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Volume 107, Issue 7 (November 2008)

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Abstract

Improvements in neonatal care over the past 3 decades have increased the survival of infants at lower birthweights and gestational ages. In this issues of the Wisconsin Medical Journal, researchers report that Wisconsin is doing well when compared to leading NICUs in the United States.

Original Research

Erika W. Hagen, PhD; Mona Sadek-Badawi, MBBCh; Aggie Albanese, BS; Mari Palta, PhD
A Comparison of Wisconsin Neonatal Intensive Care Units with National Data on Outcomes and Practices

Context: Improvements in neonatal care over the past 3 decades have increased survival of infants at lower birthweights and gestational ages. However, outcomes and practices vary considerably between hospitals.

Objective: To describe maternal and infant characteristics, neonatal intensive care units (NICU) practices, morbidity, and mortality in Wisconsin NICUs, and to compare outcomes in Wisconsin to the National Institute of Child Health and Human Development network of large academic medical center NICUs.

Methods: The Newborn Lung Project Statewide Cohort is a prospective observational study of all very low birthweight (?1500 grams) infants admitted during 2003 and 2004 to the 16 level III NICUs in Wisconsin. Anonymous data were collected for all admitted infants (N=1463). Major neonatal morbidities, including bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) were evaluated.

Results: The overall incidence of BPD was 24% (8%-56% between NICUs); IVH incidence was 23% (9%-41%); the incidence of NEC was 7% (0%-21%); and the incidence of grade III or higher ROP was 10% (0%-35%).

Conclusion: The incidence rates of major neonatal morbidities in Wisconsin were similar to those of a national network of academic NICUs.

Sarina Schrager, MD, MS; Sarah Hoffmann, BS
Women’s Knowledge of Commonly Used Contraceptive Methods

Introduction: Despite the availability of reliable contraceptive methods in this country, half of all pregnancies are unintended. There is a scarcity of research in a primary care population that measures women’s knowledge about commonly used contraceptive methods.

Methods: All women between 18 and 40 in the waiting room at 2 different family practice clinics were approached over a 2-week period. Women were asked to complete a short written questionnaire that included demographics, reproductive information, and 9 true/false questions about common contraceptive methods.

Results: Two hundred fifty-two surveys were completed. Half of all women believed that condoms are 99% effective and only 57% knew that condoms were not as effective as oral contraceptive pills. Close to half of all the women received their contraceptive information from the clinic. Only 42% of the women knew that oral contraceptive pills can reduce the incidence of some types of cancer. There was not correlation between number of questions answered correctly and number of children, type of contraceptive used, age, or race/ethnicity. Twenty-six percent of the respondents were not using any contraception.

Discussion: Overall, the women surveyed demonstrated fairly good knowledge of contraception methods. More women surveyed were aware that oral contraceptive pills can reduce the rate of uterine and ovarian cancer than in previous similar studies. Also, women in this survey were more likely to use intrauterine devices than the general population.

Case Reports

Ravi K. Mareedu, MD; Juan E. Mesa, MD
Patent Foramen Ovale with Right to Left Shunt as a Cause of Hypoxia

Patent foramen ovale with right to left shunt as a cause of hypoxia without Eisenmengers physiology or with only moderately pulmonary artery pressures is an uncommon presentation. Initial diagnosis via transesophageal echocardiography requires detection of a shunt with either color Doppler or agitated saline contrast with or without Valsalva maneuver. This rare but diagnosable case presented was simply corrected with placement of a CardioSEAL device. Causes of right to left shunt without elevated pulmonary artery pressures are discussed.

Micah R. Chan, MD, MPH; Alexander S. Yevzlin, MD; Molly Hinshaw, MD; Jonathan B. Jaffery, MD
Calciphylaxis Responsive to Lanthanum Carbonate (FOSRENOL) Therapy

Calciphylaxis is a rare and debilitating vasculopathy predominantly seen in patients with renal failure. The proposed mechanism of injury is active vascular calcification with associated elevated parathyroid hormone, hypercalcemia, or hyperphosphatemia. With improved pharmacologic agents including non-calcium containing phosphate binders, vitamin D analogues, calcimimetics, and bisphosphonates, targeted therapy on the mineralization process has been tried with varied success. We report a case of biopsy-proven calciphylaxis in a patient with acute kidney injury requiring dialysis that had persistently elevated calcium-phosphorus product refractory to treatment. The patient, however, responded rapidly to the initiation of lanthanum carbonate therapy and modified dialysis. This is the first known case reported in the literature utilizing this new non-calcium-based phosphate binder in the setting of calciphylaxis.

Your Practice

Michelle Leiker, JD
Federal Appeals Court reverses lower Court ruling; reaffirms immunity for hospitals and physicians in peer review cases

On July 23, 2008, the US Court of Appeals for the Fifth Circuit Court (Appeals Court) overturned a $33 million judgment awarded to Lawrence Poliner, MD, and found in favor of Texas Health Systems (Hospital), concluding that the peer review activities of the Hospital and its physicians were entitled to immunity under the Health Care Quality Improvement Act (HCQIA).1 The ruling resulted in a sigh of relief from hospitals and physicians involved in peer review activities.

Jay A. Gold, MD, JD, MPH
2008-2009 recommendations for use of influenza vaccine

The Wisconsin Department of Health Services (DHS) issued a memo September 12, 2008, regarding the recommendations for influenza immunization for the upcoming flu season to Wisconsin physicians and others. The memo, which is reprinted here, was signed by Jeffrey P. Davis, MD, DHS’s chief medical officer and state epidemiologist for communicable diseases; Jonathan L. Temte, MD, PhD, chair of the Wisconsin Council on Immunization Practices; and this author, on behalf of the Wisconsin Adult Immunization Coalition.

W. Stancil Starnes
ProAssurance/PIC Wisconsin offers preview of rate reductions and coverage enhancements

‘I’m mad as hell and I’m not going to take it any more.” The iconic phrase first shouted by the central figure in the hit movie Network is being used by more physicians as we ask your colleagues about today’s medical/legal climate.

Your Profession

Robert N. Golden, MD
Thoughts from the White Coat Ceremony

In September, I had the great honor and pleasure to preside over the White Coat Ceremony for the Class of 2012. Each year, both the Medical College of Wisconsin and University of Wisconsin School of Medicine and Public Health hold this formal investiture ceremony in which we welcome our new medical students and their families. But more importantly, this is our first opportunity to formally emphasize the commitment to service that is such an integral part of the medical tradition.

Your Society

Susan L Turney, MD, MS, FACP, FACMPE
New Web site aims to alleviate physician workforce shortage

In 2004, the Wisconsin Medical Society and the Wisconsin Hospital Association released “Who Will Care for Our Patients,” a report documenting the current and projected physician workforce shortage. At that time, there was a shortage of primary care physicians in rural Wisconsin and inner city Milwaukee, and general surgeons and radiologists were “critically needed in rural areas.”1 The report also predicted that by 2015, the demand for primary care physicians would increase by an additional 13.5%, while the physician supply would lag even further.

Wisconsin Medical Society
Resolutions due February 17, 2009, for Wisconsin Medical Society Annual Meeting

Just a reminder that members can submit issues/resolutions year around. For time sensitive issues, this may be a better avenue. Please use the Member Communication Form which is available on the Society Web site at http://www.wisconsinmedicalsociety.org/members_only/member_communication_form.

Other

Multiple authors who presented research at the Wisconsin Research and Education Network’s 2007 Research Forum.
Proceedings from the Wisconsin Research and Education Network’s 2007 Research Forum

The Wisconsin Research and Education Network (WREN) held its 2007 Research Forum November 1-2, 2007 in the Wisconsin Dells. During the Forum, the abstracts below were presented, representing current research relating to primary care. The Forum was held to facilitate interaction between primary care researchers of all levels in Wisconsin.
A sixth abstract, titled “Women’s Knowledge of Commonly Used Contraceptive Methods,” was also presented at the forum by author Sarah Hoffmann. The full manuscript was submitted to the Journal, and is published in its entirety on page 327.

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