In the News for the Week of 4-20-04
Clinical news in the headlines
- Highlights from the April 20 Annals of Internal Medicine
- Estrogen-only findings confirm slight increased risk of stroke
New College publication
- College debuts new diagnosis and treatment resource for internists
- ACP Foundation launches new patient education resource
- New report provides e-prescribing guidance
- CMS allows reassignment billing for off-site services
National Headache Awareness Week
- Event to highlight migraine treatment
- College urges support of sickle cell treatment bill
- ACP President-elect's new post focuses on minority access to care
- Wanted: Internists for 5K charity fun run at Annual Session
Clinical news in the headlines
The following articles appear in today's Annals of Internal Medicine. The full text of the issue is available to College members and subscribers online at http://www.annals.org?wkly.
New ACP guidelines say many diabetics should be taking statins. New College guidelines recommend statins for patients with type 2 diabetes mellitus and coronary artery disease, or diabetics at any risk for cardiovascular disease, to control cholesterol. This is the second set of guidelines issued by ACP recommending aggressive treatment of diabetes; guidelines published in April of last year called for tight control of blood pressure for diabetic patients. http://www.annals.org/cgi/content/full/140/8/644
Heavy alcohol use correlated with rise in colorectal cancer rate. A study found that patients who drink more than 45 grams of alcohol daily, or more than three average-size drinks, have a slightly higher risk of colorectal cancer, according to data collected from eight studies in five countries. The risk was the same regardless of the type of alcohol consumed. http://www.annals.org/cgi/content/full/140/8/603
Chaotic health care environment could spur innovation in general internal medicine. A task force commissioned by the Society of General Internal Medicine made eight recommendations to redefine the domain of general internal medicine. Recommendations included working in teams and tailoring the last two years of residency to the type of practice the physician will pursue as a career. http://www.annals.org/cgi/content/full/140/8/639
Researchers have found that estrogen-only therapy increases the risk of stroke for postmenopausal women, while it does not help prevent heart disease. Estrogen-only therapy was also found to increase the risk of deep vein thrombosis, but it did not increase breast or colorectal cancer risk and showed signs of reducing the risk of fractures.
The study, which was part of the Women's Health Initiative, was halted in February 2004 because of concerns about increased stroke risk. The initial findings appear in the April 14 Journal of the American Medical Association (JAMA).
The findings support FDA recommendations that hormone therapy be used only to treat menopausal symptoms in the lowest possible doses and for the shortest amounts of time, according to researchers quoted in an April 13 NIH press release. The estrogen-alone study followed more than 10,000 women aged 50-79 who had had hysterectomies for an average of 6.8 years.
In an earlier study of estrogen plus progestin compared to placebo, researchers found an increased risk of stroke, breast cancer, heart attacks and blood clots, but a reduction in hip fractures and a lower risk of colorectal cancer.
The women in both studies are now in a follow-up phase, which will end in 2007.
The NHI release is at: http://www.nhlbi.nih.gov.
A JAMA abstract is online at http://jama.ama-assn.org/cgi/content/abstract/291/14/1701. (Full text available only to subscribers.)
New College publication
ACP Medicine, an authoritative, evidence-based resource on diagnosis and treatment, is now available for purchase by College members.
The comprehensive text, published by WebMd and developed from WebMd Scientific American Medicine, is available in a variety of formats. Content is continuously updated to reflect new scientific developments and advances in treatment.
ACP Medicine is available as a quarterly updated CD-ROM, in a loose leaf binder edition with monthly updates, and in the most up-to-date format, ACP Medicine Online. In addition, ACP Medicine will be published periodically in bound volume print editions.
Future plans call for the integration of ACP Medicine content into other ACP electronic products, enabling internists to explore clinical topics from individual decision support to comprehensive background on a condition.
Members who order ACP Medicine by April 30 will receive a $50 discount off the regular price of ACP Medicine. To order or for more information, go online at http://www.acpmedicine.com.
The ACP Foundation is launching a new project this week at Annual Session to help physicians provide patients with evidence-based, commercial-free health care information via the Internet.
The Information Rx Project is a free program that utilizes several tools to direct patients to the MedlinePlus Web site. Using Information Rx paper pads, physicians "prescribe" information pertaining to a specific condition or medical concept.
Once at MedlinePlus, patients can get accurate and evidence-based information that takes into account the lower health literacy levels of many patients. The Information Rx project is the result of a partnership between the ACP Foundation and the National Library of Medicine.
Members attending Annual Session will be able to see an ongoing demonstration of the MedlinePlus Web site at the Learning Center (Hall I-1)or talk to ACP Foundation staff at the Exhibit Hall booth. The first 250 people to visit the ACP Foundation booth will receive a free copy of "The Best Medicine: Stories of Doctors and Patients who Care for Each Other," by Mike Magee, MD, and Michael D'Antonio.
For more information or to enroll in the project online, visit the Foundation's Web site at http://www.foundation.acponline.org.
A new report by a nonprofit health care group provides a roadmap to help physicians convert from paper-based to electronic prescribing systems.
The "Electronic Prescribing: Towards Maximum Value and Rapid Adoption" report, unveiled last week by the eHealth Initiative (EHI), is the result of a collaboration by more than 70 leading experts on electronic prescribing.
The group's design and implementation co-chair, Patricia L. Hale, FACP, is Chair of ACP's Medical Informatics Subcommittee. According to an April 14 EHI press release, Dr. Hale said that electronic prescribing systems could prevent more than 2 million medication errors and 190,000 unnecessary hospitalizations every year. The report pointed out, however, that surveys indicate that only 5%-18% of physicians are using e-prescribing systems.
The report noted these key steps before adopting an e-prescribing system:
Identify major implementation issues, such as the size and type of practice and level of staff support.
Make sure you have an adequate infrastructure to run the system.
Address start-up issues, such as loading patients and payer information.
Have a plan to manage staff and user questions as the system is implemented.
The eHealth Initiative release, with a link to the report, is online at http://www.ehealthinitiative.org/news/eRXReportpressrelease.mspx.
The CMS recently published a new rule that permits entities, such as hospitals and group practices, to bill and receive payment for covered, contracted services, regardless of where those services were performed.
A carrier may now make payment to a Medicare enrolled provider or facility for services furnished on or off the premises of the entity submitting the bill. Previously, independent contractors performing services off-site were required to seek reimbursement directly from Medicare.
This change does not affect billing for services performed by employees of facilities or physician groups.
To review the complete regulations, see the "Medicare Claims Processing Manual," chapter 1, section 30.2.7, "Payment for Services Provided Under a Contractual Arrangement—Carrier Claims Only," at http://www.cms.hhs.gov/manuals/104_claims/clm104index.asp.
National Headache Awareness Week
ACP is partnering with the National Headache Foundation (NHF) to promote National Headache Awareness Week, June 6-12. The event is designed to educate the public about the impact and severity of headache, and support the more than 45 million patients affected by the condition.
This year's theme, "Migraine … The Pain is Real. So is the Treatment. Get Diagnosed" communicates the importance of recognizing that migraine is a legitimate biological disease. Effective treatments are available, while getting the right diagnosis is the first step toward successful management. The event validates migraine pain and urges those with headache to seek care to eliminate needless suffering.
NHF offers interested internists a variety of free materials, including screening kits, patient education brochures, posters and newsletters. Orders for the free materials must be received by May 1. More information and an order form are online at http://www.headaches.org/consumer/nhawannouncement.html.
ACP members can also take advantage of several College resources relating to headache and migraine. Members have free access to ACP's clinical guidelines on managing migraine headache at http://www.annals.org/cgi/content/full/137/10/840.
A PIER module on migraine is online at http://pier.acponline.org/physicians/diseases/d156/d156.html. And patients can find information on headache and migraine and download a free brochure at the College's patient education Web site at http://www.doctorsforadults.com/topics/dfa_head.htm?ow.
The College is urging Congress to support a bill that would increase treatment options for sickle cell disease, which disproportionately affects patients in minority populations.
The Sickle Cell Treatment Act of 2003 (S. 874, H.R. 1736) would establish a research center charged with sharing information nationally about the disease and monitoring services provided to patients.
The bill would also provide for increased counseling for the disease, as well as community outreach and education by medical and non-medical personnel. And the bill would provide states with federal matching funds under Medicaid for medical and non-medical services related to sickle cell disease, including genetic counseling.
The College sent a letter endorsing the bill on April 9 to Sen. Jim Talent (R-Mo.) and Rep. Danny K. Davis (D-Ill.), the bills' sponsors in the Senate and the House. In the letter, College President Munsey S. Wheby, FACP, pointed out that the bill supports College advocacy for flexibility and innovation in public programs, including Medicaid.
The letters can be accessed online at http://www.acponline.org/hpp/menu/otheriss.htm.
Charles K. Francis, FACP, president-elect of the College, has been named director of the new office of health disparities at the nonprofit New York Academy of Medicine.
Dr. Francis will help shape health policy and aid in the Academy's efforts to reduce inequalities in access, treatment and health care outcomes across racial, ethnic and socioeconomic boundaries. According to an April 8 New York Academy press release, his role as director will help develop interventions to reduce disparities for patients affected by different medical conditions, including cardiovascular disease, diabetes, cancer and obesity.
Dr. Francis' has spent his career focusing on health disparities among poor, minority and underserved urban populations. He directed the department of medicine at New York's Harlem Hospital Center, served as professor of clinical medicine at Columbia University and, most recently was president of the Charles R. Drew University of Medicine and Science in Los Angeles.
Dr. Francis will be sworn in as College President this Saturday at Annual Session.
The New York Academy of Medicine's release is online at http://www.nyam.org/news/1942.html.
ACP is holding a 5K fun run and walk at Annual Session 2004 to benefit a New Orleans clinic that cares for patients who are homeless.
The 5K event will take place Saturday, April 24, from 6-7 a.m. (Warm-up begins at 5:30 a.m., with shuttle bus transportation from ACP hotels starting at 5 a.m.) The course will begin in front of the New Orleans World Trade Center.
Proceeds from the registration and sponsorship of participants will go to the Adult Homeless Clinic at New Orleans Mission. The clinic, which is staffed by more than 75 students and faculty volunteers from the Louisiana State University School of Medicine, offers services including histories, physicals, diagnoses, prescriptions and referrals.
Internists attending Annual Session and their guests are welcome to participate. You can sign up before the event at any of the registration desks at Annual Session, or at the starting location on Saturday morning. Donation for the event is $25 per person.
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A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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