For your consideration

In recent months, the Wisconsin Medical Journal’s mailbox has been stuffed, and our Editorial Board has been working overtime! We have been overwhelmed (and pleased) by the response we’ve had for our next two issues, which focus on maternal and child health and mental health, respectively. And because both issues promise to leave very little space for anything but manuscripts related to those topics, we have chosen this issue to publish some of the papers we’ve accepted, but that don’t fall under the umbrella of one of this year’s chosen themes. One such paper is the review of the effects of the current clean indoor air policies in Wisconsin workplaces by Ms Guse and her colleagues (p 27), which contains some surprises. Who would have thought that African-American and AsianAmerican indoor workers have a greater proportion of smoke-free policies than do white and Hispanic workers? Nevertheless, the authors point out that Wisconsin is falling behind the other states in implementing indoor smoke-free policies. From time to time the Journal is fortunate enough to receive a brief, but thoughtful and comprehensive review of an important topic. Such is the report on heroin dependence (p 20) by Dr Brown. While its major lasting contribution may be the extensive bibliography, the article provides reminders of long forgotten aspects of the drug (its original development as a cough suppressant) as well as a framework for thinking about the diagnosis and management of patients who are dependent (epidemiology, risk factors, and current management). Dr Bailey and his colleagues remind us that patent foramen ovale is not as rare as had been imagined (p 32) and that it can be a precursor to a cerebrovascular incident. Furthermore, since percutaneous closure of the patency is becoming a reasonable option, we should consider the diagnosis and possible remediation in patients who have a cryptogenic stroke. Drs Jensen and Suchman provide an interesting account of the Society’s first “Citizen Congress on Health Care,” (p 11) a unique event held last fall that brought together 25 citizens and 25 physicians to help reform health care in Wisconsin. Perhaps after reading about this event, you’ll be sufficiently interested to participate in the second Congress to be held this fall. This issue also features the abstracts from the fall meeting of the Wisconsin Chapter of the American College of Physicians (p 39). While there are many topics of sufficient interest to make one consider attending future meetings of the chapter, there are a few of the usual “hens teeth” that appeal to this reader. My favorite for this round is 80 year old with multiple AV malformations of the duodenum —but perhaps I was carried away by the capsule endoscopy finding the abnormality whereas other methods of detecting the cause of the GI bleed failed! The Brugada syndrome comes a close second. Finally, Dr Gold’s lucid discussion of the management of diabetic dyslipidemia (under Metastar Matters p 51) is a helpful reminder that regular lipid assessment is really worth the time and effort. On another note, in my editorial in the last issue of the Journal, I said how pleased I was that we had the privilege of publishing the Society’s “Guidelines for the Assessment and Management of Chronic Pain.” I noted that we believe the Guidelines are a substantial contribution toward the improvement of care of a significant number of patients. I’m delighted to report at this time that others seem to agree. As this issue of the Journal goes to press, Society staff have fielded dozens of phone calls from people across the country requesting copies of the Guidelines. We had hoped for such a response, but what we did not imagine is that in addition to those requests, the Guidelines have also been downloaded from the Society’s Web site more than 10,000 times! We commend the task force who so diligently worked on these Guidelines for a job well done.