In the News for the Week of 9-7-04
- Flu vaccine manufacturer announces delay
Clinical news in the headlines
- ABIM makes case for certification as key quality indicator
International relief efforts
- Stethoscope drive delivers basic equipment to needy nations
Chiron, the nation's largest manufacturer and distributor of influenza vaccine, announced it is delaying shipment of its Fluviron vaccine until early October.
The company said last month that a small number of its vaccine lots did not meet product-sterility standards, prompting it to delay delivery and reduce delivery volume. Instead of shipping 50 million doses as planned, the company will deliver between 46 million and 48 million doses, plus 2 million doses for the national flu vaccine stockpile being set up by the CDC.
Because the vaccine will be available in time for recommended vaccination timeframes, the delay should not have a significant impact on the 2004-05 flu season. The reduced dose volume is still between 20% and 25% more than the 38 million doses Chiron supplied to the U.S. market last year.
Two other manufacturers are on schedule to deliver vaccine, according to the National Influenza Vaccine Summit, which includes the College's Adult Immunization Initiative Advisory Board. Aventis-Pasteur has begun shipment and expects to deliver about 52 million vaccine doses by November. Medimmune Inc., which makes a nasal flu vaccine, will release between 1.5 million and 2 million doses in October.
A link to the National Influenza Summit fact sheet on the delay is online.
Also see "Physicians prepare for a busy flu season" in the July-August ACP Observer online.
Clinical news in the headlines
A new study comparing early intensive statin therapy to a low-dose regimen did not find that intensive therapy had significant benefits for heart attack patients. In addition, researchers found that intensive-therapy patients had an increased risk of muscle disorders.
The study included close to 4,500 patients with acute coronary syndromes. One group was given 40 mg of simvastatin (Zocor) for one month, increasing to 80 mg for the duration of the study, while another group was given placebo for four months followed by 20 mg of simvastatin. Patients were followed for between six months and two years. The study, which will appear in the Sept. 15 Journal of the American Medical Association (JAMA), was posted early online.
Researchers found that the difference in outcomes between the two groups never became statistically significant, according to the Aug. 31 New York Times. In addition, nine patients out of 2,265 in the intensive therapy group experienced myopathy, a side effect of statins that affects one in 1,000 people.
Experts quoted in the New York Times said the study indicates that some cholesterol-lowering drugs may be safer than others at high doses. Recent studies that included 80 mg of atorvastatin (Lipitor) did not find increased myopathy risk.
An accompanying JAMA editorial pointed out that another larger trial is now looking at the effectiveness of prescribing high-dose statins. In the meantime, the editorial said that physicians should feel confident using a 40 mg dose of statins, which has proven safe, but use caution when going to higher doses.
The JAMA article is online.
The New York Times is online.
For more information, see "Is it time to expand your use of statins?" in the September ACP Observer online.
The following articles appeared in this week's Annals of Internal Medicine. Full text is available to College members and subscribers online.
Virtual and optical colonoscopy. A study of more than 1,200 adults who had no signs of colon disease found that both optical colonoscopy and virtual colonoscopy missed between 10% and 14% of precancerous lesions, although all known lesions missed with one method were detected by the other.
With virtual colonoscopy, researchers could view parts of the colon that optical colonoscopy often miss. However, an editorial concluded that virtual colonoscopy is not ready for "widespread use as a screening test." More...
West Nile fever causes more serious symptoms than previously thought. A study found that West Nile fever symptoms are more serious and last longer than previously characterized. Common symptoms include fatigue, muscle weakness, headache, difficulty concentrating and fever. Almost a third of the patients in the study were hospitalized between one and 56 days. Previous characterizations of West Nile fever claimed symptoms were mild and lasted only three to six days. More...
Board certification and recertification are important quality indicators for patients, according to a new report by the American Board of Internal Medicine (ABIM). The report claims, however, that those indicators—which authors said should be a key component in quality improvement—are being overlooked in national efforts to advance physician accountability.
Authors presented the results of a Gallup Poll commissioned by the ABIM that found that three out of four adults surveyed would choose a board-certified physician over a non-certified physician who had been recommended by family or friends.
In addition, 80% of those surveyed said they would leave a doctor whose certification had lapsed, while 83% said it was important for practicing physicians to be evaluated by an independent board. The report was published in the Sept. 1 Journal of the American Medical Association (JAMA).
Authors noted that while maintenance of certification shouldn't replace quality improvement efforts such as payer-based incentive systems, it can be complementary. The report concluded that "maintenance of certification is essentially self-regulation by the profession."
The JAMA abstract is online.
An ABIM press release on the report is online.
International relief efforts
Physicians can now contribute to an international drive to collect and distribute stethoscopes to health care professionals worldwide who lack access to basic equipment.
WorldScopes—a relief effort launched last year by the AMA—will distribute stethoscopes to needy nations. Over the past year, WorldScopes has distributed thousands of stethoscopes to hospitals, medical schools and clinics in Central America, the Middle East and Africa. This year's drive is in conjunction with Medical Ethics Day on Sept. 18.
Physicians can purchase a stethoscope to donate for as little as $15. To participate, visit the WorldScopes Web site.
Bids are now being accepted in the ACP Governors Silent Auction to benefit the ACP Foundation.
This month, members can bid online for more than 50 items that include a North Carolina barbeque, a vacation in Maine, an Oregon wine collection, Indianapolis 500 tickets and regional works of art. Winning bids will be announced at the Board of Governors fall meeting on Sept. 30.
For photos and descriptions of many of the auction items, go to the Foundation's Web site.
ACP members have a chance to comment online on 21 resolutions that will be discussed at the fall 2004 Board of Governors meeting. Comments must be received by Sept. 17, 2004.
The resolutions up for discussion focus on topics including collective negotiation by physicians, health care information technology, opposition to a new Federation of State Medical Boards exam and using antitrust laws to prevent carriers from dominating insurance markets.
Members can comment on each resolution through an online response form. All comments will be forwarded to the appropriate ACP Governors to use as part of their testimony at the meeting.
ACP's resolution process allows chapters to bring issues before the Board of Governors as a resolution. If approved, the resolution is forwarded to the Board of Regents for review and action.
You can read the proposed resolutions online. (Free registration on ACP Online is required.)
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Copyright 2004 by the American College of Physicians.
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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