RESidENcy PROGRAM Scholarly and Community Medicine Projects

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Daniel Sutton, MD PROJECTS COMPLETED DURING RESIDENCY: Scholarly Project: Literature review and update -- Neonatal Hyperbilirubinemia Screening, Diagnosis, and Management Quality Improvement Project: Quality Improvement Project: Cardiac Risk Assessment by Primary Care Providers (with Dan Sutton) -- The goal of the quality improvement project was to inform PCPs and their patients as to an individual patient’s hard cardiac risk. We calculated this risk score for patients prior to upcoming appointments with PCPs. This information was presented to the patients during their visit with PCP. Post-interview phone questionnaires revealed that patients were slightly more likely to make lifestyle changes than to change medication adherence following this intervention. Most patients thought the intervention was helpful. Pre- and post-intervention surveys of PCPs revealed that there was an increase in the number of physicians who reported using cardiac risk assessment tools, the number who relayed this information to patients, and in the number of providers who thought that this improved patient care. I really want all of the physicians in Baraboo (FPs, general surgeons, Kansas Dubray, Joe Fok) to know how much I appreciate your contribution to my education. While I know that you are not looking for recognition, it is important to me that you know what a powerful infl uence you have had on my development as a doctor. If I had to do residency all over, I would choose Baraboo again in a heartbeat! Tina - Thanks for supporting me through all the call nights, OB nights, etc during my intern year and the pages at home during my 2nd and 3rd years. Thanks for putting up with my getting called into the hospital interrupting dinners, hikes, movies, visit with friends, and so on. – Dan Dan Sutton hails from the small town of Barton, WI. He earned a B.S. in Physics from the University of Wisconsin – LaCrosse and then went on to medical school at UW Madison. His love of smalltown life, as well as his interest in preventative medicine, led him to family medicine, and he joins the residency as part of the Baraboo Rural Training Track. During medical school, he volunteered with Fit Kids Challenge and Doctors Ought to Care, two organizations that encourage children to lead healthier, more active lives. In addition, he completed a summer externship with a family medicine doctor in West Bend, WI, and he volunteered with the Madison MEDIC clinics, which provide free medical care to underserved members of the community. Dan is also an elite runner. He qualifi ed for the U.S. Olympic Trials for the marathon and was featured in the November 2007 issue of Runners World. He describes himself as a running addict and typically runs 95-100 miles each week. He also loves hiking, camping, fi shing, cooking, and spending time with friends and family. Dan is engaged to be married this summer to Tina Pike. After residency, he will be joining a practice in Waupaca, WI with ThedaCare providing fullspectrum family medicine. CONTACT INFORMATION: 202 E. Lake St Waupaca, WI 54981
Newborn Bilirubin Screening Daniel Sutton, MD PGY-3 Causes of elevated bilirubin in newborns: ● ↑ RBC destruction (↓ life span, ↑ Hct), ↓ albumin, low UGT activity (~1% of adult level; not to adult levels until 14 weeks), ↓ hepatic blood flow, increased enterohepatic uptake (undeveloped GI flora, slow colonic transport, bilirubin unconjugation) Jaundice ● Common – 60% of term and 80% of preterm in 1 st week of life 1 ● Mean peak TB occurs 48-96 hours of age and is 7 to 9 mg/dL ● Primary neonatal jaundice resolves w/in 1 st 1-2 weeks ● Significance correlates to timing ● Jaundice usually spreads caudally The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Bilirubin pathophysiology ● Formed from breakdown of RBCs (90%) and other heme containing compounds (10%) ● 2 types of bilirubin: ● Unconjugated (indirect) – unmetabolized by liver, fat soluble, poorly excreted, primary form seen in neonatal jaundice ● Conjugated (direct) – metabolized, water soluble, excreted in stool and urine Timing of jaundice ● Early onset (day 1-2) - uncommon ● Usually hemolytic (Rh, ABO, hereditary spherocytosis, G6PD deficiency) ● Normal onset (days 3-10) – Very common ● Breast feeding jaundice ● Galactosemia ● Sepsis ● Late Onset (>14 days) – Common ● Breast milk jaundice - common ● Conjugated hyperbilirubinemia – uncommon ● Inherited deficiency of UGT – very rare 1
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RESidENcy PROGRAM Scholarly and Community Medicine Projects

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