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 107, Issue 2 (2008)

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With spring upon us—whether it seems like it or not—the seasonal problems of sunburn and sinuses aren’t far behind. This Wisconsin Medical Journal includes articles that focus on some of these issues and the role patients can play in prevention of related health conditions.


Sinuses, sunburn, and prevention

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


Author Affiliations: Medical Editor

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

Studying the physician patient relationship:
A 21st century approach

Shaili Jain, MD

As I see It

Author Affiliations: Doctor Jain is a General Adult Psychiatrist with Aurora Behavioral Health Services and a Clinical Assistant Professor of Psychiatry at the Medical College of Wisconsin in Milwaukee. She administers the research weblog.

Corresponding Author: Shaili Jain, MD, Aurora Psychiatric Hospital, 1220 Dewey Ave, Milwaukee, WI 53213; e-mail comments@thebedsidemanner.com.

What a piece of work is man: The Body Worlds exhibit
at the Milwaukee Public Museum

Joan M. Bedinghaus, MD, FAAF; Seth L. Foldy, MD, MPH, FAAFP

Special report on the Body Worlds exhibit

Author Affiliations: Medical College of Wisconsin, Milwaukee, Wis (Bedinghaus); Health eVolutions (Foldy).

Corresponding Author: Joan M. Bedinghaus, MD, FAAF; Department of Family and Community Medicine, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI 53226-0509; e-mail jbedingh@mcw.edu.

Original Research

Behavior Modification and Risk Perception in Patients
with Nonmelanoma Skin Cancer

John S. Rhee, MD, MPH; Melinda Davis-Malesevich, MD; Brent R. Logan, PhD; Marcy Neuburg, MD; Mary Burzynski, RN; Ann B. Nattinger, MD, MPH

Context: Nonmelanoma skin cancer (NMSC) is the most common cancer among humans, yet risk perceptions and preventive health behaviors in those who survive this cancer are relatively unknown.

Objectives: To assess the impact of the disease and its treatment on sun-protective behaviors, general preventive health behaviors, and risk perception in NMSC patients, and to determine factors associated with
behavioral change.

Design and Setting: A prospective study was conducted of 211 consecutive NMSC patients presenting to a dermatologic surgery clinic at a tertiary care university medical center from February 2005 to March 2006. These patients were all adults, were fluent in English, and had NMSC of the head and neck. Of the 211 eligible patients, complete data was obtained for 183 (87%). The most common reasons for dropout were voluntary withdrawal and incompletely answered surveys.

Intervention and Outcome Measures: Surveys that
assessed disease-specific quality of life (QoL), preventive health behaviors, sun-protective behaviors, and risk perception were administered before and after surgical treatment of NMSC.

Results: Sun-protective behaviors improved post-surgery even after controlling for seasons (P<0.001). Predictor factors associated with increased sun-protective behavior included poor skin tanning ability, summer season, no employment, less comorbid conditions, and previous NMSC treatment. Baseline QoL was not predictive of behavioral change. As for risk perception, respondents thought they were more likely than someone similar to themselves to develop future NMSCs but thought they had similar risks of developing melanoma or other non-skin cancers (P<0.001).

Conclusions: NMSC patients demonstrated disease-specific behavior modifications by selectively
improving their sun habits but showed no significant
improvement in other preventive health behaviors. This finding is consistent with patients’ specific perception of increased risk for future NMSCs, but surprisingly, not for melanoma. Increased patient education of
associated cancer risks with NMSC is warranted.

Author Affiliations: Department of Otolaryngology and Communication Sciences (Rhee, Davis-Malesevich, Burzynski), Health Policy Institute, Center for Patient Care and Outcomes Research (Nattinger), Division of Biostatistics (Logan), Department of Dermatology (Neuburg), Medica

Corresponding Author: John S. Rhee, MD, MPH, Associate Professor, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226; phone 414.805.5585; fax 414.805.7936; e-mail jrhee@mcw.edu.

Nasal Irrigation for Chronic Sinus Symptoms in Patients
with Allergic Rhinitis, Asthma, and Nasal Polyposis:
A Hypothesis Generating Study

David Rabago, MD; Emily Guerard, BS; Don Bukstein, MD

Background: Rhinosinusitis is a common, expensive disorder with a significant impact on patients’ quality of life. Chronic sinus symptoms are associated with allergic rhinitis, asthma, and nasal polyposis. Saline nasal irrigation is an adjunctive therapy for rhinosinusitis and sinus symptoms. Prior studies suggest that hypertonic saline nasal irrigation (HSNI) may be effective for symptoms associated with allergy, asthma, and nasal polyposis.

Objective: To assess the degree to which subjects using nasal irrigation for chronic sinus symptoms also reported improvements in symptoms related to allergy, asthma, or nasal polyposis.

Design: Qualitative study using in-depth long interviews of 28 participants in a prior qualitative nasal irrigation study. All participants were receiving daily nasal irrigation.

Results: Transcripts of interviews were systematically examined. Twelve of 21 subjects with allergic rhinitis spontaneously reported that HSNI improved symptoms. Two of 7 subjects with asthma and 1 of 2 subjects with nasal polyposis reported a positive association between HSNI use and asthma or nasal polyposis symptoms. Transcript content was organized into themes that included: (1) HSNI resulted in improvement of allergic rhinitis and asthma symptoms, and (2) HSNI should be used for symptoms of allergic rhinitis.

Conclusions: This hypothesis-generating study offers qualitative evidence that suggests patients with frequent rhinosinusitis and daily sinus symptoms, symptoms of concomitant allergic rhinitis, asthma, or polyposis may improve with HSNI. The parent studies offer strong evidence that HSNI is an effective adjunctive treatment for symptoms of chronic rhinosinusitis. Larger prospective studies are needed in patients with these diagnoses.

Author Affiliations: Author Affiliations: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Rabago); University of Wisconsin School of Medicine and Public Health, Madison, Wis (Guerard); Dean Health Systems, Madison, Wi

Corresponding Author: David Rabago, MD, 777 S Mills, Madison, WI 53715; phone 608.265.2487 or 608.843.0850; fax 608.263.5813; e-mail david.rabago@fammed.wisc.edu.

Practical Approach to Metabolic Evaluation and Treatment
of the Recurrent Stone Patient

Gaurav Bandi, MD; Stephen Y. Nakada, MD; Kristina L. Penniston, PhD, RD

Although significant progress has been made during the last 3 decades in the minimally invasive surgical management of stone disease, the medical prevention of urolithiasis still remains challenging as much less progress has been achieved during the same time period. The purpose of this article is to provide the practicing urologist with practical guidelines for the metabolic evaluation and management of the recurrent stone patient. The recommendations are based on the latest available information regarding the pathogenesis, medical treatment options, and decision-making rationale when managing these challenging patients.

Author Affiliations: Division of Urology, Department of Surgery, University of Wisconsin, Madison, Wis (Bandi, Nakada, Penniston).

Corresponding Author: Kristina Penniston, PhD, RD, Assistant Scientist, Division of Urology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, F4/320 Clinical Science Center, Madison, WI 53792-3236; phone 608.265.9797; fax 6

Review Articles

What’s New in Clinical Pharmacology
and Therapeutics

Paramjith S. Chawla, MD; Mahendr S. Kochar, MD, MS

The US Food and Drug Administration (FDA) has approved several new drugs in the past 2 years. This article provides an overview of some of the newer drugs that are likely to find wider use in the future. The drugs reviewed in this article can be used to treat cardiovascular system problems, diabetes mellitus, multiple sclerosis, hepatitis B infection, hyponatremia, Parkinson’s disease, rheumatoid arthritis, pain, constipation, and insomnia. Another drug discussed can be used to help a patient stop smoking. The article also discusses Gardasil, the recombinant vaccine against human papilloma virus (types 6, 11, 16, and 18).

Author Affiliations: Wheaton Franciscan Healthcare-St. Joseph, Milwaukee, Wis (Chawla); Medical College of Wisconsin, Milwaukee, Wis (Kochar).

Corresponding Author: Mahendr S. Kochar, MD, MS, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.456.4581; fax 414.456.6528; e-mail kochar@mcw.edu.

Updated CDC Guidelines for HIV Testing:
A Review for Wisconsin Practitioners

Andrew E. Petroll, MD; Carol L. Galletly, JD, PhD; Peter L. Havens, MD, MS; Maureen F. Kwiecinski, RN, JD; Steven D. Pinkerton, PhD

An estimated 250,000 people in the United States are living with undiagnosed human immunodeficiency virus (HIV) infection. Those who are unaware they are HIV-infected miss opportunities for early treatment and may unknowingly infect others. Early identification of HIV-infected individuals benefits both the infected individuals and the health of the public. To decrease the number of individuals unaware that they are HIV-infected, the Centers for Disease Control and Prevention (CDC) recently revised its recommendations for HIV testing in health care settings. Changes in the CDC-recommended HIV testing protocol include expanding the population to be routinely tested and streamlining the testing and consent process. This article discusses the CDC recommendations, current Wisconsin laws regarding HIV testing, challenges associated with reconciling these laws with current CDC guidelines, and ethical concerns surrounding the guidelines. The authors conclude that Wisconsin health care professionals should adopt the CDC recommendations for HIV testing. However, to fully implement the revised CDC testing protocol, Wisconsin law will need to be amended. Adoption of these recommendations would increase the number of people in Wisconsin who are aware of their HIV-positive status and can then receive timely treatment and information about preventing HIV transmission.

Author Affiliations: Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wis (Petroll, Galletly, Pinkerton); Department of Medicine, Medical College of Wisconsin, Milwaukee, Wis (Petroll); Department of Pediatrics, Medical College of Wisconsin, Mil

Corresponding Author: Andrew Petroll, MD, Medical College of Wisconsin, Center for AIDS Intervention Research, 2071 N Summit Ave, Milwaukee, WI 53202; phone 414.456.7703; fax 414.287.4206; e-mail apetroll@mcw.edu.

Your Practice

Seven key questions to ask when choosing
a financial advisor

Leonard W. Barry, MS

Seven questions to ask when choosing a financial advisor.

Author Affiliations: Leonard W. Barry holds a master’s
degree in personal financial planning. He is a financial consultant for SVA Wealth Management, Inc., Registered Investment Advisor, an affiliated company of Suby, Von Haden & Associates, S.C. He specializes i

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

Your Society

Efforts in pharmacogenetics will help patients get right
amount of right drug

Michael J. Dunn, MD

Phyisicans know that some patients respond better to one drug than another, despite the drugs having identical mechanisms of action.

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

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