600 Highland Ave
Madison WI 53792
Medical School: Other - 1999
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: Yes
Participates In EHR: No
License #: 42477
Taxonomy Codes:207T00000X 2084N0400X
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Awards & Recognitions
Dr. Joshua Medow is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99291||Description:Critical care first hour||Average Price:$850.00||Average Price Allowed
|HCPCS Code:99292||Description:Critical care addl 30 min||Average Price:$425.00||Average Price Allowed
|HCPCS Code:99232||Description:Subsequent hospital care||Average Price:$202.00||Average Price Allowed
HCPCS Code Definitions
- Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Medow has made to other doctors
Use of High-Flow Continuous Renal Replacement Therapy with Citrate Anticoagulation to Control ICP by Maintaining Hypernatremia in a Patient with Acute Brain Injury and Renal Failure. - Clinical medicine & research
Traumatic brain injury and intracranial hypertension often require treatment to optimize patient outcome. There are a variety of complex medical conditions that can preclude standard approaches to the treatment of intracranial hypertension. We describe a case where a novel approach using continuous dialysis with trisodium citrate was used to optimize the outcome of a young male with acute renal failure and ARDS in the setting of acute traumatic brain injury.Â© 2014 Marshfield Clinic.
The Emergent Reversal of Coagulopathies Encountered in Neurosurgery and Neurology: A technical note. - Clinical medicine & research
It is imperative for neurologists, neurosurgeons, and neurointensivists to know how to stop life-threatening hemorrhage in both surgical and non-surgical patients. However, knowing how to medically correct a coagulopathy has become increasingly challenging as more contemporary and sophisticated anticoagulation agents are developed and prescribed. In a time sensitive and life-threatening situation, where there is little margin for error, the neurosurgeon may not have ready access to information about the drug or condition that caused the coagulopathy nor the information on how to treat it. This thorough review of the literature provides a comprehensive overview of the medications and conditions that can lead to persistent and/or life-threatening intracranial hemorrhage.Â© 2014 Marshfield Clinic.
Safety of a DVT chemoprophylaxis protocol following traumatic brain injury: a single center quality improvement initiative. - Neurocritical care
Venous thromboembolism (VTE) is a complication that affects approximately 30 % of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU).Between January 1st and December 31st, 2009, consecutive patients discharged from the University of Wisconsin NSICU after >a 48 h minimum stay were evaluated as part of a QI project. A protocol for the initiation of PTP was designed and implemented for NSICU patients. The protocol did not vary based on type of intracranial injury. The rate of VTE was reported as was heparin-induced thrombocytopenia and PTP-related expansion of intracranial hemorrhage (IH) requiring reoperation. The number of patients receiving PTP and the timing of therapy were tracked. Patients were excluded for persistent coagulopathy, other organ system bleeding (such as the gastrointestinal tract), or pregnancy. Faculty could opt out of the protocol without reason. Using the same criteria, patients discharged during the preceding 6 months, from July 1st to December 31st, 2008, were evaluated as controls as the PTP protocol was not in effect during this time.During the control period, there were 48 head trauma admissions who met the inclusion criteria. In 22 patients (45.8 %), PTP was initiated at an average of 4.9 Â± 5.4 days after admission. During the protocol period, there were 87 head trauma admissions taken from 1,143 total NSICU stays who met criteria. In 63 patients (72.4 %), the care team in the NSICU successfully initiated PTP, at an average of 3.4 Â± 2.8 days after admission. All 87 trauma patients were analyzed, and the rate of clinically significant deep venous thrombosis (DVT) was 6.9 % (6 of 87). Three protocol patients (3.45 %) went to the operating room for surgery after the initiation of PTP; none of these patients had a measurable change in hemorrhage size on head CT. The change in percentage of patients receiving PTP was significantly increased by the protocol (p < 0.0001); while the average days to first PTP dose trended down with institution of the protocol, this change was not statistically significant.A PTP protocol in the NSICU is useful in controlling the number of complications from DVT and pulmonary embolism while avoiding additional IH. This protocol, based on a published body of literature, allowed for VTE rates similar to published rates, while having no PTP-related hemorrhage expansion. The protocol significantly changed physician behavior, increasing the percentage of patients receiving PTP during their hospitalization; whether long-term patient outcomes are affected is a potential goal for future study.
Posture-independent piston valve: a novel valve mechanism that actuates based on intracranial pressure alone. - Journal of neurosurgery. Pediatrics
Shunt valves are intended to maintain physiological intracranial pressure (ICP). A variety of mechanisms have been designed to accomplish this goal but have had limited success. Siphoning, in particular, has been a problem not effectively solved by proposed or manufactured valves. Poor control of ICP results in headache, neurological disturbances, decreased cognition, shunt malfunction, slit ventricles, subdural hematomas, decreased cranial volume, and maldevelopment. The authors of this study describe a prototype valve that was machined and tested ex vivo and that actuates based on ICP alone regardless of the presence of a siphon. Their object was to determine if a novel shunt mechanism that actuates perpendicular to the flow of fluid would eliminate the effect of siphoning in a valve for the treatment of hydrocephalus.A posture-independent piston valve (PIPV) was anchored to a graduated reservoir. Opening pressure was measured by noting the fluid level in the reservoir when the piston moved. Measurements were made using a 90-cm and a 120-cm water-filled siphon tube (1.3-mm standard distal catheter) to simulate an upright posture. A recumbent posture was simulated by the absence of a siphon.Opening pressure of the valve did not change regardless of the presence or absence of a water-filled siphon.The PIPV was triggered only by the pressure head at the inlet and did not actuate in the presence of a siphon, demonstrating proof of principle of the perpendicular actuating mechanism. The PIPV is a purely mechanical device that has practical application in the treatment of hydrocephalus.
Cerebellar hemorrhage as a first presentation of acquired Hemophilia A. - Neurocritical care
Acquired hemophilia A (AHA) is an uncommon coagulation disorder caused by the development of autoantibodies against coagulation factor VIII (FVIII). While intracranial hemorrhage is a known complication of AHA, intracranial hemorrhage as the presenting manifestation of AHA has only been described in three previous case reports.We report a case of an 86-year-old woman with no previously reported history of coagulopathy presenting with an acute intraparenchymal cerebellar hemorrhage and laboratory studies demonstrating an isolated prolonged activated partial thromboplastin time (aPTT). We discuss an approach to the prolonged aPTT, and review the literature concerning the diagnosis and treatment of AHA.Occipital decompressive craniectomy with evacuation of the hemorrhage was performed. Eight hours following the procedure, the patient's status acutely declined with demonstration of a reoccurrence of the cerebellar hemorrhage and new right frontal lobe hemorrhage. After discussion with the patient's family, life-sustaining support measures were withdrawn. Postmortem analysis revealed a low FVIII activity level and the presence of FVIII inhibitor.The presentation of intracranial hemorrhage with an isolated prolonged aPTT is concerning for an acquired hemophilia with FVIII deficiency. Other causes of isolated prolonged aPTT such as a lupus anticoagulant must also be considered. Preoperative identification and work-up of the coagulation abnormality is essential to guide initial treatment.
Stability of Sodium Nitroprusside and Sodium Thiosulfate 1:10 Intravenous Admixture. - Hospital pharmacy
PURPOSE: Thiosulfate has been shown to reduce the risk of cyanide toxicity during nitroprusside administration. Admixtures containing both agents may provide a safe and effective alternative to more expensive agents used to reduce blood pressure in the critically ill patient. This study determined the physical and chemical stability of a 1:10 nitroprusside:thiosulfate admixture, stored up to 48 hours. The economic consequences of a shift toward using thiosulfate and nitroprusside, and away from higher cost alternatives, are considered. METHODS: Seven samples of 50 mg nitroprusside and 500 mg thiosulfate were prepared and stored away from light, at room temperature, and in a refrigerator prepared in D5W and NS. Each sample was analyzed via a novel high-performance liquid chromatographic (HPLC) method at time 0, 8, 24, and 48 hours. The method was tested and passed specifications for linearity, reproducibility, and accuracy. A visual inspection by 9 licensed pharmacists was used to demonstrate physical stability. A cost evaluation comparing nitroprusside and thiosulfate to alternative agents was completed. RESULTS: The concentration of both nitroprusside and thiosulfate remain greater than 95% of the initial concentration through 48 hours. Physical compatibility was confirmed in all samples tested through 72 hours. CONCLUSION: The combination of nitroprusside and thiosulfate is chemically and physically stable as a single compounded dose for up to 48 hours when stored at room temperature and protected from light. The admixture represents an inexpensive option to other higher cost alternatives such as nicardipine or clevidipine.
Microwave beamforming for non-invasive patient-specific hyperthermia treatment of pediatric brain cancer. - Physics in medicine and biology
We present a numerical study of an array-based microwave beamforming approach for non-invasive hyperthermia treatment of pediatric brain tumors. The transmit beamformer is designed to achieve localized heating-that is, to achieve constructive interference and selective absorption of the transmitted electromagnetic waves at the desired focus location in the brain while achieving destructive interference elsewhere. The design process takes into account patient-specific and target-specific propagation characteristics at 1 GHz. We evaluate the effectiveness of the beamforming approach using finite-difference time-domain simulations of two MRI-derived child head models from the Virtual Family (IT'IS Foundation). Microwave power deposition and the resulting steady-state thermal distribution are calculated for each of several randomly chosen focus locations. We also explore the robustness of the design to mismatch between the assumed and actual dielectric properties of the patient. Lastly, we demonstrate the ability of the beamformer to suppress hot spots caused by pockets of cerebrospinal fluid (CSF) in the brain. Our results show that microwave beamforming has the potential to create localized heating zones in the head models for focus locations that are not surrounded by large amounts of CSF. These promising results suggest that the technique warrants further investigation and development.
Time-multiplexed beamforming for noninvasive microwave hyperthermia treatment. - IEEE transactions on bio-medical engineering
A noninvasive microwave beamforming strategy is proposed for selective localized heating of biological tissue. The proposed technique is based on time multiplexing of multiple beamformers. We investigate the effectiveness of the time-multiplexed beamforming in the context of brain hyperthermia treatment by using a high-fidelity numerical head phantom of an adult female from the Virtual Family (IT'IS Foundation) as our testbed. An operating frequency of 1 GHz is considered to balance the improved treatment resolution afforded by higher frequencies against the increased penetration through the brain afforded by lower frequencies. The exact head geometry and dielectric properties of biological tissues in the head are assumed to be available for the creation of patient-specific propagation models used in beamformer design. Electromagnetic and thermal simulations based on the finite-difference time-domain method are used to evaluate the hyperthermia performance of time-multiplexed beamforming and conventional beamforming strategies. The proposed time-multiplexing technique is shown to reduce the unintended heating of healthy tissue without affecting the treatment temperature or volume. The efficacy of the method is demonstrated for target locations in three different regions of the brain. This approach has the potential to improve microwave-induced localized heating for cancer treatment via hyperthermia or heat-activated chemotherapeutic drug release.
Sulcal and gyral anatomy of the orbitofrontal cortex in relation to the recurrent artery of Heubner: an anatomical study. - Surgical and radiologic anatomy : SRA
The aim of this study is to investigate the sulcal and the gyral anatomy of the orbitofrontal cortex with its arterial supply. Ten gross formaline fixed adult brains (20 hemispheres) were used to show the gyral and sulcal anatomy of the inferior frontal lobe, and its arterial supply. The arteries were investigated with special attention to the relationship between the recurrent artery of Heubner (RAH) and the gyrus rectus (GR). Medial and lateral orbital sulci were connected in 4 right hemispheres, and in 7 of the left. The orbital sulci were connected with olfactory sulcus in one right hemispheres, but not in the left. In the right hemispheres, the RAH traveled across the GR in 7 hemispheres and looped over the posterior aspect of the GR in 3 hemispheres. In the left hemispheres, RAH crossed the GR in 8 and looped over the posterior aspect of the GR before entering the anterior perforating substance in 2 hemispheres. There are considerable variations among the gyri and sulci of the orbitofrontal cortex and it is difficult to describe a precise architectural pattern. The RAH demands special attention during GR resection in aneurysm surgery.
Polyostotic fibrous dysplasia of the cervical spine: case report and review of the literature. - The spine journal : official journal of the North American Spine Society
Multiple lytic lesions of the spine usually represent metastatic or infectious disease processes.To describe an extremely rare presentation of an uncommon disease process.Case report/university hospital.We describe the management of a patient who presented with a pathological fracture of C3 and multiple lytic lesions of the cervical spine.After reconstructive surgery, the final pathological diagnosis was fibrous dysplasia.Fibrous dysplasia is rarely seen in the cervical spine and may mimic other pathological processes. The surgical and medical management of spinal fibrous dysplasia is described.
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600 Highland Ave Madison, WI 53792
600 Highland Ave B6/319 Csc
600 Highland Ave