In the News for the Week of 6-20-06
- Congress passes key legislation to help consolidate student debt
- Internal Medicine 2007 registration discounts now available
- Indictment handed down for illegal access of ACP membership database
- New DVD, guidebook helps patients manage migraines
- ACP urges support for information technology funding
Clinical news in the headlines
- Annals: RA drug beats placebo; inpatient COPD care falls short
- Low-quit rate blamed on poor use of smoking cessation tools
- Antidepressants not effective for anorexia
Health care access
- Emergency medical system reaching crisis point, report warns
- Hospitals exceed target in '100,000 Lives' campaign
Congress last week repealed a controversial provision that prevented those with student debt from seeking competitive consolidation rates. The action was hailed by medical organizations as a major step forward in debt relief for medical graduates.
The provision—the "single holder" rule—had been targeted for repeal by medical students and residents during ACP's Leadership Day in May. Under the single holder rule, borrowers with multiple federal student loans who wished to consolidate could do so only through their original lender, severely limiting their consolidation options.
Without the single holder rule in place, borrowers will now be able to find the best interest rates, customer service and loan packages available.
The repeal was part of the emergency supplemental appropriations act, which the president is expected to sign into law this week. According to a June 13 Yahoo news item, student loan interest rates are set to go up July 1. Borrowers are being encouraged to consolidate loans before then.
Yahoo news is online.
Don’t miss your chance to save on registration for Internal Medicine 2007 (formerly Annual Session), the most comprehensive educational event for the latest developments in general internal medicine and subspecialties. Internal Medicine 2007 is being held in San Diego April 19-21, 2007.
Register by July 31, 2006, to receive a $120 discount on registration fees and a chance to win free airfare to San Diego. Early registrants get first choice of housing accommodations, ensuring the widest hotel selection.
Internal Medicine 2007 will offer more than 260 courses, including a new core internal medicine for specialists track and a hospitalist track.
More information and registration are online.
The Justice Department last week issued an indictment against an individual for allegedly hacking into the ACP membership directory last year. The indictment, for 11 counts of computer intrusion, could carry a penalty of a prison sentence and fines.
As pointed out in a letter sent to members in May 2005, the FBI investigated the illegal computer access to the membership directory between January and May 2005. That directory does not contain any member credit card information, financial data or social security numbers. None of that encrypted information was compromised.
According to a June 15 Department of Justice news release, the person named in the indictment markets databases to people interested in marketing to physicians and other professionals.
The Justice Department release is online.
The notification letter sent to ACP members is also online.
ACP members can now order a new DVD and guidebook to help patients prevent and manage migraine headaches.
The 30-minute DVD and guidebook, "Managing Migraine: How to Prevent and Control Migraine Headaches," can help patients recognize the onset of migraines as well as the stresses, physical conditions, foods and other factors that can trigger them.
The DVD/guidebook is designed to be easily understood by patients with low literacy levels and is free to ACP members. Shipping costs apply. For more than 20 items, call Customer Service for bulk rates at 800-523-1546, ext. 2600, or 215-351-2600.
More information about all of ACPs patient education materials, including product order numbers, is online.
The College last week asked Congress to support the administration's request for $169 million to help fund health information technology (HIT).
In a June 12 letter sent to members of the House committee on appropriations, ACP pointed out that the funds are part of the administration's 2007 budget. Of that amount, $116 million would go to the office of the national coordinator for HIT, which was established in 2004.
In fiscal year 2006, that office used $36.1 million to award contracts to help develop interoperability for information technology software, set certification standards, and address privacy and security concerns. The additional funds would be used to further those goals.
The budget request also includes $50 million for programs administered by the Agency for Health Research and Quality (AHRQ) to advance the use of information technology that would enhance patient safety. AHRQ’s previous investment in hospital safety has already demonstrated the importance of patient safety reporting systems, computerized practitioner order entry and decision support systems, the letter said.
ACP was one of close to 20 signatories on the letter, which included national employers, such as Eastman Kodak Co. and Intel, and information technology groups including the American Health Information Management Association.
Full text of the letter is online.
Clinical news in the headlines
The following articles appear in the June 20 issue of Annals of Internal Medicine. Full text is available to College members and subscribers online.
New arthritis drug beats placebo in phase III trial. In a randomized trial involving 652 patients with active chronic rheumatoid arthritis despite treatment, the drug abatacept reduced disease activity, improved physical function and slowed joint damage when compared with placebo. Those receiving abatacept also had more serious infections (2.5 percent vs. 0.9 percent) and infusion reactions. The one-year study was limited to patients with established rheumatoid arthritis (mean duration of about nine years) and who had an inadequate response to methotrexate, a drug used to aggressively treat the disease. Participants continued taking methotrexate during the trial.
An editorial noted that the trial, a so-called “registration trial” needed for FDA approval, compares a new drug to a placebo rather than to the best alternative drug, which is what would be most useful to practicing clinicians. The writer also said that practicing clinicians will have to monitor patients receiving abatacept carefully until the drug’s safety profile becomes clearer with longer time on treatment.
Hospital care of patients with COPD varies widely, needs improvement. In a study of nearly 70,000 patients hospitalized for COPD, only 33% of the patients received ideal care. Ideal care was defined as receiving all five care elements recommended by American College of Physicians and American College of Chest Physicians joint guidelines and receiving none of five tests considered to be of uncertain or no benefit or even harmful.
Individual hospital performance varied widely: Fewer than 10%of patients received ideal care at some hospitals while more than 60% patients at other hospitals got ideal care. The authors say their study points to specific interventions—such as increasing use of recommended tests and treatments and omitting useless ones—to reduce variations and improve care nationally.
Smoking cessation interventions, such as nicotine replacement therapy, are vastly underutilized in the U.S., a government-sponsored panel on tobacco use reported last week, despite evidence that most adults who smoke want to quit.
The panel convened by the National Institutes of Health (NIH), noted that 70% of the 44.5 million adult smokers in the U.S. want to quit. But of the 40% who make attempts each year, less than 5% succeed, said a June 14 NIH news release. Available smoking cessation tools could double or triple the quit rate, the release said, if enough smokers requested or were offered the interventions.
Effective cessation strategies include nicotine replacement therapy, telephone quit lines and counseling—all of which tend are effective individually but more effective in combination, said the release. The panel also recommended economic measures, such as raising taxes on tobacco products and subsidizing the costs of cessation programs.
The panel suggested targeting specific interventions based on socioeconomic status, ethnicity or age, said the release.
The 14-member panel, which included experts in general medicine, psychiatry, addiction medicine and minority health, among others, concluded that a national coordinated strategy is needed to address the problem of tobacco use. A combination of mass media campaigns and other strategies, such as increasing tobacco taxes, should focus on preventing young people from starting to smoke.
The NIH news release is online.
Results of recent research on anorexia nervosa suggest that antidepressants, while widely prescribed, are no more effective than placebo in treating the eating disorder.
In the trial, 93 women between ages 16-45 with anorexia nervosa who had regained weight to reach a minimum 19 BMI were randomly assigned to receive fluoxetine or placebo for up to one year. There was no significant difference in time-to-relapse between the fluoxetine and placebo groups. The findings are published in the June 14 Journal of the American Medical Association.
The results should change the way physicians treat anorexia, which has a higher mortality than any other psychiatric disorder and affects an estimated 1% of Americans, said the June 14 New York Times. Even though participants in the study also received psychotherapy, fewer than one-third—regardless of whether they received drug treatment—remained healthy for a year or more.
However, the study authors noted, about 60% of patients at the sites included in the study reported having been treated with a selective serotonin reuptake inhibitor. The findings of this study and several past studies, they said, suggest that psychological and behavioral interventions would be better therapeutic options. In addition, they said, more research is needed on novel psychological treatments as well as psychotropic (such as olanzapine) and nonpsychotropic (such as cycloserine) medications.
The JAMA abstract is online.
The New York Times is online.
Health care access
The country’s overburdened emergency medical system is in crisis, said a report released last week, and is in desperate need of additional funding to meet daily demands as well as potential future disaster needs.
The report by the Institute of Medicine (IOM) pinpointed insufficient funding and uncompensated care as major drains on the system, according to a June 14 IOM news release. In 2003, U.S. emergency department admissions increased 26% over the previous decade to almost 114 million patients, said the release. Over the same period, however, there was a net loss of 703 hospitals and 425 emergency departments.
And while emergency services are essential to effective disaster response, according to the release, funding for such services received only 4% of the $3.38 billion in emergency preparedness funds allocated in 2002-03 to the Department of Homeland Security.
The report is the first national review of emergency services in 40 years, the June 15 Philadelphia Inquirer reported. Factors contributing to the current crisis, said a report author interviewed in the article, include an aging Baby Boomer population, a growing number of uninsured and lack of access to primary care doctors.
The report suggested that Congress act immediately to increase funding in three areas:
- $50 million for uncompensated emergency and trauma care;
- $88 million in grants to test ways to promote more coordination and regionalization of emergency care; and
- $37.5 million a year for five years to address problems in pediatric emergency care.
In a report this year, ACP warned of the looming collapse of primary care—a factor exacerbating the overcrowding in emergency medicine—and outlined recommendations to create a new national internal medicine workforce. That report is online.
The IOM news release is online.
The Philadelphia Inquirer is online.
According to a report released last week, U.S. hospitals have exceeded the goals set by the highly publicized 100,000 Lives Campaign by dramatically improving care over the past 18 months.
Hospitals enrolled in the campaign, which was launched by the Boston-based nonprofit Institute for Healthcare Improvement (IHI) in December 2004, collectively prevented about 122,300 avoidable deaths, said a June 14 IHI news release. The more than 3,000 hospitals who participated in the campaign represent about 75% of U.S. hospital beds.
Participating hospitals have agreed to implement up to six evidence-based interventions, said the news release. Those include:
- activate a rapid response team at the first sign that a patient’s condition is worsening.
- deliver evidence-based care following acute myocardial infarction, such as appropriate administration of aspirin and beta-blockers.
- prevent adverse drug events by ensuring that accurate, continually updated lists of patients’ medications are reviewed and reconciled during their hospital stay.
- prevent central line infections by following preventive steps, such as proper handwashing.
- prevent surgical site infections by, for example, ensuring timely administration of antibiotics.
- prevent ventilator-associated pneumonia by, for example, raising the head of the patient’s bed between 30 and 45 degrees.
Links to the IHI news release and report are online.
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Copyright 2006 by the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. Following a physical exam and review of previously performed chest radiographs and pulmonary function testing, what is the most appropriate management?
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