Marc Tumerman, MD
As I See It: Paying for population health care: The link between reimbursement models and quality health care
(full text PDF)

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.

Wisconsin Medical Society
As I See It: 2006 Summer Fellowships in Government and Community Service
(full text PDF)

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.

Original Research

Catherine A. McCarty, PhD, MPH, RD; Daniel J. McCarty, PhD; Annie C. Wetter, PhD, CSCS
Calories from Newspaper Dessert Recipes are Associated with Community Obesity Rates
(full text PDF)

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.

Gary D. Gilmore, MPH, PhD; William R. Schwan, PhD; Mary K. McLaughlin, PhD
An Assessment of Emergency Preparedness in Western Wisconsin
(full text PDF)

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.

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
Impact of a Child Care Educational Intervention on Parent Knowledge about Appropriate Antibiotic Use
(full text PDF)

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.

Review Articles

Nilsa I. Loyo-Berríos, PhD; Joseph N. Blustein, MD, MPH
Primary-Open Glaucoma and Myopia: A Narrative Review
(full text PDF)

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.

Case Reports

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
FoxHollow Atherectomy as a Treatment Modality for Common Femoral Artery Occlusion
(full text PDF)

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.

Michael McCormick, MD; Todd Nelson, MD
Cocaine-induced Fatal Acute Eosinophilic Pneumonia: A Case Report
(full text PDF)

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.

Your Practice

Stephen A. DiTullio, JD
Crucial aspects of the hiring process
(full text PDF)

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.

A. Derrill Crowe, MD
Medical malpractice insurance tests the mettle of insurance companies
(full text PDF)

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.

Your Profession

Robert N. Golden, MD
Looking back, looking forward
(full text PDF)

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.

Your Society

Wisconsin Medical Society Standard Benefit Plan Committee
The Wisconsin Medical Society’s Standard Benefit Plan
(full text PDF)

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.”

Letters to the Editor

John K Brendel, MD
Reviews should be comprehensive and non-biased
(full text PDF)

Nick Akgulian, MD
Caribbean clinic seeks volunteers
(full text PDF)

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