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Volume 107, Issue 1 (2008)


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Abstract

During the 2007-2008 academic year, the University of Wisconsin School of Medicine and Public Health is commemorating its 100th anniversary. To pay tribute to this notable milestone, this issue of the Wisconsin Medical Journal looks back at the SMPH’s history and features several articles with a connection to the school.

Focus On… A Century of Inspiration

University of Wisconsin School of Medicine and Public Health

Dian Land; Micaela Sullivan-Fowler; Mary Hitchcock

Editor’s Note: This issue of the Wisconsin Medical Journal commemorates the University of Wisconsin School of Medicine and Public Health’s 100th anniversary. All scientific articles in this issue have some sort of connection or affiliation with the school.

Author Affiliations: Micaela Sullivan-Fowler, Curator/Coordinator of Historical Services at the Ebling Library Mary Hitchcock, Historical Services Librarian Dian Land, SMPH Writer and Editor

Corresponding Author: Dian Land dj.land@hosp.wisc.edu

Editorials

As I See It: Reflections on a summer internship in public health

Victoria S. Lee, BS

As I see it.

Author Affiliations: Ms. Lee is a Medical Scholar who recently graduated from the University of Wisconsin–Madison with a degree in economics. She plans to attend medical school this fall and spent the past summer working in public health at the Wisconsin Department of H

Corresponding Author: Victoria S. Lee, c/o Murray L. Katcher, MD, PhD, 1 W Wilson St, Rm 218, Madison, WI 53701-2659; phone 608.266.5818; fax 608.266.8925; e-mail vslee@wisc.edu.

Letters to the Editor

Various Readers

Letters written to the Medical Editor

Author Affiliations: Wisconsin Medical Journal

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

Commentaries

Chronic kidney disease (CKD) in Wisconsin: Time to address this public health problem

A. Vishnu Moorthy, MD; Mark V. Wegner, MD, MPH

Over the past 30 years, the number of individuals with chronic kidney disease (CKD) has been growing silently to epidemic proportions, both in the United States and worldwide.1-2 This increasing burden of CKD, both on patients and the health care system, is readily apparent when examining the significant increase in the number of patients with kidney failure who have required dialysis or kidney transplantation during the past 3 decades. The number of patients developing kidney failure annually in the United States has increased more than 7-fold, from 14,500 cases in 1978 to over 106,912 in 2005, (34.7/100,000 population).3

Author Affiliations: Nephrology Section, Department of Medicine, University of Wisconisin School of Medicine and Public Health, Madison, Wis (Moorthy); Wisconsin Division of Public Health, Madison, Wis (Wegner).

Corresponding Author: A. Vishnu Moorthy, MD, UW Nephrology, 3034 Fish Hatchery Rd, Fitchburg WI 53713; phone 608.270.5689; e-mail avm@medicine.wisc.edu.

Original Research

Wisconsin Firearm Deer Hunting Season: Injuries at a Level I Trauma Center, 1999-2004

Matthew A. Halanski, MD; Timothy E. Corden, MD

ABSTRACT
Context: Hunting continues to be a passion and common pastime for many US citizens, especially in rural areas. Unfortunately, with the large volume of hunters entering the woods each season, hunting injuries continue to be common.

Objective: Review the experience of a level I trauma center during each of Wisconsin’s 9-day deer firearm hunting seasons over a 6-year period and identify potential prevention elements based on the findings.

Design: We retrospectively reviewed all hunting-related injury patient data entered into the University of Wisconsin Hospital and Clinic’s (UWHC) level I trauma registry from 1999 to 2004, for each 9-day Wisconsin deer hunting firearm season. We compared injury occurrence with Wisconsin DNR statewide hunting-related firearm injury incidence data over the same time frame. The study was conducted at a level I university tertiary referral trauma center. The study included any patient admitted to the UWHC during the study period with a hunting-related injury entered into the trauma registry.

Outcomes Measured: Primary outcomes recorded included patient demographics, mechanism of injury, types of injuries, comorbidities, injury severity scores, and mortality.

Results: Twenty-four patients were treated for hunting-related injuries during the study period. The majority of hunters were male (95%), with an average age of 44.5 years. Treestand injuries accounted for 16 of the 24 injuries treated; the rest of the injuries were firearm-related. Most of the injuries (18) occurred during the first 3 days of the hunting season, with the remaining 6 injuries taking place around the Thanksgiving holiday period. Injury severity scores (ISS) ranged from 1 to 50. Orthopedic concerns accounted for 79% of the injuries, while general surgical was 50%, and neurosurgical was 12.5%. Two fatalities occurred due to complications from injuries caused by falling from a treestand.

Conclusion: Falls from a tree-stand and firearm shootings represent 2 mechanisms for severe hunting-related injuries during the 9-day deer firearm hunting season in Wisconsin. Formal treestand safety instruction should be emphasized during hunting education classes and all hunters need to heed safe hunting recommendations pertaining to firearms and treestands, and be particularly cautious during the first few days of the hunting season.

Author Affiliations: Helen DeVos Children’s Hospital, Grand Rapids, Mich (Halanski); Children’s Hospital of Wisconsin (Corden); Injury Research Center, Medical College of Wisconsin, Milwaukee, Wis (Corden).

Corresponding Author: Matthew A. Halanski, MD, Helen DeVos Children’s Hospital, Division of Pediatric Orthopedic Surgery, 1425 Michigan Ave NE, Suite D – MC 142, Grand Rapids, MI 49503; e-mail mhalansk@hotmail.com.

Local Public Health Department Funding: Trends Over Time and Relationship to Health Outcomes

Melissa C. Boeke, MS; Susan J. Zahner, DrPH, RN; Bridget C. Booske, PhD, MHSA; Patrick L. Remington, MD, MPH

Background: Local health departments contribute to population health improvement through the core functions of assessment, policy development, and assurance. Their capacity to perform these functions may be affected by funding and staffing.

Objective: To describe local health department funding and staffing levels and determine the relationship between these measures and county-level health outcomes.

Methods: Ten years of total funding, funding by revenue source, and staffing data from local health departments in all 72 Wisconsin counties were collected from the Department of Health and Family Services and analyzed. Summary measures for county health outcomes were obtained from the 2006 Wisconsin County Health Rankings, and a correlation matrix was created to determine associations between outcomes and measures of health department capacity.

Results: On average, Wisconsin local health departments spend $20.60 per capita, ranging from $7.50 to $68.30 among counties. While total per capita funding in the state (adjusted for inflation) increased $0.82 per year, a closer look reveals 3 distinct periods: increases of $0.20 per year during 1995-1997 and $1.33 per year during 1997-2001; but a decrease of $0.27 during 2001-2004. Local health departments in counties with worse health outcomes had only slightly higher average funding and staffing levels during 2002-2004.

Conclusion: Levels of health department funding in Wisconsin, already low by US standards, declined slightly in the past 3 years. Although counties with the worst health outcomes had slightly higher levels of public health funding, considerable disparities exist. State policymakers might consider investing more
resources in counties with the greatest need, to support evidence-based public health programs and reduce
existing geographic health disparities in Wisconsin.

Author Affiliations: University of Wisconsin – Madison, Population Health Institute, Madison, Wis (Remington, Boeke, Booske); University of Wisconsin School of Nursing, Madison, Wis (Zahner).

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

Improving the Accuracy of Payment Classifications Through Use of a Case Management Protocol

Jay A. Gold, MD, JD, MPH; Bill French, MBA, RHIA, CPHQ, CHPIT; Nathan Williams, MS

Objectives: The purpose of this study is to determine if a Case Management Protocol (CMP) improves the accuracy of assignment of Medicare patients to the appropriate payment classification.

Methods: MetaStar, Wisconsin’s Quality Improvement Organization (QIO), invited Wisconsin hospitals to participate in this project; 19 hospitals did so. A CMP enables physicians to enter an order in the medical record to “admit the patient under the case management protocol” when it is not obvious to the physician whether the patient should be admitted as an inpatient or placed in an outpatient status. A trained case management professional accesses the documentation in the medical record and makes a recommendation to the physician as to the appropriate status. The decision is ratified by the physician in the form of a signed order.

Results: In comparing 1-day inpatient stays as a percentage of all hospital stays in a group of hospitals that considered the use of the CMP, to that same percentage in the hospitals that did not consider the use of a CMP, there was a reduction of 1-day stays for the former group that was significantly (P<.01) greater than for the latter group; the decrease in target payments for the former group also was significantly greater than that for the latter group (P<.01).

Conclusion: The use of a CMP to assign Medicare patients to appropriate payment classifications is an effective method of increasing the accuracy of such assignment.

Author Affiliations: MetaStar, Inc. (Gold, French, Williams).

Corresponding Author: Bill French, Vice President eHealth Services, MetaStar; phone 608.274.1940; e-mail bfrench@metastar.com.

Spinal Intramedullary Cysticercosis of the Conus Medullaris

Yusuf Izci, MD; Roham Moftakhar, MD; M. Shahriar Salamat, MD, PhD; Mustafa K. Baskaya, MD

Neurocysticercosis is the most common central nervous system (CNS) parasitic disease worldwide, but spinal cysticercal infection is relatively rare, especially in the United States. Because of increased immigration to the United States from endemic areas, the incidence of neurocysticercosis has risen, especially in California, Texas, Arizona, and other southwestern states, but not in Wisconsin.

Spinal intramedullary cysticercosis involving the conus medullaris is an uncommon clinical condition that can lead to irreversible neurological deficits if untreated. Rarely, Taenia solium, a cestode that causes neurocysticercosis, may produce spinal intramedullary lesion, which may mimic an intramedullary tumor.

We report a case of thoracolumbar spinal intramedullary cysticercosis caused by Taenia solium. Spinal neurocysticercosis should be kept in mind in the differential diagnosis of intramedullary conus lesions even if the patient lives in Wisconsin.

Author Affiliations: University of Wisconsin Hospital and Clinics, Department of Neurological Surgery and Department of Pathology, Madison, Wis (Izci, Moftakhar, Salamat, Baskaya).

Corresponding Author: Mustafa K. Baskaya, MD, Department of Neurological Surgery, University of Wisconsin-Madison, CSC K4/828, 600 Highland Ave, Madison, WI 53792; phone 608.265.5967; fax 608.263.1728; e-mail m.baskaya@neurosurg.wisc.edu.

Amyloidosis Presenting as Lower Gastrointestinal Hemorrhage

Bret J. Spier, MD; Michael Einstein, MD; Eric A. Johnson, MD; Andrew O. Zuricik, III, MD; Johnny L. Hu, MD; Patrick R. Pfau, MD

AL-Amyloid rarely presents in the gastrointestinal tract as acute gastrointestinal hemorrhage, especially in the absence of clinical disease elsewhere in the body. There are no reported cases of monoclonal gammopathy of undetermined significance progressing to AL-Amyloid presenting as lower gastrointestinal hemorrhage. We report a case of a patient initially diagnosed with monoclonal gammopathy of undetermined significance who progressed to AL-Amyloid over the course of 1 year. His progression resulted in primary colonic amyloidosis that manifested as lower gastrointestinal hemorrhage. The diagnosis was made by biopsy of a sigmoid plaque demonstrating necrotic material on histopathology. Amyloid deposition was seen on congo red and on birefringence. The bleeding stopped spontaneously without intervention and he was discharged his fourth day in the hospital. Further evaluation revealed no involvement in other organ systems. The plan is to treat with melphalan and dexamethasone. We conclude that early endoscopic examination and biopsy of the surrounding intestinal tissue is indicated when patients with monoclonal gammopathy of undetermined significance present with gastrointestinal hemorrhage to evaluate for the progression to AL-Amyloidosis. Treatment to prevent recurrent hemorrhage and further progression of the disease should be considered.

Author Affiliations: Gastroenterology and Hepatology, Department of Internal Medicine (Spier, Einstein, Johnson, Pfau), Department of Pathology (Hu), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Cardiology, Department of Internal Medicine, Unive

Corresponding Author: Patrick R. Pfau, MD, Section of Gastroenterology and Hepatology, University of Wisconsin Medical School, H6/516 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-5124; phone 608.263.7322; fax 608.265.5677; e-mail prp@medicine.wisc.edu.

Your Practice

Could declining home values affect your retirement plans?

Jay Czarapata, CFP®, CRPS®

Homeowners who stay put and ride out the current slump in the housing market should not be overly concerned about the value of their homes or the long-term effect on their net worth. As the population continues to grow, the demand for housing and new homes continues to rise, just not as quickly as in past years, according to leading economic indicators.

Author Affiliations: Jay Czarapata, CFP® is a Certified Financial Planner who practices in the Milwaukee office of SVA Wealth Management, Inc., Registered Investment Advisor, an affiliated company of Suby, Von Haden & Associates, S.C.

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

Your Profession

White Coat Wisdom

Stephen J. Busalacchi

Publisher, Apollo’s Voice, LLC
The following excerpt is from the book, White Coat Wisdom, in the chapter Young at Art, in which LuAnn Moraski, DO, a pediatrician and internist from the Medical College of Wisconsin explains what it takes to learn medicine, as opposed to getting a medical degree.
Doctor LuAnn Moraski, a residency director, states flatly that she once killed a patient. Not on purpose, of course, and she’s making damn sure her residents don’t make that same mistake.

Author Affiliations: Stephen J. Busalacchi is a medical journalist whose work has appeared on Wisconsin Public Radio and National Public Radio. Most recently, he was director of public relations for the Wisconsin Medical Society from 1997-2006, before starting his own health

Corresponding Author: (608) 698-5298 PRDR@tds.net Website www.PRDRSteve.com

Your Society

Thank you to our reviewers

Wisconsin Medical Journal

The Wisconsin Medical Journal would like to thank those who served as manuscript reviewers
this past year. Manuscript review is an important collegial act and is essential to the integrity of
the Journal. We are grateful for their help in ensuring authors receive prompt, objective, and
insightful feedback on their work.

Author Affiliations: Wisconsin Medical Journal

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

Wisconsin Medical Society Foundation List of Donors

Wisconsin Medical Society Foundation

List of annual donors.

Author Affiliations: Wisconsin Medical Society Foundation

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

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