Wisconsin's Program Research Articles

Acute care utilization among individuals with sickle cell disease and related cardiopulmonary and renal complications.

Cardiopulmonary and renal end organ (CPR) complications are associated with early mortality among individuals with sickle cell disease (SCD). However, there is limited knowledge regarding acute care utilization for individuals with SCD and CPR complications. Our objective was to determine the prevalence of CPR complications in a state specific SCD population and compare acute care utilization among individuals with and without CPR complications. We leveraged 2017-2020 data for individuals with SCD identified by the Sickle Cell Data Collection program in Wisconsin. The prevalence of CPR complications is determined for distinct age groups. Generalized linear models adjusted for age compared the rate of acute care visits/person/year among individuals who had cardiopulmonary only, renal only, both cardiopulmonary and renal, or no CPR complications. There were 1378 individuals with SCD, 52% females, mean (SD) age 28.3 (18.5) years; 48% had at least one CPR complication during the study period. The prevalence of CPR complications was higher in adults (69%) compared to pediatric (15%) and transition (51%) groups. Individuals with SCD and cardiopulmonary complications had higher acute visit rates than those without CPR complications (5.4 (IQR 5.0-5.8) vs 2.4 (IQR 2.1-2.5), p <0.001)). Acute care visit rates were similar between individuals with SCD who had renal only complications and no CPR complications (2.7 (IQR 2.5-3.0) vs 2.4 (2.1-2.5), p = 0.24). The high acute care visit rates, especially for those with cardiopulmonary complications, warrant further investigation to understand risk factors for CPR complications, the underlying reasons and identify effective disease management strategies.

Developing a Statewide Strategy for Meaningful Youth Engagement: Insights from a Youth-Driven Program in Wisconsin.

There are various ways to integrate the lived experiences and perspectives of youth and young adults into Maternal Child Health (MCH) goals, initiatives, and programs. This article describes the history, evolution, and current strategy of a program that engages youth from across the state of Wisconsin. It serves as an example for others who may be interested in building capacity for youth leadership and engagement. The Providers and Teens Communicating for Health (PATCH) Program started as a community-based pilot project and evolved into a robust statewide youth engagement infrastructure. Meaningful youth engagement requires capacity, adaptability, and expertise. Thus, in this case, it has proven advantageous to develop complementary and mutually beneficial partnerships to support adolescent health more effectively and efficiently in Wisconsin.

Timeliness of Opioid Administration for Pain in the Emergency Department for Adults with Sickle Cell Disease

Background: Individuals with sickle cell disease (SCD) often require emergent care to manage debilitating pain. The American Society of Hematology recommends individuals seeking care for the treatment of acute pain should have their pain assessed and medication administered within one hour of their arrival at the emergency department (ED). Data regarding guideline timeliness of pain treatment in adults are not well understood. We therefore sought to determine the timeliness of care for pain treatment in the ED for adults with SCD and factors associated with timeliness of care. We hypothesized that those using public insurance will have greater delays in receipt of intravenous opioids for pain. Methods: We leveraged the Center for Disease Control's Sickle Cell Data Collection Program in Wisconsin to identify individuals with SCD who received care in the ED associated with the adult SCD comprehensive clinic between 2017-2020. Individuals were identified as having SCD if confirmed via the state newborn screening program or if they had 3 or more visits/claims with a diagnosis of SCD in a five-year time frame. ED treat and release visits with 1) any diagnosis of pain or vaso-occlusive crises, and 2) receipt of an intravenous opioid were considered painful crises. The timeliness of ED pain treatment was determined by calculating the time between placement in an ED room and receipt of first intravenous opioid. All analyses were conducted at the visit level. A multivariable generalized linear model was used to determine if age, sex or insurance status were associated with time to opioid administration. Results: There were 382 individuals with SCD who contributed to 3400 ED treat and release visits; 1755 were for painful crises. The mean age of individuals was 31.8 (SD = 9.5) years and the majority of the visits were by females (64%). The primary payers included Medicaid (63.9%), Medicare (25.6%), private (5.7%), and other (4.7%). The median time to administration of intravenous opioids after being roomed was 57 minutes (IQR: 39 - 86 minutes). Intravenous opioids were not administered within 60 minutes of being roomed for 43% of the ED visits. The multivariable model demonstrated that females (as compared to males; 72.6 vs 55.4 minutes), and those on Medicaid and Medicare (70.4 and 72.6 minutes respectively as compared to private insurance 46 minutes) had a significantly longer time to receipt of first intravenous opioid (Table 1). Conclusion: Our data show that intravenous opioids were not given within 60 minutes of being roomed for more than 40% of ED visits for pain at an adult care facility . These analyses do not include the time in waiting room prior to being roomed, thus the problem of timely care is worse than reflected by these results. Females and those on public insurance have significantly longer time to receipt of pain treatment. Immediate work is needed to identify steps to ensure that adults with SCD seeking emergent care for pain receive guideline-adherent pain treatment.

Acute Care Utilization Among Individuals with Sickle Cell Disease and Related Cardiopulmonary and Renal Complications

Introduction: Individuals with SCD are at risk of developing numerous chronic complications including cardiopulmonary and renal (CPR) end organ complications, which are associated with early mortality. However, there is limited knowledge regarding the proportion of individuals with SCD who have CPR end organ complications and the acute care utilization of this subset of patients. The objective of this study was to determine the prevalence of CPR end organ complications in a state specific SCD population and compare acute care utilization among SCD individuals who have CPR end organ complications with those who do not. Methods: We leveraged the Sickle Cell Data Collection Program in Wisconsin, which includes linked data from Medicaid and electronic health records from two large tertiary care facilities in the state for years 2018 - 2020. Individuals were considered to have SCD if they had more than two visits or claims with an associated diagnosis code of SCD. Individuals with SCD were considered to have cardiopulmonary complications if they had a visit or claim with a diagnosis code for cardiomyopathy, dysrhythmia, pulmonary heart disease, heart failure, Long QT syndrome, and/or pulmonary fibrosis. Renal complications included chronic kidney disease, proteinuria and/or hematuria. The prevalence was determined as the proportion of people with CPR end organ complications. The prevalence between distinct age groups and sex was compared using chi square tests. The number of acute care visits (including ED treat and release and hospitalizations) were compared between SCD individuals with and without CPR end organ complications using generalized linear models assuming negative binomial distribution adjusted for age. We also conducted pairwise comparisons to determine if there were differences in acute care utilization between individuals who had no CPR end organ complications and those who had both cardiopulmonary and renal, cardiopulmonary only, and renal only respectively. All pairwise comparisons were adjusted for age and multiple comparisons using false discovery rates. P-value of <0.05 was considered significant. Results: Our study included 1095 individuals with SCD in Wisconsin (mean age (SD) = 26.4 (17.5) years and 54% females). There were 423 children (≤18 years of age) included in the cohort, of which 10.1% had at least one CPR end organ complication. There were 672 adults, and the prevalence of CPR end organ complications was significantly higher in adults as compared to children (63.2% vs 10.1%, p value <0.001). The distribution of CPR end organ complications by age is shown in Figure 1. There was no difference in prevalence of CPR end organ complications by sex (p value = 0.62). Overall, there were a median of 5 (IQR: 2- 11) acute care visits in the entire cohort during the 3 year study period. The number of acute care visits among individuals with SCD and CPR end organ complications was significantly higher than for those who did not have CPR end organ complications (median 9 (IQR: 3 - 19) vs 4(1-7), age adjusted p-value <0.0001). The pairwise comparisons showed that the number of acute care visits was significantly higher among SCD individuals who had cardiopulmonary complications (median 9 (IQR: 4 - 20)) or cardiopulmonary and renal complications (median 9 (IQR: 4 - 25)) compared to those who did not have any CPR end organ complications (median 5 (IQR: 1 -7), p-value = 0.001). However, there was no significant difference in acute care visits between SCD individuals with renal complications and those with no CPR end organ complications (p = 0.61). The number of acute care visits for those who had only cardiopulmonary complications was also significantly higher than those who had only renal end organ complications (median 9 (IQR: 3 - 20 vs median 4 (1 - 10), p-value = 0.001). Conclusions: The data from the SCD surveillance program in WI show that a majority of adults with SCD have CPR end organ complications. Acute care utilization is specifically higher for individuals with SCD who have cardiopulmonary complications, suggesting that further studies are needed to understand the reasons for their acute care visits. Prevention or treatment of CPR end organ complications might decrease the high number of acute care visits in a subset of the SCD population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Police‐driven diversion program in Wisconsin lowers rearrest rate

Completion of a six‐month diversion program for drug offenders in Madison, Wisconsin, led to a substantial reduction in the odds of rearrest compared with individuals not participating in the program, reports a newly published study. The results point to the importance of ongoing engagement of participants, in that mere assignment to the program without successful completion was not associated with reduced recidivism.

Financial burden and medication adherence among near-poor older adults in a pharmaceutical assistance program.

With increasing drug prices in the past decade, affordability and medication adherence are a growing concern for near-poor older adults, especially for those who are not receiving Low-Income Subsidy in Medicare Part D. SeniorCare is a pharmaceutical assistance program in Wisconsin for near-poor older adults, providing comprehensive prescription coverage with flat copayments. To evaluate five-year trends in financial hardship and medication adherence and to examine factors associated with these outcomes in SeniorCare members. SeniorCare program enrollment and pharmacy claims data from 2014 to 2018 were used. The study population was near-poor older adults in SeniorCare with annual family income ≤200% of the federal poverty level. Financial burden was assessed using the proportion of total annual out-of-pocket costs to total annual income. Medication adherence was assessed by adapting the measures endorsed by the Pharmacy Quality Alliance and National Quality Forum. Descriptive statistics and independent t-tests were used to evaluate the trends, and multivariate logistic regressions were conducted to examine factors associated with financial burden and medication adherence. From 2014 to 2018, mean annual out-of-pocket costs per member declined by 3.7% (p<0.001) for all drugs, while those for specialty drugs increased by 31.2% (p<0.05). Around 3.3% spent more than 5% of their income for prescription drugs in 2014, which decreased to 2.4% in 2018 (p<0.001). The proportions of adherent patients increased from 78.1% to 81.2% (p<0.001) for diabetes medications (excluding insulins), from 77.3% to 79.5% (p<0.001) for statins, and from 79.8% to 80.8% (p<0.05) for RASA. Members subject to a $500 annual deductible were more likely to experience high financial burden (adjusted odds ratio (AOR)=1.677, p<0.001) and less likely to be adherent to diabetes medications (AOR=0.484, p<0.001). The near-poor older adults enrolled in Wisconsin SeniorCare program had low financial burden and good medication adherence within the program.

Knowledge Learning of Insurance Risks Using Dependence Models

Learning the customers’ experience and behavior creates competitive advantages for any company over its rivals. The insurance industry is an essential sector in any developed economy and a better understanding of customers’ risk profile is critical to decision making in all aspects of insurance operations. In this paper, we explore the idea of using copula-based dependence models to learn the hidden risk of policyholders in property insurance. Specifically, we build a novel copula model to accommodate the dependence over time and over space among spatially clustered property risks. To tackle the computational challenge caused by the discreteness feature of large-scale insurance data, we propose an efficient multilevel composite likelihood approach for parameter estimation. Provided that latent risk induces correlation, the proposed customer learning method offers improved predictive analytics by allowing insurers to borrow strength from related risks in predicting new risks and also helps reveal the relative importance of the multiple sources of unobserved heterogeneity in updating policyholders’ risk profile. In the empirical study, we examine the loss cost of a portfolio of entities insured by a government property insurance program in Wisconsin. We find both significant temporal and spatial association among property risks. However, their effects on the predictive distribution of loss cost are different for the new and renewal policyholders. The two sources of dependence are complements for the former and substitutes for the latter. These findings are shown to have substantial managerial implications in key insurance operations such as experience rating, capital allocation, and reinsurance arrangement.

Development and Validation of a Marginality Index for Nursing Students

The purpose of this study was to develop a marginality tool that speaks specifically to the domain of nursing education. Minority nursing students in the United States have consistently reported feelings associated with the process of marginalization. Given the dearth of instruments that measure marginality directly, the concept has not been sufficiently investigated in nursing students METHOD: The Englund Marginality Index (EMI) was administered to 323 nursing students currently enrolled in a baccalaureate nursing program in Wisconsin. A psychometric evaluation of the index was performed. The EMI consists of 19 items and explained 70 percent of the variance. Cronbach's α coefficient for the instrument was .90. Test-retest correlation was strong at r = .92, a strong support for the temporal stability of the instrument. The findings from this study demonstrate that the EMI is a valid and reliable measure of marginality.

Evaluating the Impact of Music &amp; Memory’s Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study

BackgroundIndividuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident’s care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies.ObjectiveThe aim of this study was to assess the impact of Music & Memory’s personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs.MethodsThe data collected were on the utilization of iPods and iPads by the residents. Residents’ outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents’ QOL. A 1-way analysis of variance was utilized to examine changes in resident’s agitation and QOL based on the resident’s utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate.ResultsA total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents’ engagement. PMATE utilization was not associated with changes in the residents’ agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents’ QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of −5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers.ConclusionsThe study is one of the first to explore the impact of Music & Memory’s PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents’ QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings.

Innovation in Outcomes-Based Water Quality Policy: A Case Study from the Yahara Watershed, Wisconsin, USA

This case examines the risks and opportunities for stakeholders involved in an experimental water quality management program in Wisconsin, USA. This program pays for pounds of pollution reduced through soil conservation practices on farm fields and other high-runoff areas across the landscape—nonpoint sources of pollution—by redirecting funds from the sewerage plant and municipal point sources of pollution. Uncertain monitoring and modeling of pollution sources used for program payments and accountability create perceived and real risks to program participants and the environment, including the threat of regulatory enforcement, lost revenue, and failure to achieve environmental outcomes. On the other hand, in this case study, regulatory flexibility also opened a space for stakeholder dialog and programmatic cooperation that could lead to more adaptive and locally acceptable watershed pollution control in the future.

Reflections on Bipartisan Solutions to Addressing Poverty.

This reflection on the Medicalization of Poverty asks how healthcare itself plays a role in the development of poverty. Drawing on Governor Thompson's extensive work reforming the welfare system, the reflection first stresses the importance of involving the very people impacted by any reform - a conscious process Governor Thompson used when pioneering the W-2 program in Wisconsin and then extended to the overhaul of Medicare's prescription drug benefit. Second, it stresses the advantage of developing bipartisan solutions to solve hard problems such as how best to provide affordable healthcare and reduce poverty in the lives of Americans.

Uncertain monitoring and modeling in a watershed nonpoint pollution program

Performance-based programs governing land use rely on environmental measurement, prediction, and assessment. Yet complex, nonlinear social and environmental change can lead to uncertainties in quantification and forecasting and create challenges for operationalizing programs. This research examines the roles that environmental monitoring and modeling uncertainty play in experimental land and water governance through an analysis of a regulatory water quality program in Wisconsin, USA. The case demonstrates how uncertainties in measurement and prediction of pollution runoff shape program design and participant perceptions. We draw on interviews, a survey, participant observation, and policy document analysis to illustrate how regulators and participants (including municipalities, sewerage treatment plants, farmers and nonprofit organizations) perceive and react to uncertainty. Because current and future water quality data are based largely on model estimates, but regulatory compliance will likely be based on measured in-stream outcomes, participants must evaluate potential risks of involvement. Stakeholders have relied on partnership building and legal modifications such as extended compliance timelines to reduce the risks associated with uncertainty. Experimentation under uncertainty led to sustained stakeholder dialogue, and an iterative process of deciding how monitoring and modeling should be used to track and prove program progress.

Development and implementation of a pharmacist-run comprehensive medication review program in Wisconsin.

The development and implementation of a centralized, pharmacist-run population health program were pursued within a health system to increase patient exposure to comprehensive medication reviews (CMRs) and improve visit processes. Program implementation included choosing appropriate pilot pharmacy locations, developing a feasible staffing model, standardizing the workflow, and creating a patient referral process. The impact on patient exposure, specific interventions, and the sustainability of the program were evaluated over a seven-month period. A total of 96 CMRs were scheduled during the data collection period. Attendance at scheduled CMRs was 54% (52 visits); there were 25 cancellations (26%) and 19 no-shows (20%). Since program implementation, there has been more than a twofold increase (2.08) in the number of CMRs completed within the health system. On average, all aspects of each patient visit took 1.78 hours to complete. Pharmacists spent 28% of scheduled time on CMR tasks and 72% of time on telephone calls and technical tasks to maintain appointments. A pharmacist-run CMR program helped to elevate the role of the community pharmacist in a health system and to improve patient exposure to CMRs. Sustaining a centralized CMR program requires support from other members of the health-system team so that pharmacists can spend more time providing patient care and less time on the technical tasks involved.

Evaluating Performance-Based Contracting in Welfare-to-Work Programs: Selection and Earnings Gain Effects in Wisconsin Works

The Wisconsin Works (W-2) program, the TANF program in Wisconsin, has introduced performance contracting to align W-2 service providers??? objectives with the state???s goals by establishing financial and administrative incentives. Using individual-level administrative datasets from 1998 to 2005, this study examines whether the introduction and revision of the earnings gain rate standard improved the economic performance of W-2 participants. Results reveal that under exacerbating economic conditions and weakening financial incentives, the adoption of the earnings gain standard had a positive effect on maintaining the earing gain of W-2 participants. However, W-2 agencies responded to the changes in the earnings gain rate standard by controlling the movement of W-2 participants in and out of the program and selecting those who were more likely to be employed. This study discusses a better contract design to improve the effectiveness of the welfare service provision.

Integrated Control of Potato Pathogens Through Seed Potato Certification and Provision of Clean Seed Potatoes.

Long-term data sets are rare in agriculture, and the impact of plant diseases on food production is challenging to measure, which makes it difficult to assess the impact of policy changes or research-based disease control efforts. Despite this challenge, it is clear that one of the largest impacts of biological research on food security over the past century has been in production of vegetatively propagated fruit and vegetable crops such as potato. The yield and quality of these crops is higher in countries that have effective plant propagation and certification systems. Of these systems, seed potato production and certification is among the most developed. We analyzed a dataset from a century-old seed potato certification program in Wisconsin to assess the efficacy for potato disease control and the cost of this program compared to other disease control and potato production costs. We found that over the past century, certification has gradually reduced the incidence of mechanically transmitted vascular potato pathogens that lack insect vectors to undetectable levels, and much of this reduction occurred prior to the use of tissue culture and the development of immunoassays. Rejection of seed lots from certification is now rare, with Potato virus Y (PVY), a virus spread nonpersistently by numerous, noncolonizing aphid species, and farmer errors being the main causes of rejection. PVY level increases occurred in 2000, coincident with the first detection of a new invasive vector, soybean aphid, in the Midwest. The increased PVY incidence was more pronounced in varieties that exhibit mild foliar symptoms. Starting in 2004, a decrease in PVY incidence occurred following comprehensive science-based changes to early generation seed potato production. The cost of the certification program has not increased in two decades, and the fees charged are comparable to those in 1913. The cooperative nature of the seed potato certification program has contributed to its sustainability across generations. However, looming soilborne disease problems are not easily addressed by certification and will likely cause significant challenges in the future.

Research Mentor Training: Initiatives of the University of Wisconsin Institute for Clinical and Translational Research

The University of Wisconsin-Madison (UW) has served as a hub of multidisciplinary expertise in both research mentor and mentee training and evaluation, with long-standing, federally-funded efforts to support innovative practice, training interventions, and research to improve training programs for diverse scholars in science, technology, engineering, mathematics, and medicine (STEMM). Ten years ago, the Wisconsin Program for Scientific Teaching, co-directed by Drs. Pfund, Miller and Handelsman, led an effort to train future biology faculty to become more effective research mentors. Cohorts of biology graduate students, postdoctoral trainees, faculty, and staff met to discuss mentoring challenges and solutions, generating case studies and discussion questions along the way. Following evaluation and revision, these materials were published as Entering Mentoring,1 a manual to help others facilitate research mentor training seminars and workshops. Published evaluations of the Entering Mentoring seminars indicate that mentors who participate in training gain important skills.2 These trained mentors are more likely to consider issues of diversity, discuss expectations with their mentees, and to seek the advice of their peers. Entering Mentoring, since adapted to create nine different curricula that target specific STEM disciplines, has subsequently been used across the country to train hundreds of research mentors. All of these developed materials have been field-tested at UW in the Center for the Integration of Research, Teaching, and Learning (CIRTL, PI: Robert Mathieu) and are available at no charge on the project website (http://www.researchmentortraining.org). Entering Mentoring has served as a foundation and framework for the Clinical and Translational Science Award (CTSA)-funded initiatives of the UW Institute for Clinical and Translational Research (ICTR). In 2010, a multidisciplinary team from five CTSA-funded institutions, supported by a CTSA Administrative Supplement awarded UW, sought to adapt Entering Mentoring to make it applicable for the mentors of clinical and translational researchers. Over a 6-month period, the curriculum team outlined, reviewed, and adapted learning objectives and core training activities to address six research mentoring competencies: (1) maintaining effective communication; (2) aligning expectations; (3) assessing understanding; (4) addressing diversity; (5) fostering independence; and (6) promoting professional development.3 Further adaptations and beta-testing followed, with the final curriculum published as Mentor Training for Clinical and Translational Researchers.4 Using this curriculum, as designed, allows small groups of mentors to engage in a discussion of case studies and activities intended to help them meet specific learning objectives, set forth for each of the six competencies. The curriculum is typically implemented in four 2-hour sessions, led by two trained facilitators. The Mentor Training for Clinical and Translational Researchers4 curriculum was evaluated in a randomized controlled trial conducted at 16 U.S. institutions (15 CTSA sites), between January 2010 and July 2011. A total of 283 mentor-mentee pairs were recruited, with 98% retention of participants through the trial. Mentors were allocated to the 8-hour training group (n = 144) or to the control group (n = 139). We hypothesized that this systematic, formal mentor training strategy would improve mentoring skills across the six core curriculum competencies, and positively influence behaviors. Baseline and six month post randomization interviews were conducted using the validated Mentoring Competency Assessment (MCA) tool5, newly developed for this trial. Follow-up surveys of mentors, who received training, documented statistically significant self-reported skill gains and self-reported changes in mentoring behaviors.6 In addition, interviewed mentees corroborated these positive changes. With this documented success, the most recent research mentor training initiative at UW, funded by a CTSA supplement, has been creation of a web-based Legacy Resource for mentoring development, which has been established to serve national and international mentors and mentees by dissemination of resources, most notably research mentor training curricula (https://mentoringresources.ictr.wisc.edu/). This website provides information on best mentoring practices, as well as access to mentor training curricula, such as Mentor Training for Clinical and Translational Researchers4. The website also offers facilitator training materials, assessment instruments, and centralized data collection for the evaluation of mentoring relationships and mentor training efforts, thus creating a mechanism for ongoing evaluation. Development of the new website consisted of three phases: 1) assembling and testing three new specialized curricula; 2) developing the web- based resources, and 3) integrating the assessment mechanism into the website.

The Wisconsin Approach to Newborn Screening for Severe Combined Immunodeficiency

J Versky, M Thakar, J Routes. J Allergy Clin Immunol. 2012;129(3):622–627 Severe combined immunodeficiency (SCID) is a life-threatening disease of infants that is curable with hematopoietic cell transplantation if detected early, whereas the outcome is less favorable if treatment is delayed. The study evaluated outcomes of a screening program in Wisconsin. Newborns in Wisconsin over a 3-year period. Population-based screening for SCID by using the T-cell receptor excision circle (TREC) assay applied to samples obtained from routine newborn screening (Guthrie) cards has been underway in the state of Wisconsin since 2008. Five infants with SCID or other forms …

The University of Oklahoma: The First Independent Academic Anesthesia Department?

John Alfred Moffitt, M.D., was the Head of the Department of Anesthesiology at the Oklahoma Medical Center when it became the first ever academic independent Department of Anesthesia. Photograph courtesy of the University of Oklahoma Bird Library Medical History Archives at the OU Health Sciences Center by Mr. Jack Wagner. Introduction The true independence of a teaching department in an academic setting is based on its organizational separation from other departments with which it is affiliated. In academic anesthesia, such independence was unheard of for three quarters of century after the introduction of clinical anesthesia in 1846. The struggle for academic independence and authority for anesthesiology reached a high point in the second quarter of the 20 century when Dr. Ralph Waters established an academic anesthesia teaching center in Madison, Wisconsin in 1927. Yet, despite his vision and the sympathetic endorsement of his surgical colleagues, Dr. Waters’ division of anesthesia at the University of Wisconsin remained, not as an independent teaching program in the form of a department, but a section under the department of surgery. It took another quarter century for this beacon of anesthesia education to achieve full independent status in 1952. Organized medicine worldwide was slow to recognize the importance of anesthesia as a specialty. An inevitable question will be asked; if the Wisconsin program was not the beginning of true independent academic anesthesia teaching for medical students in 1927, when and where did such a program begin, and how? To date, all indications point to the University of Oklahoma, when a trained anesthesiologist from the Wisconsin program joined the faculty of the medical school in Oklahoma City as an instructor in anesthesia and assumed the leadership of the first truly independent Department of Anesthesia in 1930.

The Pain Management Resource Nurse Program at Baptist Health of Northeast Florida

A pain management resource nurse “Train the Trainer” program was attended by the chosen nurse organizer in a five-hospital system including a home health agency. A grant was applied for and awarded from an independent donor to initiate a Pain Management Resource Nurse program. Applications from nurses with an interest in pain management were accepted and each person interviewed by the organizer. After the selection process was completed, the University of Wisconsin program was administered to 15 registered nurses across the health system. An attitudes and practice survey as well as a pretest were administered at the beginning of instruction of the first class and repeated at the end of the final class. The four classes were administered once per month for 4 months. All information for the class was provided to each nurse via a flash drive along with the 6th edition of the American Pain Society's Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain for reference materials. Additionally, as a reward, each nurse was offered tuition for attendance to the 19th national conference of the American Society of Pain Management Nursing in Jacksonville, Florida. Each nurse also had the option of 1 year's membership in that professional organization. Clinical application in the form of individual patient consultations and other health care professionals' education occurred between the didactic portions and afterward. Test results revealed a positive average increase of 21%. The new knowledge of the nurses applied clinically has resulted in patient pain and comfort advocates throughout the health system. The Pain Management Resource Nurse program is effective in providing useful education for nurses.

63 NEW ACGME MANDATED MINUMUM SURGICAL NUMBERS: IMPACT ON RESIDENT OPERATIVE EXPERIENCE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes1 Apr 201163 NEW ACGME MANDATED MINUMUM SURGICAL NUMBERS: IMPACT ON RESIDENT OPERATIVE EXPERIENCE Peter Langenstroer, Margaret Mulligan, and R. Corey O'Connor Peter LangenstroerPeter Langenstroer Milwaukee, WI More articles by this author , Margaret MulliganMargaret Mulligan Milwaukee, WI More articles by this author , and R. Corey O'ConnorR. Corey O'Connor Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2665AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urology program's quality is in part measured by the graduating residents' operative experience and duty hours compliance. This emphasis creates conflict between attaining the maximum operative experiences while being duty hour complaint and providing appropriate operative, clinical, and didactic education. In July, 2009, the Residency Review Committee in Urology implemented a minimum standard for operative cases that acts as a metric of resident competence. We set out to evaluate how the prior operative percentiles and national averages compare to the new minimum case volume standards. METHODS An operative time study was developed using the Medical College of Wisconsin program figures and the ACGME 2008−09 Urology National Resident Report to calculate task time for registered surgical procedures. The urologic cases during a 6 month period (Jan. '08−June '08), were recorded to establish operative time logs. The operative times were used to calculate the total surgical times for the new minimum standards and the prior national averages. These results were then compared. RESULTS Analysis of surgical time demonstrated that based on the 2008−09 National Average data, the 10th, 30th and 50th percentiles resulted in time consumption of 4,181 hours, 4,991 hours, and 6,430 hours respectively. The surgical time consumed with the new minimum standards was 4,282 hours. Thus, the minimum standards fall between the 10th and 30th percentiles. CONCLUSIONS The new ACGME minimum standards reflect a reasonable baseline of operative experience. By not concentrating on attaining high volume case logs, an increase in available resident time may allow for diversification of other aspects resident education. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e28 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Langenstroer Milwaukee, WI More articles by this author Margaret Mulligan Milwaukee, WI More articles by this author R. Corey O'Connor Milwaukee, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...