In the News for the Week of 2-14-06
- Medicare payment update becomes law
Clinical news in the headlines
- Interrupting treatment found harmful in AIDS trial
- Study finds low-fat diet doesn’t ward off cancer, heart disease
- Decline in death rates marks turn in cancer battle
- Three-state pilot’s success a step forward in creating national network
- Center for Practice Innovation now accepting applications
- ACP seeks nominations for awards and Masterships
The president last week signed into law a revised budget bill that reverses the 4.4% physician pay cut that took effect on Jan. 1. The revised bill, which returns physician payment levels to the 2005 rates, had been passed by the House of Representatives earlier this month.
The CMS will automatically reprocess all 2006 claims submitted prior to the bill’s enactment, adjusted to 2005 rates. The CMS plans to send physicians those additional amounts by June.
Updated billing questions and answers are online.
Clinical news in the headlines
The largest study to date on AIDS treatment was halted early last month after it became apparent that volunteers assigned to intermittent drug treatment were faring worse than those who took prescribed medicines continuously.
The findings disappointed many who hoped to find an alternative to keeping AIDS patients on lifelong drug therapy, said the Feb. 7 Washington Post. After 15 months, 5.4% of patients assigned to interrupted treatment died or developed a serious complication compared with 3.6% in the continuous treatment group. Every category of complication—including heart, liver and kidney disease—was higher in the group on interrupted treatment.
The study, funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), tested the idea that patients on antiretroviral therapy could stop taking the drugs when their immune systems were functioning and return to treatment when their immunity deteriorated, said the Washington Post. Researchers theorized that patients who interrupted treatment would experience less drug resistance and have more treatment options if their infection worsened.
In addition, many thought that interrupting treatment would lead to fewer side effects, such as higher risk of cardiovascular problems, high cholesterol and diabetes, the article said. Some experts also hoped that patients who took the drugs intermittently would be more likely to take the medicine when prescribed.
Researchers began enrolling volunteers in 33 countries in January 2002, with the study expected to last between three and five years, said a Jan. 18 NIH news release. More than 90% of the goal of 6,000 volunteers had been enrolled when the study was halted Jan. 11. The experiment was known as Strategies for Management of Antiretroviral Therapy, or SMART.
Enrollees in the study were HIV positive with CD4+ cell counts of greater than 350 cells per cubic millimeter of blood, the NIH release said. Participants were assigned to receive either continuous drug therapy or episodic therapy determined by their CD4+ count. Therapy in the latter group was started whenever a patient’s CD4+ count fell below 250 and halted when it went above 350.
The study has raised many questions that demand further research, such as whether HIV sets up an inflammatory state in the body that exacerbates other diseases and whether a patient could stop treatment if their CD4 count reached a normal level (700), said the Washington Post. In addition, many patients may resist restarting drug treatment despite the SMART findings, due to side effects.
The NIH news release is online.
The Washington Post is online.
The latest results from the federally-funded Women’s Health Initiative showed that following a low-fat diet for more than eight years did not significantly lower women’s risk of developing cancer or heart disease.
The study included more than 48,000 postmenopausal women age 50-79 who had no prior history of cancer except nonmelanoma skin cancer in the last 10 years. About 40% of the women received nutritional counseling and were asked to follow a low-fat diet, eating at least five servings of vegetables and fruit and six servings of grains daily. The remaining women did not change their diets.
After eight years, there was no significant difference between groups in the number of women who developed invasive breast cancer, colorectal cancer or heart disease. The results appear in the Feb. 8 Journal of the American Medical Association (JAMA).
The findings would seem to contradict recent public health guidelines that encourage eating even more servings of fruits and vegetables and distinguish between good and bad fats, according to the Feb. 8 Philadelphia Inquirer. However, some experts interviewed noted that while the difference for disease risk between the two groups was not statistically significant (a 9% lower rate of breast cancer in the low-fat group), the data indicate that the diet may have had a small effect that could become more significant over time.
Most women in the study fell short of the goal of reducing their total fat intake to 20% of daily calories—and the differences in vegetable and fruit consumption between the intervention and control groups were only modest. If those departures were taken into account, the authors wrote, "projections are that breast cancer incidence in the intervention group would be 8% to 9% lower than in the comparison group."
Such a study might be designed differently if started today, the Philadelphia Inquirer noted. In the years since the study began in 1993, researchers have come to recognize the negative effects of trans fat found in processed foods, for example. Women in the study were told simply to reduce all fats.
The JAMA article is free online.
The Philadelphia Inquirer is online.
A decline in the number of American smokers as well as improved detection and treatment methods for some cancers has led to the first decline in cancer deaths in more than 70 years, the American Cancer Society reported last week.
Cancer deaths fell slightly by 369 deaths to 556,902 between 2002 and 2003, the latest data available, said the Feb. 9 New York Times. Numbers were higher for women, rising by 409 compared with a drop of 778 in men. Experts attributed the overall decline partly to earlier detection and to more effective treatment of prostate, colorectal and breast cancers.
The death rate had been declining by about 1% a year since 1991, the article said, but actual deaths still rose because of the growing population. Smoking accounted for 30% of deaths, while death rates due to smoking are higher in women than in men.
The article noted that while the overall numbers are encouraging, significant challenges remain. The five-year survival rate for pancreatic cancer, for example, is less than 4%, and African Americans are more likely than other groups to die from prostate cancer.
A release on the ACS report is online.
The New York Times is online.
In a major move toward creating a national health information network, three regional networks operating on different systems in different parts of the country successfully exchanged information over the Internet as part of a federally funded pilot project.
The three-state project involved regional health care information organizations in Boston, Indianapolis and Mendocino County, Calif. The project was launched in January 2005, according to a Feb. 8 news release from the Markle Foundation, whose "Connecting for Health" coalition led the project. The successful prototype suggests that local and regional networks can communicate and exchange information even if they operate on different technological platforms or have different ways of organizing patient records.
The prototype system linked information using a record locator service, the news release said. The service does not involve any central data storage but works by identifying the location of patient records wherever those are stored. The system’s framework makes it possible for groups of specialty providers with offices in several regions, for example, to have a common way of communicating.
The project demonstrated, for example, that the rural network in Mendocino County, north of San Francisco, made up of small practices with modest technology resources, could affordably exchange information with large urban systems that have extensive technological infrastructures, said the news release. The two regions were able to exchange anonymous information over the Internet about prescription records and lab results, without using common patient identifiers.
The three groups involved in the prototype project are planning to test the system in live clinical settings by the end of this summer, according to the release.
Project organizers soon plan to release technical and legal policies to help organizations trying to create Web-based decentralized health information networks, said the Markle Foundation release. Those materials will include actual code, technical specifications, testing interfaces, and privacy and security policies.
The Markle Foundation news release is online.
The College's Center for Practice Innovation (CPI) is now accepting applications for practices to participate in its premier project.
The CPI will select between 25 and 50 small- and medium-sized practices from among the applicants to participate. The project will offer customized support and resources to test innovative approaches to practice redesign.
Innovations will focus on four priority areas: clinical quality improvement, practice management, physician education and patient safety/disease management. Participants will be chosen to represent diverse practice settings, size, stage of technology implementation, and patient and payer mix.
The center has posted an online application as well as additional information. The first 100 practices to complete the online application will receive a $50 honorarium. Practices that would like a paper-based application should contact the CPI via e-mail.
Additional funding will permit the Center to expand operations so practices not selected in this first phase will be considered for future projects.
For more information about CPI, see "Help is on the way for small physician practices" in the January-February ACP Observer.
The ACP Awards Committee invites you to help identify deserving individuals for the College's awards and Masterships.
Each year, the College bestows 18 awards and a number of Masterships during the Convocation Ceremony at Annual Session. These awards recognize the accomplishments of distinguished individuals in a wide variety of areas, including the practice of medicine, teaching, research, and public and volunteer service.
Individuals may not self-nominate. For all awards and Masterships, each nominee must have a minimum of five detailed letters of nomination and support and a current CV before being considered by the Awards Committee. The College must receive all materials by July 1. Nominations are invited for the 2006-07 awards cycle. with new Masters and awardees to be honored at Annual Session 2007 in San Diego.
The "Awards and Mastership Booklet" contains criteria for College awards and Masterships, as well as specific instructions for writing nominating and supporting letters.
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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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