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Volume 107, Issue 3 (May 2008)

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Abstract

Encouraging a dialogue about health system reform; finding effective ways to encourage patients to literally get moving; successfully utilizing health care resources—these are all ways to help improve the health of patients in Wisconsin. In this issue of the Wisconsin Medical Journal, we take a closer look at these topics and others that can help ensure we’re “moving toward better health.”

Annual Meeting

2008 House of Delegates Action on Resolutions and Board Reports

Wisconsin Medical Society

Editor’s Note: To read the complete text of resolutions and amendments, visit the members-only section of our Web site: http://www.wisconsinmedicalsociety.org.

Author Affiliations: Wisconsin Medical Society

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

Editorials

The staff of Asclepius: A new perspective on the symbol of medicine

Kyle Bradford Jones

The staff of Asclepius (Aesculapius in Latin; Figure 1) has been associated with medicine since ancient times. Asclepius, a son of Apollo, was a practitioner of medicine and is 1 of 4 specific gods and goddesses to whom is sworn the original Hippocratic Oath.1 The other element of this symbol, the serpent, was seen by the Greeks as a symbol of healing and renewal due to the continual shedding of skin, and was often worshipped to protect one’s health.

Author Affiliations: Medical College of Wisconsin, Milwaukee, Wis.

Corresponding Author: Kyle Bradford Jones, 6095 N Green Bay Ave #203, Glendale, WI 53209; phone 801.660.0535; e-mail kbjones@mcw.edu

Reexamining the health care system

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

Newspapers, television journalists and blogs nationwide have caught up to what many physicians have understood for a very long time: The system in which we work and teach is broken. Instead of being held together with glue and baling wire, the system demands a substantial overhaul and a new direction. Whether through proposals by presidential candidates or in the Wisconsin Legislature, reform will be the major focus of social legislation in the future.

Author Affiliations: Medical Editor, Wisconsin Medical Journal

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

Original Research

Minutes in Motion: Motivating a Community to Move

Brenda Rooney, PhD, MPH; Tisha Hooks, PhD, MS; Krystal Baciak; Sarah Havens, BS; Heather Gilles, BS

Introduction: “Minutes in Motion” (MIM) was a community-based exercise challenge designed to recruit a large number of people to increase their physical activity for 6 weeks. We examined participant characteristics
that improved the likelihood of success.
Methods: This program challenged community members to engage in 30 minutes of physical activity every day for 6 weeks. Participants were asked to submit the number of minutes they exercised at the halfway point of the challenge and again at the end. Those who participated were eligible for prizes. Participants also were asked to complete voluntary pre- and post-surveys that included questions about usual amount of physical activity, perceived improvement from the exercise, and self-efficacy to exercise.
Results: Of the 3505 community members who signed up for MIM, 78% initially participated and 61% met the challenge goal. The program evaluation was completed by 567 participants. As a result of MIM, 41% of subjects reported they were more active, 51% reported weight loss, 44% had improved endurance, and 51% had improved mood. Fifty-eight percent of subjects exercised more per week at the end of the study than they did before, and self-efficacy to exercise increased in 47% of the subjects. Keeping a log, exercising at work, and wearing a pedometer were related to many of these outcomes.
Conclusions: A physical activity challenge targeted at a community can recruit a large number of people to increase their minutes in motion. Outcomes can be enhanced with certain recommended participation elements.

Author Affiliations: Gundersen Lutheran Health System, La Crosse, Wis (Rooney, Havens, Gilles); Winona State University, Winona, Minn (Hooks); Gundersen Lutheran Medical Foundation, La Crosse, Wis (Baciak).

Corresponding Author: Brenda Rooney, PhD, Gundersen Lutheran Health System, 1900 South Ave, La Crosse, WI 54601; phone 608.775.2152; fax 608.775.5887; e-mail blrooney@gundluth.org

Public Views on Determinants of Health, Interventions to Improve Health, and Priorities for Government

Stephanie A. Robert, PhD; Bridget C. Booske, PhD; Elizabeth Rigby, PhD; Angela M. Rohan, PhD

Objective: There is increasing evidence about the importance of factors that impact health beyond health care and individual behavior, yet there is little public and policy discourse about these things in the United States. We surveyed Wisconsin adults to see what they think are the most important factors that affect health. We also examined which interventions they believe would improve health, and whether government should prioritize such interventions.
Methods: A phone survey of a random sample of 1459 Wisconsin adults was conducted between September 2006 and February 2007.
Results: The Wisconsin public believes that health practices, access to health care, and health insurance are the most important factors affecting health, and that health insurance is a high government priority. Other broader social and economic determinants of health, such as employment, social support, income, housing, and neighborhood factors are seen as less important to health. Although respondents believe that health practices are important to health, they are less likely to suggest that government prioritize improving individual health practices. Although the public believes the government should prioritize access to health care and health insurance, they are not as likely to support government implementing social or economic policies in order to improve health.
Conclusion: In light of research demonstrating the importance of social and economic determinants of health, and of ongoing public forums meant to raise awareness of these determinants of health, it will be important to track whether public opinion of Wisconsin adults changes over time to increase attention to the social and economic determinants of health and related policy initiatives.

Author Affiliations: University of Wisconsin-Madison (Robert, Booske, Rohan) and University of Houston (Rigby).

Corresponding Author: Bridget C. Booske, PhD, Senior Scientist, Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut St, Ste 760, Madison, WI 53726; phone 608.263.1947

Parental Perception of Quality of Hospital Care for Children with Sickle Cell Disease

Jared Kam, BS; Julie A. Panepinto, MD, MSPH; Amanda M. Brandow, DO; David C. Brousseau, MD, MS

Problem Considered: Children with sickle cell disease account for 75,000 hospital days annually in the United States, yet little is known about how parents perceive the quality of hospital care these children receive.
Methods: Parents of hospitalized children that had sickle cell disease, cancer, or were admitted to the general pediatric service completed a validated survey assessing the parent-perceived quality of hospital care their children received. The primary outcome was parent-reported quality of care. A chi-square analysis was used to compare the percent of children with low quality care who had sickle cell disease with each control group.
Results: Parents of 112 children completed the survey; 17 children had sickle cell disease, 36 had cancer, and 59 were admitted to the general pediatric service. Parents of children with sickle cell disease were more likely to report low quality care compared to parents of children with cancer (29.4% versus 5.6%, P=0.017) and parents of general pediatric patients (29.4% versus 6.8%, P=0.011).
Conclusion: Parents of hospitalized children with sickle cell disease perceive their children’s care as being of lower quality than parents of children with cancer or children admitted to the general pediatric service.

Author Affiliations: Medical College of Wisconsin, Milwaukee, Wis (Kam); Department of Pediatrics (Hematology/Oncology/Bone Marrow Transplant) and the Children’s Research Institute, Medical College of Wisconsin, Milwaukee, Wis (Panepinto, Brandow); Department of Pediatr

Corresponding Author: David C. Brousseau, MD, MS, Associate Professor, Pediatrics, Medical College of Wisconsin, CCC 550, 999 N 92nd St, Milwaukee, WI 53226; phone 414.266.2625; fax 414.266.2635; e-mail dbrousse@mcw.edu

A Long-term Follow-up of a Single Rural Surgeon’s Experience with Laparoscopic Inguinal Hernia Repair

Tim Napier, MD, FACS; Jeremi T. Olson, PA-C; Jennifer Windmiller, BA; Jennifer Treat, MA

Introduction: Inguinal hernia repair is one of the most common surgical procedures performed in the United States, with an estimated 700,000 or more completed annually.
Objective: This study looks at 7 years of laparoscopic totally extra-peritoneal (TEP) inguinal hernia repair at a rural Wisconsin medical center. The goal is to accurately measure recurrence rates and mechanisms of recurrences within a single professional’s practice using a follow-up of no less than 2 years. A secondary goal was to record the percentage of patients with short-term and long-term complications.
Method: Patients with laparoscopic TEP inguinal hernia repairs from 1997 through 2004 were seen in follow-
up visits ?2 years after their initial repair. Of a possible 165 patients, 100 (61%) participated, returning for a total of 141 (64%) follow-up exams. Follow-up range was 2-7 years, with a mean of 3.7 years. All repairs were completed using a single technique (TEP) by a single surgeon. Repair variables included mesh thickness, style of mesh to cord accommodation, and fixation technique. Study participants ranged from 16 to 88 years, with an average age of 65.9 years. A wide range of socioeconomic indicators were represented, including education, occupation, and household income. Five participants were female and 95 were male.
Main Outcome Measure: The primary study outcome was the identification of an accurate recurrence rate along with the mechanism of hernia recurrence. Patients with long-term groin pain (dysesthesia) and identification of short-term complications were also noted.
Results: Between 2004 and 2007, 100 patients were seen for follow-up. None had symptomatic hernia recurrences. One recurrence was found at exam and confirmed with a herniogram and laparoscopic surgical exploration. Two additional patients, identified by exam and herniograms as having suspected recurrences, are awaiting surgical exploration. In the case of 1 recurrence, the mechanism appears to be partial migration of mesh from the placement area. Long-term groin dysesthesias (moderate or occasional) occurred in 2 patients or 1.4% of repairs. Spermatic cord hematoma (18% of repairs) was the most common short-term complication.
Conclusions: Laparoscopic TEP inguinal hernia repairs are effective and durable in a rural setting. An acceptable recurrence rate (0.7%-2.1%) may be related to mesh placement, completeness of dissection, and the small but real risk of mesh migration or displacement prior to healing fixation. Long-term pain complications are reasonably low.

Author Affiliations: Mile Bluff Medical Center and Hess Memorial Hospital, Mauston, Wis (Napier, Treat, Olson, Windmiller); St. Mary’s Hospital, Dean Clinic, Madison, Wis (Olson).

Corresponding Author: Tim Napier, MD, FACS, Mile Bluff Medical Center, 1040 Division St, Mauston, WI 53948; phone 608.847.9839; e-mail tnapier@milebluff.com or timnapier@verizon.net

Your Practice

Social Security: Take the money at 62 or wait?

Molly J. McCarragher, JD

If you are eligible for Social Security, you may begin receiving reduced benefits as early as age 62, no matter when you reach full retirement age, according to the Social Security Administration.
Should you begin taking Social Security at 62? Or wait until you reach full retirement age? Or wait a little longer to take advantage of delayed retirement credits?

Author Affiliations: Ms. McCarragher is a relationship manager with SVA Wealth Management, Inc., Registered Investment Advisor, an affiliate of Suby, Von Haden & Associates, S.C. For more information contact Wisconsin Medical Society Insurance and Financial Services, Inc. tol

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

Your Profession

An integrated school of medicine and public health—What does it mean?

Robert N. Golden, MD

In 2005, the University of Wisconsin Medical School became the UW School of Medicine and Public Health, a move that signaled the plan to develop a new model that unites public health and medicine. The vision was to create a superior research, education, and community engagement enterprise that integrates biomedical sciences, care of individual patients, and the health of diverse populations.

Author Affiliations: Dean, University of Wisconsin School of Medicine and Public Health,
Vice Chancellor for Medical Affairs, University of Wisconsin-Madison

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

MetaStar to begin new Medicare contract

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

During the past few years, this column has featured articles on a number of projects and activities on which MetaStar and its partners have been working. Those activities were all part of the Medicare Quality Improvement Organization (QIO) contract with the Centers for Medicare & Medicaid Services (CMS), known as the 8th Statement of Work.

Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. Ms Simmons is vice president of communications. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract w

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

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