In the News for the Week of 8-22-06
- Community-associated MRSA most common cause of skin infections
- Blood thinner approved to treat STEMI
- College's CEO to speak at HIT summit
- Recruit-a-Resident program offers rewards
- ACP advocates for changes in consultation policy
Editorial note: Observer Weekly will not be published on Aug. 29 and Sept. 5, 2006.
A study released last week reported that community-associated methicillin-resistant Staphylococcus aureus (MRSA) has spread rapidly throughout the U.S., causing almost 60% of skin and soft-tissue infections.
In the study, researchers assessed cases of skin and soft-tissue infections at 11 university-affiliated emergency departments throughout the country during August, 2004. Overall, 59% of the infections were caused by community-associated MRSA, with the most common strain (USA300) accounting for 97% of cases. The findings appear in the Aug. 17 New England Journal of Medicine.
Trimethoprim-sulfamethoxazole and rifampin were effective in treating 100% of cases, the study reported, followed by clindamycin (95%), tetracycline (92%) and fluoroquinolones (60%). Most infections were resistant to erythromycin.
While the results suggest that trimethoprim-sulfamethoxazole is the most effective treatment for MRSA, the variability in antibiotic susceptibility among other reported strains should be taken into account, said an accompanying editorial. As a result, physicians should consider wound culture after antibiotic therapy. Ironically, the editorial noted, surgical drainage has emerged as the best treatment option for staphylococcal infections, a treatment commonly used before the advent of penicillin.
The findings highlight the importance of educating patients about preventing the spread of infections, including covering lesions, hand washing and not sharing contaminated items, said the authors. In addition, hospitals should tighten their infection-control policies, they said, such as ensuring that health care workers wear gloves and gowns when in contact with wound patients.
The FDA last week approved expanded use for clopidogrel bisulfate (Sanofi-Aventis' Plavix) to treat acute ST-segment elevation myocardial infarction (STEMI).
The blood-thinning drug was first approved in 1997 to treat acute coronary syndrome, said an Aug. 17 FDA news release. In approving the expanded use, FDA officials said the drug can prevent subsequent blockages in STEMI patients, thus preventing a possible second heart attack or stroke.
Quoting American Heart Association statistics, the FDA release noted that this type of heart attack strikes about 500,000 people in the U.S. annually. Side effects of the drug include bleeding and, rarely, low white blood cell counts or thrombotic thrombocytopenic purpura.
The FDA news release is online.
College CEO John Tooker, FACP, will be a keynote speaker at the eHealth Initiative’s third annual Health Information Technology (HIT) Summit Sept. 25-27 in Washington, D.C.
The summit, which is co-sponsored by ACP, will feature an assembly of state leaders focused on improving quality through HIT and health information exchange at the state and federal levels. The event is being held in conjunction with the 13th annual National HIPAA Summit.
The conference will feature an in-depth look at new policies emerging from government and the private sector, including:
- performance measurement
- privacy and confidentiality
- financing and incentive models
- the impact of new regulations, such as Stark and anti-kickback
- how to build organizational structures that build trust and drive change.
More information and registration forms are online.
The 2006 Recruit-a-Resident program is offering educational rewards to residency programs that recruit at least 90% of their residents to be Associate members of the College.
Programs that reach the 90% threshold will receive the latest Updates (recent important papers in internal medicine subspecialties) and Multiple Small Feedings of the Mind (answers to essential clinical questions for the practicing internist) on CD-ROM. Programs will also receive the exclusive Recruit-a-Resident product, MKSAP OneTwenty to distribute to each resident in their program.
MKSAP OneTwenty contains two sets of 60 pre-tested MKSAP questions that meet the American Board of Internal Medicine’s high statistical standards. MKSAP OneTwenty is designed to help residents test their knowledge, compare their performance to practicing physicians, and receive focused, in-depth instruction on the questions they answer incorrectly.
As of Aug. 1, 2006, 15 programs have successfully recruited at least 90% of their residents to become Associate members. The 90% participation rate must be achieved by Dec. 31, 2006, for residents to receive these free educational products.
More information about the Recruit-a-Resident program is in the College's online brochure, or contact Jodi Siegrist, Council of Associates Coordinator, at 800-523-1546, ext 2611, or email@example.com.
The College is calling for changes in Medicare billing requirements for physician consultations regarding transfer of care.
In an Aug. 14 letter to CMS administrator Mark B. McClellan, FACP, the College asked for two changes to the Medicare Claims Processing Manual 30.6.10:
- Modify the transfer of care requirements to more closely match the term used by practicing physicians.
- Allow physicians to bill for consultations for postoperative conditions in addition to billing for preoperative consultations.
“ACP believes that these two changes are great strides in increasing the consistency of the consultation guidelines," wrote Joseph W. Stubbs, FACP, chair of ACP’s Medical Services Committee.
The full text of the letter is online.
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Copyright 2006 by the American College of Physicians.
A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis. He has had progressive pain in his left knee with activity, which limits his ability to hike. The patient has similar pain in the right knee, but it is less severe. He reports no recent morning stiffness. He is able to climb two or three flights of stairs without chest pain or shortness of breath. He has no other medical problems and reports no additional symptoms. Medications are methotrexate and folic acid. Following a physical exam and lab tests, what is the next best step in management?
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