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PubMed1991

Prolonged hypothermic cardiac storage with University of Wisconsin solution. An assessment with human cell cultures.

Hypothermic storage of cardiac allografts is routinely used for transplantation but is associated with an increased mortality when ischemic times are greater than 4 hours. The ideal storage conditions (solution and temperature) could extend the current limits of cold ischemia. Human endothelial cells and ventricular myocytes were studied to screen various solutions and temperatures for organ preservation. Four solutions (modified Euro-Collins, phosphate-buffered saline, Stanford cardioplegia, and University of Wisconsin) were evaluated. Endothelial cells were evaluated after prolonged hypothermic storage consisting of 0 degree, 4 degrees, and 8 degrees C for 36 hours, and ventricular myocytes were stored at 0 degree and 8 degrees C for 24 hours. Cell viability was determined by morphology (10 dishes per group), and trypan blue exclusion (5 dishes per group) in addition to a cell adhesion assay (endothelial cells 5 dishes per group) and adenine nucleotide analysis with high-performance liquid chromatography techniques (ventricular myocytes 5 dishes per group). Endothelial cell morphology was best preserved by University of Wisconsin solution (p less than 0.001, chi 2) and at 0 degree C (p less than 0.01, chi 2). Endothelial cells stored with University of Wisconsin solution excluded trypan blue better (1.0% +/- 0.5% cells stained, p less than 0.001. Analysis of variance [ANOVA]). Cell adhesion was poorly protected with Stanford cardioplegia (p less than 0.001, ANOVA). Myocyte morphology was preserved best with University of Wisconsin solution at 0 degree C (p less than 0.001, chi 2). According to trypan blue staining, Euro-Collins and University of Wisconsin solutions were superior to Stanford cardioplegia or phosphate-buffered solutions (p less than 0.001, ANOVA). Temperature did not influence the trypan blue results. Adenosine triphosphate was maintained best with University of Wisconsin solution at 0 degree C (p less than 0.01, ANOVA). Myocytes were more sensitive to the effects of prolonged storage compared with endothelial cells by morphologic criteria and trypan blue staining characteristics, irrespective of the shorter preservation times. University of Wisconsin solution was the most effective solution tested. Colder temperatures (0 degree to 4 degrees C) provided better protection than 8 degrees C. Myocytes were more sensitive to prolonged preservation than endothelial cells. Furthermore, the technique used appears helpful as a model of prolonged hypothermic storage and could be expanded to assess other interventions.

Adenosine Diphosphate↗
PubMed2006

University of Wisconsin versus histidine-tryptophan-ketoglutarate for tissue preservation in live-donor liver transplantation.

OBJECTIVES: University of Wisconsin solution has twice the cold hepatic preservation time as does Euro-Collins solution. Histidine-tryptophan-ketoglutarate has a lower potassium content than does University of Wisconsin solution and is used more frequently. To date, however, studies comparing University of Wisconsin and histidine-tryptophan-ketoglutarate in live-donor liver transplantation are lacking. We therefore sought to examine the hepatic function of live-donor liver transplantation allografts preserved in University of Wisconsin solution as compared with those preserved in histidine-tryptophan- ketoglutarate solution. MATERIALS AND METHODS: Between July 2003 and August 2004, 33 live-donor liver transplantations were performed at the University of Rochester Medical Center, Rochester, NY, USA. University of Wisconsin solution was used for the first 9 allografts, and histidine-tryptophan-ketoglutarate was used for the subsequent 24 allografts. Daily total bilirubin, aspartate amino transferase, amino alanine transferase, alkaline phosphatase, gamma glutamyl transpeptidase, and international normalized ratio levels were measured for the first 8 postoperative days. Peak values were compared between the groups. RESULTS: There was no primary graft nonfunction in either group. Two patients in the histidine-tryptophan- ketoglutarate group developed hepatic artery thromboses and underwent a retransplantation. Mean peak aspartate amino transferase and amino alanine transferase levels were higher in patients in the histidine-tryptophan-ketoglutarate group (aspartate amino transferase, 661+/-801 U/L; amino alanine transferase, 696+/-964 U/L) than they were in patients in the University of Wisconsin group (aspartate amino transferase, 439+/-415 U/L; amino alanine transferase, 464+/-376 U/L); however, this difference was not significant. Mean total bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase levels, and international normalized ratios were similar in both groups. CONCLUSIONS: University of Wisconsin and histidine-tryptophan- ketoglutarate solutions are both effective in preserving live-donor liver allografts. In the current study, patients in the histidine-tryptophan-ketoglutarate group had higher peak aspartate amino transferase and amino alanine transferase levels initially, but these became almost identical by postoperative day 8.

Adenosine↗
PubMed1994

The role of adenosine in extended myocardial preservation with the University of Wisconsin solution.

The purpose of this study was to determine the role that adenosine plays in enhanced myocardial preservation during cold storage with the University of Wisconsin solution. Hearts from adult rabbits were flushed with University of Wisconsin solution with or without adenosine and stored at 4 degrees C for 24 hours. Interstitial fluid purine levels during the period of cold storage were estimated with cardiac microdialysis probes. In a second series of experiments hearts were flushed with University of Wisconsin solution with or without adenosine or St. Thomas' Hospital cardioplegic solution and stored for 18 hours (4 degrees C). Functional recovery was assessed by reperfusing the hearts on a Langendorff apparatus (100 cm H2O) for 45 minutes with Krebs-Henseleit buffer. During cold storage dialysate adenosine concentrations in hearts flushed with University of Wisconsin solution were 20- to 40-fold greater than adenosine levels in hearts flushed without adenosine. After 45 minutes of reperfusion hearts preserved with University of Wisconsin solution exhibited a rate-pressure product of 11,098 +/- 576 mm Hg/min, significantly greater than that for hearts flushed with University of Wisconsin solution minus adenosine (8106 +/- 780 mm Hg/min) and St. Thomas' Hospital solution (7317 +/- 768 mm Hg/min). These results suggest that adenosine plays a major role in enhanced myocardial preservation with the University of Wisconsin solution, possibly by maintaining elevated interstitial fluid adenosine levels during the period of cold storage.

Adenosine↗
PubMed1993

Differential impact of Carolina rinse and University of Wisconsin solutions on microcirculation, leukocyte adhesion, Kupffer cell activity and biliary excretion after liver transplantation.

This quantitative in vivo fluorescence microscopy study investigated the relative impact of an optimized rinse solution (warm Carolina rinse) and that of an established storage solution (University of Wisconsin solution) on various pathomechanisms of hepatic reperfusion injury after cold storage. Syngeneic orthotopic, arterialized liver transplantation was performed in male Lewis rats after 24 hr of cold ischemia (n = 24). The four experimental groups differed according to the type of preservation/rinse solution used: University of Wisconsin solution/albumin rinse (group 1), autologous blood (just external cooling)/albumin rinse (group 2), blood/Carolina rinse (group 3) and University of Wisconsin solution/Carolina rinse (group 4). Hepatic microvascular perfusion, leukocyte accumulation and phagocytic activity of Kupffer cells were assessed by means of intravital fluorescence microscopy 30 to 90 min after reperfusion. Disturbances of microvascular perfusion were most pronounced in group 2, markedly reduced by University of Wisconsin solution (group 1) and Carolina rinse (group 3) and minimized by combined use of University of Wisconsin solution and Carolina rinse in group 4. Intrahepatic leukocyte-endothelium interaction in sinusoids and postsinusoidal venules was found to depend on the application of Carolina rinse before reperfusion rather than the use of University of Wisconsin solution during cold storage. Activation of phagocytosis by Kupffer cells was most pronounced in group 1, intermediate in groups 2 and 3 and not noticeable in group 4. Hepatocellular excretory function as assessed on the basis of total bile flow and excretion of bile acids during the first 90 min after reperfusion was found to be improved by application of Carolina rinse, both after storage in blood or in University of Wisconsin solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1993

A clinical trial of University of Wisconsin solution for pulmonary preservation.

Suboptimal pulmonary preservation with modified Euro-Collins solution (9/90 to 4/91) prompted us to change to University of Wisconsin solution (4/91 to 4/92). Between September 1990 and April 1992, 94 patients received 100 pulmonary allografts (13 heart-lungs, 45 double lungs, 42 single lungs) that were flushed and preserved with either Euro-Collins (n = 30) or University of Wisconsin (n = 70) solution. Selection of donors and procurement and storage of donor lungs were identical. Bilateral single lung transplantation was performed more often in the University of Wisconsin group and resulted in a significantly longer graft ischemic time (University of Wisconsin group; 303 +/- 62 minutes; Euro-Collins group; 260 +/- 62 minutes; p = 0.007, t test). The use of cardiopulmonary bypass was not statistically significantly different. Preservation injury identified by the radiograph on day 1 was more severe (p = 0.036; Mann-Whitney U test) in the Euro-Collins group than in the University of Wisconsin group. In double lung and heart-lung recipients gas exchange of the allografts was evaluated by the arterial/alveolar oxygen tension ratios at nine intervals during the first 72 hours. The mean arterial/alveolar oxygen tension ratio was 0.62 +/- 0.26 in the University of Wisconsin group and 0.46 +/- 0.23 in the Euro-Collins group, but this difference did not reach significance (p = 0.119, analysis of variance). Despite the longer ischemic time, pulmonary preservation achieved by University of Wisconsin solution appears to be comparable with that achieved by Euro-Collins solution.

Adenosine↗
PubMedDate not supplied

Cardiac storage with University of Wisconsin solution, calcium, and magnesium.

BACKGROUND: Previous investigations from this institution and others support the role of University of Wisconsin solution for prolonged hypothermic cardiac storage. Modification of the divalent cation concentrations has been beneficial for cardioplegic investigations and may enhance cardiac recovery after extended preservation. METHODS: To investigate this hypothesis, isolated rodent hearts were obtained from Sprague-Dawley rats and mounted on a Langendorff apparatus. Rat hearts were flushed (15 ml/kg) and stored (30 ml) for 8 hours at 0 degree C in unmodified University of Wisconsin solution (n = 16/group) or University of Wisconsin solution with calcium concentrations of 0.025 to 10 mmol/L or magnesium concentrations of 10 to 20 mmol/L (six to eight hearts/group). Finally, combinations of calcium and magnesium were examined. Rat hearts were studied before storage and after 45 minutes of reperfusion with an intraventricular balloon. RESULTS: Developed pressure (mean +/- standard deviation) was increased with calcium 0.1 mmol/L (University of Wisconsin solution: 69.2% +/- 7.0%; Ca++ 0.1 mmol/L: 78.9% +/- 6.1%, p < 0.05), whereas only the addition of the highest calcium concentration (10 mmol/L) was significantly harmful (developed pressure: 58.3% +/- 8.4%, p < 0.05; creatine kinase release: 408 +/- 200 versus 170 +/- 104 IU/gm, p < 0.05; lactate dehydrogenase release: 103 +/- 43 versus 37 +/- 26 IU/gm, p < 0.05). Coronary flow recovered to control values with magnesium 15 mmol/L, which was significantly greater than that achieved with unmodified University of Wisconsin solution (97.1% +/- 14.6% versus 72.1% +/- 8.4%, p < 0.05). Of the calcium-magnesium combinations tested, developed pressure was increased compared with unmodified University of Wisconsin solution with calcium 0.1 and magnesium 20 mmol/L (76.8% +/- 6.4%, p < 0.05). Diastolic function was reduced in all groups (p < 0.0001) and not significantly different between groups. CONCLUSIONS: The experiments indicated that recovery after storage with University of Wisconsin solution is enhanced with the addition of calcium and magnesium. The addition of high concentrations of calcium (> or = 2.5 mmol/L) appears harmful.

Adenosine↗
PubMedDate not supplied

Nursing drives interdisciplinary health care workforce planning in Wisconsin: one state's experience.

The Consortium for Primary Care in Wisconsin convened a forum to develop an interdisciplinary primary care workforce plan to address issues related to the supply of and demand for primary health care providers in Wisconsin. Nursing leaders played a pivotal role in making this effort successful and in ensuring that the focus would be on all primary health care professionals, not just physicians. This process used a primary care workforce planning tool (IRM) developed by the Bureau of Health Professions, U.S. Public Health Service which allowed Wisconsin to (1) examine its own workforce needs with data produced in Wisconsin, (2) compare the state's situation with national trends, and (3) include these data and projections in a cooperative process for state-level planning for interdisciplinary workforce development. The Bureau has encouraged other states and organizations to adopt a similar strategy through a series of IRM workshops in which the Wisconsin process serves as a model for training materials developed for these workshops. The Wisconsin planning process is an innovative model for other states to follow in facilitating workforce development and serves to encourage other states to share their experiences in the academic literature.

Health Planning↗
PubMed1998

Serologic evidence of a natural infection of white-tailed deer with the agent of human granulocytic ehrlichiosis in Wisconsin and Maryland.

White-tailed deer participate in the maintenance of the Ixodes tick life cycle and are reservoirs for some tick-borne infectious agents. Deer may be useful sentinels for tick-transmitted agents, such as ehrlichiae. In order to determine whether white-tailed deer are markers of natural transmission or are reservoirs for the human granulocytic ehrlichiosis (HGE) agent, we performed indirect immunofluorescent-antibody (IFA) tests and immunoblotting with the HGE agent and Ehrlichia chaffeensis on sera from 43 and 294 deer captured in northwest Wisconsin during 1994 and 1995, respectively, and 12 deer from southern Maryland. According to IFA testing, 47% of 1994 Wisconsin sera, 60% of 1995 Wisconsin sera, and 25% of Maryland sera contained HGE agent antibodies. All IFA-positive deer sera tested reacted with the 44-kDa band which is unique to the Ehrlichia phagocytophila group. Serologic reactions to E. chaffeensis were detected by IFA testing in 15 of 337 (4%) Wisconsin deer and in 10 of 12 (83%) Maryland deer, while 60 and 80% of E. chaffeensis IFA-positive Wisconsin and Maryland deer sera, respectively, reacted with the E. chaffeensis 28- to 29-kDa antigens by immunoblotting. A total of 4% of deer from Wisconsin and 25% of deer from Maryland were found by IFA testing to have antibodies to both the HGE agent and E. chaffeensis; 75% of these were confirmed to contain E. chaffeensis antibodies by immunoblotting. These results suggest that white-tailed deer in diverse geographical regions of the United States are naturally infected with the HGE agent, E. chaffeensis, or both and that these animals, and potentially humans, are exposed to infected ticks at a high frequency in nature.

Animals↗
PubMedDate not supplied

Cancer trends in Wisconsin: 1988 to 1996.

Cancer represents a major health issue in the United States, accounting for 1.2 million newly diagnosed cases each year. In Wisconsin, an estimated 25,000 residents will be diagnosed with cancer each year and over 10,000 will die from their disease, representing nearly one-fourth of all Wisconsin deaths. Lung cancer has been Wisconsin's most lethal cancer, accounting for 28% of male and 21% of female cancer mortality in 1996. Between 1988 and 1996, age-adjusted cancer incidence in Wisconsin rose 20%--to 405 cases per 100,000 population. Fortunately, in the same period, age-adjusted mortality dropped 8% to 159 cases per 100,000 population. Males have higher cancer incidence and mortality rates than females. The most frequent cancer diagnoses in males were of prostatic (29%), lung (15%) and colonic (9%) origin; among females, breast (31%), lung (11%), and colon (10%) cancers were most often diagnosed. Wisconsin cancer rates are likely to increase as Wisconsin's population ages, highlighting the need for greater cancer awareness and improved prevention, screening and cancer treatment.

Breast Neoplasms↗
PubMed2000

Increasing prevalence of overweight among Wisconsin adults, 1989-1998.

OBJECTIVES: Overweight is an important condition that increases the risk of chronic diseases such as diabetes, heart disease, and cancer. We examined trends in overweight prevalence among Wisconsin adults from 1989 to 1998 and assessed progress in reaching the overweight 2000 goal for Wisconsin. METHODS: We used data on the self-reported height, weight, and calculated body mass index from the Wisconsin Behavioral Risk Factor Survey to examine overweight prevalence trends among Wisconsin adults. RESULTS: The prevalence of overweight has increased over 40% during the past decade from 23% of adults in 1989, to 34% of adults in 1998. The increase occurred in men and women, blacks and whites, and all age groups. In 1998, 330,000 more adults were overweight in Wisconsin, compared to 1989. CONCLUSION: As rates of overweight continue to increase, the incidence and prevalence of many chronic diseases will also increase. Effective population-based efforts are required to reduce caloric intake and increase physical activity among Wisconsin adults.

Adult↗
PubMed2000

Antibiotic susceptibility of invasive Streptococcus pneumoniae in Wisconsin, 1999.

BACKGROUND: Streptococcus pneumoniae is a major cause of community acquired infections in the United States, and rates of antibiotic resistance have increased dramatically in the past decade. Statewide rates of pneumococcal resistance to penicillin and other antibiotics have not been previously reported in Wisconsin. To determine these rates, we assessed invasive pneumococcal isolates for reduced susceptibility to nine different antibiotics. METHODS: Pneumococcal isolates from blood, cerebrospinal fluid or other normally sterile body sites were submitted by 91% of laboratories that perform invasive bacterial cultures. Isolates were tested for susceptibility to penicillin, cefotaxime, ceftriaxone, levofloxacin, meropenem, erythromycin, vancomycin, sulfamethoxazole-trimethoprim and chloramphenicol. RESULTS: There were 409 invasive pneumococcal isolates identified in 1999 among Wisconsin residents, including 385 (94%) isolates from blood. The mean patient age was 42.5 years (range, < 1 year to 96 years), and 213 (52%) were male. Of the pneumococcal isolates, 24% were not susceptible to penicillin, including 10% with high level resistance. Isolates with reduced penicillin susceptibility were also likely to have reduced susceptibility to other antibiotics. Patients with penicillin nonsusceptible (intermediate and fully resistant) pneumococcal isolates were significantly younger (mean, 37.0 years) than those with susceptible isolates (mean, 44.3 years) (p = .04). The proportion of patients with a penicillin nonsusceptible isolate varied by region, ranging from 12.8% in northeastern Wisconsin to 35.5% in northern Wisconsin. CONCLUSIONS: The proportion of invasive pneumococcal isolates with penicillin resistance in Wisconsin is similar to other regions of the United States. Inappropriate antibiotic use contributes to the emergence of resistant pneumococcal infections, and educational efforts are underway to promote judicious antibiotic use in Wisconsin.

Adolescent↗
PubMed2003

Racial disparities in cancer incidence and mortality: Wisconsin and United States, 1996-2000.

These findings focus on African American-white disparities in cancer incidence and mortality between 1996 and 2000 in Wisconsin and the United States. Cancer incidence data were obtained from the Wisconsin Cancer Reporting System (WCRS), the National Cancer Institute's (NCI) Surveillance, Epidemiology and End Results (SEER) Program, and mortality data from the National Center for Health Statistics. Results of this study highlight site-specific differences in cancer incidence and mortality rates age adjusted to the 2000 US standard population. Incidence and mortality rate ratios (RR) were calculated comparing African American and white populations. Supplemental variables of cancer-related risk behaviors from the Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) and stage of disease at diagnosis information from WCRS were also examined for differences between African American and white populations. Results showed Wisconsin had an overall greater disparity than the United States for all cancers combined and for cancers of the lung, cervix, and gastrointestinal sites. During the 5-year period, Wisconsin's overall cancer mortality rate was 196 per 100,000, but among African Americans in Wisconsin, the overall mortality rate was 272 per 100,000.

Black People↗
PubMed2004

National survey of children with special health care needs: Wisconsin-specific data.

BACKGROUND: The National Center for Health Statistics developed and conducted (2000-2002) the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey (SLAITS). OBJECTIVE: The purpose of this paper is to present the Wisconsin-specific data derived from analysis of the national survey and to make a comparison with the United States as a whole. RESULTS: In Wisconsin, approximately one fifth (21%) of households have CSHCN, and 13.4% of children have a special health care need; US comparison data are 20% and 12.8%, respectively. When examined by type of special need, Wisconsin shows slightly higher proportions of CSHCN in all categories, when compared with U.S. data, with the exception of limitation in activity. Families in Wisconsin with CSHCN are more likely to report being involved with medical decision making and satisfied with services they receive (67%); having a medical home (57%); having adequate insurance; easy use of community-based service systems (81%); and receiving services to make transition to adult life (7.5%). CONCLUSION: Though Wisconsin has a slightly higher proportion of CSHCN than the United States as a whole, a greater proportion of Wisconsin families receive important services. These measurements allow us to strive for further improvement through coordination of services in the private health care delivery sector with public health programs.

Adolescent↗
PubMed2005

The epidemiology of traumatic brain injury in Wisconsin, 2001.

PROBLEM: Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. To implement more effective injury prevention and treatment programs, it is important to identify the regional impact, causes, risk factors, and trends of TBI. This report summarizes the public health impact of TBI in Wisconsin. METHODS: Data on fatal and non-fatal TBI injuries in Wisconsin in 2001 were obtained from 2 separate data sources: National Center for Vital Statistics and the Wisconsin Bureau for Health Information. Rates of fatal and nonfatal TBI were calculated using 2000 population estimates as denominators. RESULTS: There were 1059 TBI fatalities and 4006 living TBI-related hospital discharges in Wisconsin in 2001. The overall rate of TBI in Wisconsin for 2001 was 94.4 per 100,000 people. The number of fatal and nonfatal TBI related injuries was higher for males than females, at all ages, except nonfatal injuries in persons older than 65 years. Fatalities from TBI were highest in young adults and the elderly. CONCLUSIONS: TBI is a major cause of death and hospitalizations in Wisconsin. Male teens and young adults, and the elderly are high-risk groups for TBI. Preventive measures should be aimed at these high-risk groups.

Adolescent↗
PubMed2005

The silent epidemic among Wisconsin women: chronic obstructive pulmonary disease trends, 1980-2000.

PURPOSE: To investigate trends in mortality from chronic obstructive pulmonary disease (COPD) in Wisconsin. METHODS: COPD mortality data for those 45 years of age and older were extracted from the Centers for Disease Control and Prevention WONDER database and analyzed. Rates were adjusted to the 2000 US Census. RESULTS: In Wisconsin, the mortality rate from COPD increased by 88% between 1980 and 2000. A similar increase in COPD mortality occurred in the United States during this same period. Among Wisconsin males, the 33% increase from 1980-2000 was higher than the increase for US males. Likewise, the rate among Wisconsin females increased 3.9 times compared to an increase of 2.8 among US females. Unlike men, mortality increased in all age groups of women from 1980 to 2000. CONCLUSIONS: COPD mortality rates are increasing dramatically in Wisconsin, especially among women. Long-term trends in smoking do not explain the increases in COPD death rates among women. Other possible reasons include changes in the pattern of smoking or in the type of cigarette smoked, or women may be more susceptible to lung disease. Wisconsin physicians should target women for diagnosis and treatment of COPD and for smoking cessation and prevention.

Aged↗
PubMed2005

Using local data to monitor obesity rates in Wisconsin counties, 1994-2003.

INTRODUCTION: Although county-level obesity estimates are necessary for planning and evaluating community-based interventions, the quality of these data has never been examined. OBJECTIVES: To evaluate the reliability of the county-level obesity prevalence estimates from Wisconsin's 72 counties and to highlight the variation of obesity among Wisconsin counties. METHODS: Obesity prevalence data for each county in Wisconsin were obtained from the Wisconsin Behavioral Risk Factor Surveys (BRFS) from 1994 to 2003. During this 10-year period, 26,635 residents were interviewed by telephone, with sample sizes ranging from 6586 in Milwaukee County to 15 in Menominee County. The number of counties with reportable and reliable estimates, using criteria of sample sizes > or = 50 and > or = 300, respectively, was determined. RESULTS: The 10-year obesity prevalence was reportable for 68 of Wisconsin's 72 counties, ranging from 9.7% in Bayfield County to 29% in Langlade County. By pooling data from the BRFS for 5-, 3-, and 1-year periods, estimates are reportable for 43, 24, and 4 counties, respectively. A sample size of at least 300 provides a more reliable estimate, but is available for only 5 counties for a 5-year period. CONCLUSIONS: By pooling 10 years of survey data, obesity rates can be estimated for most of Wisconsin's 72 counties, demonstrating marked variation in rates across the state. This surveillance system provides valuable data for larger counties for planning and program evaluation. Supplemental surveys can be conducted to provide more reliable and timely estimates.

Humans↗
PubMed2005

Genetic services plan for Wisconsin.

During 1999-2001, a multidisciplinary group met to develop a plan for the future of genetic services in Wisconsin. The result was The Genetic Services Plan for Wisconsin (available at www.slh.wisc.edu/genetics/stateplan_toc.html), a problem-oriented needs-identification guide to address current and future challenges likely to affect the provision of genetic services in Wisconsin. The Plan is directed to all individuals who have a stake in the future of medical genetic services in Wisconsin. These include, but are not limited to, primary and other health care professionals, genetics professionals, governmental representatives, policy makers, legislators, educators, third-party payers, and current and potential consumers. This article provides an overview of The Genetic Services Plan for Wisconsin (Plan) and highlights the recommendations made for the continuing integration of new genetic knowledge across the continuum of medical care delivery in Wisconsin.

Genetic Services↗
PubMed2006

Partnering with citizens to reform Wisconsin health care: a report of Citizen Congress II.

INTRODUCTION: Commissioned by the Wisconsin Medical Society in 2003, the Wisconsin Citizen Congress project aims to get at least 5000 physicians and 100,000 citizens in a partnership for health and health care improvement in Wisconsin. The power of activated citizens and a citizen-physician partnership is one of few hopeful answers to current policy failures in health care. Citizen Congress II aimed to validate and extend the results of Citizen Congress I. METHODS: Citizens and physicians were recruited locally, aiming for an optimally-sized group that reasonably represented the diverse people and regions of Wisconsin. A weekend of dialogue with expert facilitators used state-of-the-art methods and sought common goals and a plan of action for health care policy improvement in Wisconsin. RESULTS: Fifteen hours of dialogue validated the results of Citizen Congress I by producing trusting and high-energy dialogue and very similar characteristics of ideal health and health care. As progress from Congress I, advocacy opportunities for local and state health policy improvement were explored and written plans produced. There was strong support for continuing Congress work, aiming toward a strong and focused advocacy group. CONCLUSION: Citizen-physician dialogue and partnership is a hopeful innovation in the area of health policy and community health improvement. Its power comes from a partnership of organized voters and organized medicine. It has the potential to promote change longed for by many. It is strongly consistent with the quality and access initiatives of the new Wisconsin Medical Society strategic plan.

Community Participation↗