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1913 Legacy Campaign raises $1.75 million
The Board of Directors of the American College of Surgeons (ACS) Foundation has announced that Fellows and friends have contributed $1.75 million to the 1913 Legacy Campaign, which meets 35 percent of the campaign’s $5 million goal. Applied Medical Technology, Inc. and Coloplast Corp. both recently donated Leadership Gifts ($100,000 and up) to the campaign, in support of the ACS Division of Education’s Patient Education Program.
The 1913 Legacy Campaign, officially announced at the 25th Annual Fellows Leadership Society Luncheon during the 2013 ACS Clinical Congress, continues to secure gifts to advance programming that is critical to the College’s mission. Philanthropic investments will benefit the surgeon, the profession, and the societal good.
The Surgeon
Investments in the development of innovative programs to advance simulation-based surgical education and training as well as funding to better engage and embrace international surgeons.
The Profession
Promoting best practices and quality improvements through the newly established Codman Quality and Safety Fund and programs for rural surgery and surgical ethics. The Codman Fund is named in honor of Ernest A. Codman, MD, FACS, a key figure in founding the College who advocated for the "End Result Idea" – the premise that hospital staffs should follow every patient long enough to determine whether the treatment was successful and then learn from failures.
The Societal Good
Funding opportunities for patient education programs and support for surgical volunteerism. For more information on how to participate in this unprecedented campaign that honors the College’s Centennial, contact the ACS Foundation at 312-202-5338 or visit www.facs.org/1913Campaign.
The Board of Directors of the American College of Surgeons (ACS) Foundation has announced that Fellows and friends have contributed $1.75 million to the 1913 Legacy Campaign, which meets 35 percent of the campaign’s $5 million goal. Applied Medical Technology, Inc. and Coloplast Corp. both recently donated Leadership Gifts ($100,000 and up) to the campaign, in support of the ACS Division of Education’s Patient Education Program.
The 1913 Legacy Campaign, officially announced at the 25th Annual Fellows Leadership Society Luncheon during the 2013 ACS Clinical Congress, continues to secure gifts to advance programming that is critical to the College’s mission. Philanthropic investments will benefit the surgeon, the profession, and the societal good.
The Surgeon
Investments in the development of innovative programs to advance simulation-based surgical education and training as well as funding to better engage and embrace international surgeons.
The Profession
Promoting best practices and quality improvements through the newly established Codman Quality and Safety Fund and programs for rural surgery and surgical ethics. The Codman Fund is named in honor of Ernest A. Codman, MD, FACS, a key figure in founding the College who advocated for the "End Result Idea" – the premise that hospital staffs should follow every patient long enough to determine whether the treatment was successful and then learn from failures.
The Societal Good
Funding opportunities for patient education programs and support for surgical volunteerism. For more information on how to participate in this unprecedented campaign that honors the College’s Centennial, contact the ACS Foundation at 312-202-5338 or visit www.facs.org/1913Campaign.
The Board of Directors of the American College of Surgeons (ACS) Foundation has announced that Fellows and friends have contributed $1.75 million to the 1913 Legacy Campaign, which meets 35 percent of the campaign’s $5 million goal. Applied Medical Technology, Inc. and Coloplast Corp. both recently donated Leadership Gifts ($100,000 and up) to the campaign, in support of the ACS Division of Education’s Patient Education Program.
The 1913 Legacy Campaign, officially announced at the 25th Annual Fellows Leadership Society Luncheon during the 2013 ACS Clinical Congress, continues to secure gifts to advance programming that is critical to the College’s mission. Philanthropic investments will benefit the surgeon, the profession, and the societal good.
The Surgeon
Investments in the development of innovative programs to advance simulation-based surgical education and training as well as funding to better engage and embrace international surgeons.
The Profession
Promoting best practices and quality improvements through the newly established Codman Quality and Safety Fund and programs for rural surgery and surgical ethics. The Codman Fund is named in honor of Ernest A. Codman, MD, FACS, a key figure in founding the College who advocated for the "End Result Idea" – the premise that hospital staffs should follow every patient long enough to determine whether the treatment was successful and then learn from failures.
The Societal Good
Funding opportunities for patient education programs and support for surgical volunteerism. For more information on how to participate in this unprecedented campaign that honors the College’s Centennial, contact the ACS Foundation at 312-202-5338 or visit www.facs.org/1913Campaign.
ACA coverage may lead to more malpractice claims
The volume of malpractice claims against physicians could increase by 5% as more Americans gain health care coverage and access health services under the Affordable Care Act, according to a study by the RAND Corporation released April 9.
That increase could translate into higher malpractice premiums for physicians, RAND researchers found in a study of the ACA’s impact on all liability insurances.
"The Affordable Care Act is unlikely to dramatically affect liability costs, but it may influence small and moderate changes in costs over the next several years," said lead author David Auerbach, a policy researcher at RAND. "For example, auto insurers may spend less for treating injuries, while it may cost a bit more to provide physicians with medical malpractice coverage."
RAND investigators theorized that a greater number of insured patients would escalate the rate of malpractice lawsuits because of more procedures, interactions, and visits with physicians. Previous analyses have found the uninsured currently use about half of the care that insured patients do, they said.
To test their theory, the researchers compared National Practitioner Data Bank (NPDB) data on liability claims from 2008 to 2010 to insurance coverage data from the Census Bureau’s American Community Survey (ACS). The results suggested that having insurance coverage is associated with a 2%-10% increase in malpractice activity. Thus, if 10% of a state’s population gains coverage, analysts estimated a 5% rise in malpractice claims.
"This study highlights the far-reaching impacts of the Affordable Care Act," said Jayne Plunkett, head of casualty reinsurance for Swiss Re, an international reinsurance company that sponsored the study. "Businesses and policymakers need to understand how and why their risk profiles might change as the Affordable Care Act is implemented."
But other insurers believe the study results are another uncertain forecast of the ACA’s future effects.
"You’re trying to look through a very cloudy crystal ball in making predictions about the Affordable Care Act," said Frank O’Neil, senior vice president and chief communications officer for ProAssurance, a national medical liability insurer. "There are a number of things that could cause a 5% change in medical liability rates that could happen at the same time as the implementation of the ACA, but be totally unrelated."
For example, if there is a sudden increase in either the frequency or the severity of malpractice claims in a particular state, that could impact the medical liability climate, Mr. O’Neil said. He added that other experts believe that new patients entering the health care system may be so appreciative of previously absent care that they would be reluctant to sue.
"There are a lot of unknowns yet, and I think it’s hard to agree or disagree with a prediction that doesn’t say over what time frame [an increase in claims] would occur," he said. The study "should be taken as just one other prediction."
The volume of malpractice claims against physicians could increase by 5% as more Americans gain health care coverage and access health services under the Affordable Care Act, according to a study by the RAND Corporation released April 9.
That increase could translate into higher malpractice premiums for physicians, RAND researchers found in a study of the ACA’s impact on all liability insurances.
"The Affordable Care Act is unlikely to dramatically affect liability costs, but it may influence small and moderate changes in costs over the next several years," said lead author David Auerbach, a policy researcher at RAND. "For example, auto insurers may spend less for treating injuries, while it may cost a bit more to provide physicians with medical malpractice coverage."
RAND investigators theorized that a greater number of insured patients would escalate the rate of malpractice lawsuits because of more procedures, interactions, and visits with physicians. Previous analyses have found the uninsured currently use about half of the care that insured patients do, they said.
To test their theory, the researchers compared National Practitioner Data Bank (NPDB) data on liability claims from 2008 to 2010 to insurance coverage data from the Census Bureau’s American Community Survey (ACS). The results suggested that having insurance coverage is associated with a 2%-10% increase in malpractice activity. Thus, if 10% of a state’s population gains coverage, analysts estimated a 5% rise in malpractice claims.
"This study highlights the far-reaching impacts of the Affordable Care Act," said Jayne Plunkett, head of casualty reinsurance for Swiss Re, an international reinsurance company that sponsored the study. "Businesses and policymakers need to understand how and why their risk profiles might change as the Affordable Care Act is implemented."
But other insurers believe the study results are another uncertain forecast of the ACA’s future effects.
"You’re trying to look through a very cloudy crystal ball in making predictions about the Affordable Care Act," said Frank O’Neil, senior vice president and chief communications officer for ProAssurance, a national medical liability insurer. "There are a number of things that could cause a 5% change in medical liability rates that could happen at the same time as the implementation of the ACA, but be totally unrelated."
For example, if there is a sudden increase in either the frequency or the severity of malpractice claims in a particular state, that could impact the medical liability climate, Mr. O’Neil said. He added that other experts believe that new patients entering the health care system may be so appreciative of previously absent care that they would be reluctant to sue.
"There are a lot of unknowns yet, and I think it’s hard to agree or disagree with a prediction that doesn’t say over what time frame [an increase in claims] would occur," he said. The study "should be taken as just one other prediction."
The volume of malpractice claims against physicians could increase by 5% as more Americans gain health care coverage and access health services under the Affordable Care Act, according to a study by the RAND Corporation released April 9.
That increase could translate into higher malpractice premiums for physicians, RAND researchers found in a study of the ACA’s impact on all liability insurances.
"The Affordable Care Act is unlikely to dramatically affect liability costs, but it may influence small and moderate changes in costs over the next several years," said lead author David Auerbach, a policy researcher at RAND. "For example, auto insurers may spend less for treating injuries, while it may cost a bit more to provide physicians with medical malpractice coverage."
RAND investigators theorized that a greater number of insured patients would escalate the rate of malpractice lawsuits because of more procedures, interactions, and visits with physicians. Previous analyses have found the uninsured currently use about half of the care that insured patients do, they said.
To test their theory, the researchers compared National Practitioner Data Bank (NPDB) data on liability claims from 2008 to 2010 to insurance coverage data from the Census Bureau’s American Community Survey (ACS). The results suggested that having insurance coverage is associated with a 2%-10% increase in malpractice activity. Thus, if 10% of a state’s population gains coverage, analysts estimated a 5% rise in malpractice claims.
"This study highlights the far-reaching impacts of the Affordable Care Act," said Jayne Plunkett, head of casualty reinsurance for Swiss Re, an international reinsurance company that sponsored the study. "Businesses and policymakers need to understand how and why their risk profiles might change as the Affordable Care Act is implemented."
But other insurers believe the study results are another uncertain forecast of the ACA’s future effects.
"You’re trying to look through a very cloudy crystal ball in making predictions about the Affordable Care Act," said Frank O’Neil, senior vice president and chief communications officer for ProAssurance, a national medical liability insurer. "There are a number of things that could cause a 5% change in medical liability rates that could happen at the same time as the implementation of the ACA, but be totally unrelated."
For example, if there is a sudden increase in either the frequency or the severity of malpractice claims in a particular state, that could impact the medical liability climate, Mr. O’Neil said. He added that other experts believe that new patients entering the health care system may be so appreciative of previously absent care that they would be reluctant to sue.
"There are a lot of unknowns yet, and I think it’s hard to agree or disagree with a prediction that doesn’t say over what time frame [an increase in claims] would occur," he said. The study "should be taken as just one other prediction."
IOM identifies 17 social factors to collect in EHRs
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
The Institute of Medicine has identified the top 17 social and behavioral areas that should be addressed in all electronic health records to improve health outcomes and advance public health research efforts.
The IOM compiled the list as a guide for federal officials who are currently developing criteria for Stage 3 of the meaningful use program for EHRs, slated to begin in 2017.
A 13-member committee, which included physicians as well as experts in health information technology and social determinants of health, compiled a list of "candidate" domains that included sociodemographic, psychological, and behavioral factors. The committee also identified domains related to individual-level social relationships and the effect of neighborhoods and communities.
The candidate domains (in no particular order) are sexual orientation, race/ethnicity, country of origin, education, employment, financial resources strain (food and housing insecurity), health literacy, stress, negative mood and affect, psychological assets (patient engagement, conscientiousness, optimism, and self-efficacy), dietary patterns, physical activity, nicotine use and exposure, alcohol use, social connections and social isolation, exposure to violence, and area socioeconomic and racial/ethnic characteristics.
In selecting the domains, the IOM committee considered the evidence for whether the domains were associated with health outcomes, as well as whether collecting the information in an electronic health record would be useful for treatment and in public health research.
While some of the information, such as race, ethnicity, gender, language, and smoking status, is routinely collected in electronic health records now, the committee included them on the list to ensure they would remain a priority.
The IOM is planning a follow-up report to narrow down the current list and to recommend specific measures for each of the domains. The second report will also look closely at the barriers to collecting this type of social and behavioral information from patients.
On Twitter @maryellenny
Exchanges reaching previously uninsured, say health system execs
The Affordable Care Act’s health insurance exchanges have provided coverage for the previously uninsured, two health system executives said April 7 at the ninth World Health Care Congress.
About 30,000-40,000 new enrollees to Kaiser Permanente’s California health plans were previously uninsured, said Dr. Robert Pearl, executive director and CEO of the Permanente Medical Group.
"When you get coverage, you start to get health care, which from my perspective is a good thing," he said. Although delivering more care may drive costs up initially, in the long run, it will help create a more cost-effective and higher-quality system.
Kaiser has begun reaching out to those newly insured and found that many need immediate care for chronic conditions, Dr. Pearl said. But having more patients covered by insurance also aligns with Kaiser’s mission of focusing on preventive care, he said.
The exchanges will drive many changes in the health care system, he said. Among them is making health care more integrated, both vertically and horizontally.
The ACA is forcing a realignment of health care, according to Scott E. Streator, vice president for the health insurance marketplace with CareSource – a nonprofit provider of Medicare and Medicaid managed care plans and low-cost insurance plans – based in Dayton, Ohio. He described it as at least a 3-year process. Costs will likely go up in the first year because so many previously uninsured patients will use new benefits. In the second year, skeptics are likely to sign up through the exchanges, bringing more patients, but also potentially higher costs. Savings from coverage likely will not materialize until 2017 – a few years after the first enrollees initially received benefits, he said.
CareSource has gained about 30,000 new enrollees since Oct. 1, Mr. Streator said, adding that about 80% have paid their premiums and about 80% have received a subsidy of some sort.
About 60% were previously uninsured, Mr. Streator said.
Other organizations have recently issued data showing that the number of uninsured seems to be declining. The Robert Wood Johnson Foundation estimated that of the 7 million Americans who have supposedly signed up for a plan through the federal or state exchanges, 5.4 million were previously uninsured. The foundation said that there had been an almost 3% drop in the rate of uninsured since September.
And a Gallup poll released April 7 showed that the rate of uninsured Americans is at its lowest point since late 2008. The data are based on interviews with more than 43,500 adults from early January through late March.
The Gallup poll noted that just under 15% of Americans were uninsured in late March, down from 18% in August 2013. The rate has fallen consistently since open enrollment for the exchanges began in October, with a big drop from early March (15.8%) to the end of the month when enrollment closed (14.7%).
On Twitter @aliciaault
The Affordable Care Act’s health insurance exchanges have provided coverage for the previously uninsured, two health system executives said April 7 at the ninth World Health Care Congress.
About 30,000-40,000 new enrollees to Kaiser Permanente’s California health plans were previously uninsured, said Dr. Robert Pearl, executive director and CEO of the Permanente Medical Group.
"When you get coverage, you start to get health care, which from my perspective is a good thing," he said. Although delivering more care may drive costs up initially, in the long run, it will help create a more cost-effective and higher-quality system.
Kaiser has begun reaching out to those newly insured and found that many need immediate care for chronic conditions, Dr. Pearl said. But having more patients covered by insurance also aligns with Kaiser’s mission of focusing on preventive care, he said.
The exchanges will drive many changes in the health care system, he said. Among them is making health care more integrated, both vertically and horizontally.
The ACA is forcing a realignment of health care, according to Scott E. Streator, vice president for the health insurance marketplace with CareSource – a nonprofit provider of Medicare and Medicaid managed care plans and low-cost insurance plans – based in Dayton, Ohio. He described it as at least a 3-year process. Costs will likely go up in the first year because so many previously uninsured patients will use new benefits. In the second year, skeptics are likely to sign up through the exchanges, bringing more patients, but also potentially higher costs. Savings from coverage likely will not materialize until 2017 – a few years after the first enrollees initially received benefits, he said.
CareSource has gained about 30,000 new enrollees since Oct. 1, Mr. Streator said, adding that about 80% have paid their premiums and about 80% have received a subsidy of some sort.
About 60% were previously uninsured, Mr. Streator said.
Other organizations have recently issued data showing that the number of uninsured seems to be declining. The Robert Wood Johnson Foundation estimated that of the 7 million Americans who have supposedly signed up for a plan through the federal or state exchanges, 5.4 million were previously uninsured. The foundation said that there had been an almost 3% drop in the rate of uninsured since September.
And a Gallup poll released April 7 showed that the rate of uninsured Americans is at its lowest point since late 2008. The data are based on interviews with more than 43,500 adults from early January through late March.
The Gallup poll noted that just under 15% of Americans were uninsured in late March, down from 18% in August 2013. The rate has fallen consistently since open enrollment for the exchanges began in October, with a big drop from early March (15.8%) to the end of the month when enrollment closed (14.7%).
On Twitter @aliciaault
The Affordable Care Act’s health insurance exchanges have provided coverage for the previously uninsured, two health system executives said April 7 at the ninth World Health Care Congress.
About 30,000-40,000 new enrollees to Kaiser Permanente’s California health plans were previously uninsured, said Dr. Robert Pearl, executive director and CEO of the Permanente Medical Group.
"When you get coverage, you start to get health care, which from my perspective is a good thing," he said. Although delivering more care may drive costs up initially, in the long run, it will help create a more cost-effective and higher-quality system.
Kaiser has begun reaching out to those newly insured and found that many need immediate care for chronic conditions, Dr. Pearl said. But having more patients covered by insurance also aligns with Kaiser’s mission of focusing on preventive care, he said.
The exchanges will drive many changes in the health care system, he said. Among them is making health care more integrated, both vertically and horizontally.
The ACA is forcing a realignment of health care, according to Scott E. Streator, vice president for the health insurance marketplace with CareSource – a nonprofit provider of Medicare and Medicaid managed care plans and low-cost insurance plans – based in Dayton, Ohio. He described it as at least a 3-year process. Costs will likely go up in the first year because so many previously uninsured patients will use new benefits. In the second year, skeptics are likely to sign up through the exchanges, bringing more patients, but also potentially higher costs. Savings from coverage likely will not materialize until 2017 – a few years after the first enrollees initially received benefits, he said.
CareSource has gained about 30,000 new enrollees since Oct. 1, Mr. Streator said, adding that about 80% have paid their premiums and about 80% have received a subsidy of some sort.
About 60% were previously uninsured, Mr. Streator said.
Other organizations have recently issued data showing that the number of uninsured seems to be declining. The Robert Wood Johnson Foundation estimated that of the 7 million Americans who have supposedly signed up for a plan through the federal or state exchanges, 5.4 million were previously uninsured. The foundation said that there had been an almost 3% drop in the rate of uninsured since September.
And a Gallup poll released April 7 showed that the rate of uninsured Americans is at its lowest point since late 2008. The data are based on interviews with more than 43,500 adults from early January through late March.
The Gallup poll noted that just under 15% of Americans were uninsured in late March, down from 18% in August 2013. The rate has fallen consistently since open enrollment for the exchanges began in October, with a big drop from early March (15.8%) to the end of the month when enrollment closed (14.7%).
On Twitter @aliciaault
FROM THE WORLD HEALTH CARE CONGRESS
Blacks balk at life-saving early lung cancer therapy
MADRID – Blacks may need additional guidance from clinicians to use radiotherapy for potentially curable lung cancer, a retrospective population-based study suggests.
Among 6,628 patients diagnosed with early-stage nonsquamous non–small cell lung cancer (NSCLC), primary radiation therapy doubled median survival from 11 months to 22.6 months for cases not receiving surgery (Log rank P value less than .0001).
Despite the survival advantage, blacks were significantly more likely than whites were to skip radiotherapy for stage IA NSCLC (46% vs. 37.5%; P = .02), Dr. Eric Flenaugh, chief of pulmonary and critical care medicine and vice chair of the department of medicine at Morehouse School of Medicine, Atlanta, reported at the world congress of the American College of Chest Physicians.
A subgroup analysis of nonsurgical stage IA cases in which surgery was not recommended or was contraindicated showed that 61% of whites went on to radiotherapy, compared with 47% of blacks (P = .007). When surgical resection was recommended but not performed, radiotherapy use was similar between races.
"What this basically says is that if they [blacks] chose not to have surgery, then they weren’t going to have anything," Dr. Flenaugh said in an interview. "We have to look at our approach to discussing with African Americans who have curable-stage cancer, particularly the IAs, that if you’re not a surgical candidate or choose not to have surgery, there are other options like radiotherapy that can improve your survival."
The data did not allow the investigators to determine patients’ chemotherapy status or which factors drove the lower uptake of radiotherapy, but prior research has shown that blacks undergo surgery for lung cancer less often than whites, even after access to care has been demonstrated (J. Clin. Oncol. 2006;24:413-8).
The current analysis, led by internal medicine resident Srinadh Annangi, MBBS, used data from the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) database for 6,628 patients diagnosed with NSCLC between 2004 and 2010, of which 4,210 did not receive surgery. NSCLC was staged as IA, IB, IIA, and IIB according to AJCC (American Joint Committee on Cancer) 6th edition classifications.
A little more than half of the 5,915 whites and 713 African-Americans were male, with a median age of 78 years and 67.5 years, respectively.
The proportion of tumors less than 2 cm in size for stages IA and IIA and less than 5 cm for stages IB and IIB was not significantly different between races, according to the poster presentation.
No significant racial disparities were seen for nonsurgical stage IB, IIA, and IIB cancers.
Among operable NSCLC cases, whites were significantly more likely to have surgery than were blacks (37% vs. 32%; P = .0004), whereas blacks were significantly more likely to have surgery recommended but refused or not performed (9% vs. 6%; P = .012).
Importantly, the proportion of blacks undergoing their recommended surgery was lower for both stage IA (78.3% vs. 86%; P less than .05) and IB cancers (74.6% vs. 81.3%; P less than .05).
The authors note that surgical resection remains the preferred treatment approach for operable stage I and II NSCLC, but conclude that eliminating the racial disparities in radiotherapy for early-stage NSCLC deemed inoperable or where surgery is refused can improve survival in the African American population.
Dr. Flenaugh and his coauthors reported no financial disclosures.
MADRID – Blacks may need additional guidance from clinicians to use radiotherapy for potentially curable lung cancer, a retrospective population-based study suggests.
Among 6,628 patients diagnosed with early-stage nonsquamous non–small cell lung cancer (NSCLC), primary radiation therapy doubled median survival from 11 months to 22.6 months for cases not receiving surgery (Log rank P value less than .0001).
Despite the survival advantage, blacks were significantly more likely than whites were to skip radiotherapy for stage IA NSCLC (46% vs. 37.5%; P = .02), Dr. Eric Flenaugh, chief of pulmonary and critical care medicine and vice chair of the department of medicine at Morehouse School of Medicine, Atlanta, reported at the world congress of the American College of Chest Physicians.
A subgroup analysis of nonsurgical stage IA cases in which surgery was not recommended or was contraindicated showed that 61% of whites went on to radiotherapy, compared with 47% of blacks (P = .007). When surgical resection was recommended but not performed, radiotherapy use was similar between races.
"What this basically says is that if they [blacks] chose not to have surgery, then they weren’t going to have anything," Dr. Flenaugh said in an interview. "We have to look at our approach to discussing with African Americans who have curable-stage cancer, particularly the IAs, that if you’re not a surgical candidate or choose not to have surgery, there are other options like radiotherapy that can improve your survival."
The data did not allow the investigators to determine patients’ chemotherapy status or which factors drove the lower uptake of radiotherapy, but prior research has shown that blacks undergo surgery for lung cancer less often than whites, even after access to care has been demonstrated (J. Clin. Oncol. 2006;24:413-8).
The current analysis, led by internal medicine resident Srinadh Annangi, MBBS, used data from the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) database for 6,628 patients diagnosed with NSCLC between 2004 and 2010, of which 4,210 did not receive surgery. NSCLC was staged as IA, IB, IIA, and IIB according to AJCC (American Joint Committee on Cancer) 6th edition classifications.
A little more than half of the 5,915 whites and 713 African-Americans were male, with a median age of 78 years and 67.5 years, respectively.
The proportion of tumors less than 2 cm in size for stages IA and IIA and less than 5 cm for stages IB and IIB was not significantly different between races, according to the poster presentation.
No significant racial disparities were seen for nonsurgical stage IB, IIA, and IIB cancers.
Among operable NSCLC cases, whites were significantly more likely to have surgery than were blacks (37% vs. 32%; P = .0004), whereas blacks were significantly more likely to have surgery recommended but refused or not performed (9% vs. 6%; P = .012).
Importantly, the proportion of blacks undergoing their recommended surgery was lower for both stage IA (78.3% vs. 86%; P less than .05) and IB cancers (74.6% vs. 81.3%; P less than .05).
The authors note that surgical resection remains the preferred treatment approach for operable stage I and II NSCLC, but conclude that eliminating the racial disparities in radiotherapy for early-stage NSCLC deemed inoperable or where surgery is refused can improve survival in the African American population.
Dr. Flenaugh and his coauthors reported no financial disclosures.
MADRID – Blacks may need additional guidance from clinicians to use radiotherapy for potentially curable lung cancer, a retrospective population-based study suggests.
Among 6,628 patients diagnosed with early-stage nonsquamous non–small cell lung cancer (NSCLC), primary radiation therapy doubled median survival from 11 months to 22.6 months for cases not receiving surgery (Log rank P value less than .0001).
Despite the survival advantage, blacks were significantly more likely than whites were to skip radiotherapy for stage IA NSCLC (46% vs. 37.5%; P = .02), Dr. Eric Flenaugh, chief of pulmonary and critical care medicine and vice chair of the department of medicine at Morehouse School of Medicine, Atlanta, reported at the world congress of the American College of Chest Physicians.
A subgroup analysis of nonsurgical stage IA cases in which surgery was not recommended or was contraindicated showed that 61% of whites went on to radiotherapy, compared with 47% of blacks (P = .007). When surgical resection was recommended but not performed, radiotherapy use was similar between races.
"What this basically says is that if they [blacks] chose not to have surgery, then they weren’t going to have anything," Dr. Flenaugh said in an interview. "We have to look at our approach to discussing with African Americans who have curable-stage cancer, particularly the IAs, that if you’re not a surgical candidate or choose not to have surgery, there are other options like radiotherapy that can improve your survival."
The data did not allow the investigators to determine patients’ chemotherapy status or which factors drove the lower uptake of radiotherapy, but prior research has shown that blacks undergo surgery for lung cancer less often than whites, even after access to care has been demonstrated (J. Clin. Oncol. 2006;24:413-8).
The current analysis, led by internal medicine resident Srinadh Annangi, MBBS, used data from the National Cancer Institute’s SEER (Surveillance, Epidemiology, and End Results) database for 6,628 patients diagnosed with NSCLC between 2004 and 2010, of which 4,210 did not receive surgery. NSCLC was staged as IA, IB, IIA, and IIB according to AJCC (American Joint Committee on Cancer) 6th edition classifications.
A little more than half of the 5,915 whites and 713 African-Americans were male, with a median age of 78 years and 67.5 years, respectively.
The proportion of tumors less than 2 cm in size for stages IA and IIA and less than 5 cm for stages IB and IIB was not significantly different between races, according to the poster presentation.
No significant racial disparities were seen for nonsurgical stage IB, IIA, and IIB cancers.
Among operable NSCLC cases, whites were significantly more likely to have surgery than were blacks (37% vs. 32%; P = .0004), whereas blacks were significantly more likely to have surgery recommended but refused or not performed (9% vs. 6%; P = .012).
Importantly, the proportion of blacks undergoing their recommended surgery was lower for both stage IA (78.3% vs. 86%; P less than .05) and IB cancers (74.6% vs. 81.3%; P less than .05).
The authors note that surgical resection remains the preferred treatment approach for operable stage I and II NSCLC, but conclude that eliminating the racial disparities in radiotherapy for early-stage NSCLC deemed inoperable or where surgery is refused can improve survival in the African American population.
Dr. Flenaugh and his coauthors reported no financial disclosures.
AT CHEST WORLD CONGRESS 2014
Major finding: Blacks were significantly less likely than were whites to receive radiotherapy for stage IA NSCLC (P = .02).
Data source: A population-based cohort study in 6,628 patients with lung cancer.
Disclosures: Dr. Flenaugh and his coauthors reported no financial disclosures.
Depression at least five times more common than PTSD after critical illness
Patients discharged from intensive care units were far more likely to report physical symptoms of depression than posttraumatic distress disorder symptoms, based on research published online April 6 in Lancet Respiratory Medicine.
"Depression and posttraumatic distress disorder are important mental health problems after critical illness, but our findings show that depression is at least five times more common than posttraumatic distress disorder and is largely somatic in nature," said James C. Jackson, Psy.D., at Vanderbilt University in Nashville, Tenn., and his associates. "This finding suggests that physical disability contributes predominantly to this depression, which has implications for the roles of physical rehabilitation vs. antidepressant medications in the prevention and management of depression after ICU admission." Lancet
Respir. Med. 2014 March 6 [doi: 10.1016/S2213-2600(14)70051-7]
The prospective, multicenter longitudinal cohort study enrolled 821 patients (median age, 61 years) treated in medical and surgical ICUs for respiratory failure, cardiogenic shock, or septic shock.
Data were available for 406 patients 3 months after discharge, of which 37% reported at least mild depression symptoms, while only 7% reported posttraumatic stress disorder (PTSD) symptoms. At 12 months after discharge, 33% of patients reported depression, compared with 7% for PTSD. Depression was primarily somatic in nature and was common even among patients with no past history of the disorder (prevalence, 30% and 29% at 3 and 12 months, respectively). Disabilities in activities of daily living affected from 23%-32% of patients.
"Our data further show that monitoring these outcomes is relevant for survivors of all ages, and that non–pharmacological interventions during the ICU stay (previously assumed to improve physical outcomes in ICU survivors) should be tested in terms of their ability to change mental health and functional outcomes," the investigators concluded.
Dr. Jackson receives grant support from the National Institutes of Health. Ten of his associates reported receiving funding, honoraria, and other support from Hospira; Abbott; Orion Pharma; the Veterans Affairs Clinical Science Research and Development Service; the Tennessee Valley Geriatric Research, Education, and Clinical Center; the National Institutes of Health; and the Vanderbilt Clinical and Translational Research Scholars Program.
Just 15 years ago, the long-term sequelae of severe sepsis and acute respiratory distress syndrome were unknown, said Dr. Hallie C. Prescott and Dr. Theodore J. Iwashyna. But as survival rates in intensive care units improved, "it became clear that something was not right. Survivors were not the same after critical illness. Rather, they had new weaknesses, cognitive impairment, depression, and early death."
But the causes and treatment of post–intensive care syndrome have eluded researchers, said Dr. Prescott and Dr. Iwashyna. The current study’s findings help fill that gap. "By differentiation of depression into cognitive and physical components, Jackson and colleagues have provided an important step towards tailoring of future interventions to specific symptoms subsets, and not the generic diagnosis of depression."
Somatic symptoms among survivors might be from functional limitations and medical comorbidities instead of a neurochemical imbalance, they added. "As such, traditional pharmacologic therapies for depression might be less likely to provide significant benefit alone (or at all). Instead, doctors might need to address the many diagnoses that contribute to poor sleep, impaired concentration, weakness, and fatigue. Although largely absent from the history of post–intensive care syndrome to date, consideration is needed of how common chronic medical conditions such as diabetes, heart failure, and chronic pulmonary disease contribute to the morbidity of survivors of critical illness."
Dr. Prescott is a clinical fellow and Dr. Iwashyna is an assistant professor of internal medicine with the University of Michigan, Ann Arbor. They reported receiving grant support from the National Institutes of Health and the Department of Veterans Affairs. These remarks were taken from their editorial accompanying Dr. Jackson’s report (Lancet 2014 [doi:10.1016/S2213-2600(14)70071-2]).
Just 15 years ago, the long-term sequelae of severe sepsis and acute respiratory distress syndrome were unknown, said Dr. Hallie C. Prescott and Dr. Theodore J. Iwashyna. But as survival rates in intensive care units improved, "it became clear that something was not right. Survivors were not the same after critical illness. Rather, they had new weaknesses, cognitive impairment, depression, and early death."
But the causes and treatment of post–intensive care syndrome have eluded researchers, said Dr. Prescott and Dr. Iwashyna. The current study’s findings help fill that gap. "By differentiation of depression into cognitive and physical components, Jackson and colleagues have provided an important step towards tailoring of future interventions to specific symptoms subsets, and not the generic diagnosis of depression."
Somatic symptoms among survivors might be from functional limitations and medical comorbidities instead of a neurochemical imbalance, they added. "As such, traditional pharmacologic therapies for depression might be less likely to provide significant benefit alone (or at all). Instead, doctors might need to address the many diagnoses that contribute to poor sleep, impaired concentration, weakness, and fatigue. Although largely absent from the history of post–intensive care syndrome to date, consideration is needed of how common chronic medical conditions such as diabetes, heart failure, and chronic pulmonary disease contribute to the morbidity of survivors of critical illness."
Dr. Prescott is a clinical fellow and Dr. Iwashyna is an assistant professor of internal medicine with the University of Michigan, Ann Arbor. They reported receiving grant support from the National Institutes of Health and the Department of Veterans Affairs. These remarks were taken from their editorial accompanying Dr. Jackson’s report (Lancet 2014 [doi:10.1016/S2213-2600(14)70071-2]).
Just 15 years ago, the long-term sequelae of severe sepsis and acute respiratory distress syndrome were unknown, said Dr. Hallie C. Prescott and Dr. Theodore J. Iwashyna. But as survival rates in intensive care units improved, "it became clear that something was not right. Survivors were not the same after critical illness. Rather, they had new weaknesses, cognitive impairment, depression, and early death."
But the causes and treatment of post–intensive care syndrome have eluded researchers, said Dr. Prescott and Dr. Iwashyna. The current study’s findings help fill that gap. "By differentiation of depression into cognitive and physical components, Jackson and colleagues have provided an important step towards tailoring of future interventions to specific symptoms subsets, and not the generic diagnosis of depression."
Somatic symptoms among survivors might be from functional limitations and medical comorbidities instead of a neurochemical imbalance, they added. "As such, traditional pharmacologic therapies for depression might be less likely to provide significant benefit alone (or at all). Instead, doctors might need to address the many diagnoses that contribute to poor sleep, impaired concentration, weakness, and fatigue. Although largely absent from the history of post–intensive care syndrome to date, consideration is needed of how common chronic medical conditions such as diabetes, heart failure, and chronic pulmonary disease contribute to the morbidity of survivors of critical illness."
Dr. Prescott is a clinical fellow and Dr. Iwashyna is an assistant professor of internal medicine with the University of Michigan, Ann Arbor. They reported receiving grant support from the National Institutes of Health and the Department of Veterans Affairs. These remarks were taken from their editorial accompanying Dr. Jackson’s report (Lancet 2014 [doi:10.1016/S2213-2600(14)70071-2]).
Patients discharged from intensive care units were far more likely to report physical symptoms of depression than posttraumatic distress disorder symptoms, based on research published online April 6 in Lancet Respiratory Medicine.
"Depression and posttraumatic distress disorder are important mental health problems after critical illness, but our findings show that depression is at least five times more common than posttraumatic distress disorder and is largely somatic in nature," said James C. Jackson, Psy.D., at Vanderbilt University in Nashville, Tenn., and his associates. "This finding suggests that physical disability contributes predominantly to this depression, which has implications for the roles of physical rehabilitation vs. antidepressant medications in the prevention and management of depression after ICU admission." Lancet
Respir. Med. 2014 March 6 [doi: 10.1016/S2213-2600(14)70051-7]
The prospective, multicenter longitudinal cohort study enrolled 821 patients (median age, 61 years) treated in medical and surgical ICUs for respiratory failure, cardiogenic shock, or septic shock.
Data were available for 406 patients 3 months after discharge, of which 37% reported at least mild depression symptoms, while only 7% reported posttraumatic stress disorder (PTSD) symptoms. At 12 months after discharge, 33% of patients reported depression, compared with 7% for PTSD. Depression was primarily somatic in nature and was common even among patients with no past history of the disorder (prevalence, 30% and 29% at 3 and 12 months, respectively). Disabilities in activities of daily living affected from 23%-32% of patients.
"Our data further show that monitoring these outcomes is relevant for survivors of all ages, and that non–pharmacological interventions during the ICU stay (previously assumed to improve physical outcomes in ICU survivors) should be tested in terms of their ability to change mental health and functional outcomes," the investigators concluded.
Dr. Jackson receives grant support from the National Institutes of Health. Ten of his associates reported receiving funding, honoraria, and other support from Hospira; Abbott; Orion Pharma; the Veterans Affairs Clinical Science Research and Development Service; the Tennessee Valley Geriatric Research, Education, and Clinical Center; the National Institutes of Health; and the Vanderbilt Clinical and Translational Research Scholars Program.
Patients discharged from intensive care units were far more likely to report physical symptoms of depression than posttraumatic distress disorder symptoms, based on research published online April 6 in Lancet Respiratory Medicine.
"Depression and posttraumatic distress disorder are important mental health problems after critical illness, but our findings show that depression is at least five times more common than posttraumatic distress disorder and is largely somatic in nature," said James C. Jackson, Psy.D., at Vanderbilt University in Nashville, Tenn., and his associates. "This finding suggests that physical disability contributes predominantly to this depression, which has implications for the roles of physical rehabilitation vs. antidepressant medications in the prevention and management of depression after ICU admission." Lancet
Respir. Med. 2014 March 6 [doi: 10.1016/S2213-2600(14)70051-7]
The prospective, multicenter longitudinal cohort study enrolled 821 patients (median age, 61 years) treated in medical and surgical ICUs for respiratory failure, cardiogenic shock, or septic shock.
Data were available for 406 patients 3 months after discharge, of which 37% reported at least mild depression symptoms, while only 7% reported posttraumatic stress disorder (PTSD) symptoms. At 12 months after discharge, 33% of patients reported depression, compared with 7% for PTSD. Depression was primarily somatic in nature and was common even among patients with no past history of the disorder (prevalence, 30% and 29% at 3 and 12 months, respectively). Disabilities in activities of daily living affected from 23%-32% of patients.
"Our data further show that monitoring these outcomes is relevant for survivors of all ages, and that non–pharmacological interventions during the ICU stay (previously assumed to improve physical outcomes in ICU survivors) should be tested in terms of their ability to change mental health and functional outcomes," the investigators concluded.
Dr. Jackson receives grant support from the National Institutes of Health. Ten of his associates reported receiving funding, honoraria, and other support from Hospira; Abbott; Orion Pharma; the Veterans Affairs Clinical Science Research and Development Service; the Tennessee Valley Geriatric Research, Education, and Clinical Center; the National Institutes of Health; and the Vanderbilt Clinical and Translational Research Scholars Program.
FROM THE LANCET
Major finding: At 3 months and 12 months after discharge, 37% and 33% of patients reported at least mild depression while only 7% reported symptoms of posttraumatic stress disorder.
Data source: Prospective, multicenter longitudinal cohort study of 821 patients with respiratory failure or shock treated in ICUs, with 448 assessed at 3 months and 382 assessed at 12 months.
Disclosures: Dr. Jackson receives grant support from the National Institutes of Health. Ten of his associates reported receiving funding, honoraria, and other support from Hospira; Abbott; Orion Pharma; the Veterans Affairs Clinical Science Research and Development Service; the Tennessee Valley Geriatric Research, Education, and Clinical Center; the National Institutes of Health; and the Vanderbilt Clinical and Translational Research Scholars Program.
Sacral nerve stimulation reduced irritable bowel symptoms
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
Permanent sacral nerve stimulation looked promising in a prospective, randomized controlled study to reduce symptoms in a select group of 21 adults with diarrhea-predominant or mixed irritable bowel syndrome.
In this crossover trial, all patients had sacral nerve stimulators implanted. One group had the stimulator turned on for 1 month and off the next month, while the other group had the opposite – the stimulator was off and then on during those same time periods. Active stimulation improved symptom scores as measured by the Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome (GSRS-IBS).
The median change in symptom scores between months 1 and 2 differed significantly between the two groups. In the group that had the stimulator on and then off, symptom scores increased by a median of 12 points. In the group that had the stimulator off and then on, scores decreased by a median of 18 points, Janne L. Fassov, Ph.D., and associates reported.
One year later, with sacral nerve stimulation continuing and data available from 19 patients, the median GSRS-IBS score of 25 was significantly lower than the median symptom score of 62 at baseline, reported Dr. Fassov of Aarhus (Denmark) University Hospital.
The Annals of Surgery published the findings online ahead of print (2014 Feb. 6 [doi:10.1097/SLA.000000000000559]).
The investigators recruited 43 patients from their tertiary care institution who had failed standard treatments for diarrhea-predominant or mixed irritable bowel syndrome. After undergoing a percutaneous nerve evaluation under general anesthesia, they underwent 3 weeks of stimulation using a test electrode connected to an external neurostimulator. Thirty-one patients who had at least a 30% reduction in GSRS-IBS symptom scores during the 3-week test period were offered permanent implantation of the neurostimulator. Patients worked with a nurse specialist for 1-20 months after implantation to individually optimize the stimulator settings for best symptom control before being randomized in the current study.
Two patients who became pregnant and three who withdrew consent did not get stimulators. Five of 26 patients with permanent implantation were excluded from the results, two because of gastric bypass procedures before the crossover month, one who was mentally unstable, and two who refused to have the stimulator turned off because of its excellent effects.
Although patients and investigators were not told when the stimulators were on or off, patients usually could sense when they were on, so the study was not truly blinded.
One of the 21 remaining patients withdrew from the study before finishing it after needing morphine to relieve abdominal pain during the month that the neurostimulator was off.
In the 20 patients who completed the study, quality of life scores on the Irritable Bowel Syndrome Impact Scale (IBS-IS) improved during the month with stimulation. When stimulation went from on to off, IBS-IS scores increased by a median of 16 points. When stimulation went from off to on, IBS-IS scores decreased by a median of 42 points. The difference in median changes between the two groups was statistically significant.
Scores improved significantly with stimulation in all five domains of the symptom scale (pain, bloating, constipation, diarrhea, and satiety) and in all five domains of the quality of life scale (fatigue, daily impaired activities, sleep, emotional distress, and eating habits).
Ten device-related adverse events in seven patients included elective revision of the lead for suspected migration in two patients, persistent postoperative pain at the implantation site requiring relocation of the pacemaker in three patients, recurrent cystitis in one patient that resolved with triple voiding, and spontaneously resolving postoperative pain at the implantation site in four patients.
Sacral nerve stimulation is a well-established, cost-effective treatment for fecal incontinence, and the effects of stimulation for inflammatory bowel disease in this study were similar to those that have been reported for fecal incontinence, the investigators noted. Because minor complications are common with sacral nerve stimulation, this treatment should be reserved for patients with inflammatory bowel disease who do not respond to pharmacotherapy, they suggested.
Medtronic provided its neurostimulators for the study free of charge. Some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
On Twitter @sherryboschert
FROM ANNALS OF SURGERY
Major finding: Median symptom scores worsened by 12 points between months when the stimulator was on and then off and improved by 18 points between months when the stimulator was off and then on, a significant difference.
Data source: A prospective, randomized, controlled crossover study of 21 patients with diarrhea-predominant or mixed irritable bowel syndrome at a single institution.
Disclosures: Medtronic provided the neurostimulators for the study free of charge and some of Dr. Fassov’s associates in the study have been speakers and/or advisers for Medtronic. The Danish Council for Strategic Research funded the study.
VIDEO: Rethink the VTE prophylaxis mantra
LAS VEGAS – Venous thromboembolism prophylaxis – a sine qua non of the Joint Commission and others – doesn’t seem to prevent deep vein thrombosis or pulmonary embolism in hospitalized medical patients, but it does make them more likely to bleed, according to investigators from the Michigan Hospital Medicine Safety Consortium.
The findings are prompting one of those investigators to reassess his own approach. In an interview at the Society of Hospital Medicine’s 2014 meeting, Dr. Scott Kaatz, chief quality officer at Hurley Medical Center in Flint, Mich., told us how he’s thinking a bit differently these days when it comes to VTE prophylaxis in medical inpatients.
LAS VEGAS – Venous thromboembolism prophylaxis – a sine qua non of the Joint Commission and others – doesn’t seem to prevent deep vein thrombosis or pulmonary embolism in hospitalized medical patients, but it does make them more likely to bleed, according to investigators from the Michigan Hospital Medicine Safety Consortium.
The findings are prompting one of those investigators to reassess his own approach. In an interview at the Society of Hospital Medicine’s 2014 meeting, Dr. Scott Kaatz, chief quality officer at Hurley Medical Center in Flint, Mich., told us how he’s thinking a bit differently these days when it comes to VTE prophylaxis in medical inpatients.
LAS VEGAS – Venous thromboembolism prophylaxis – a sine qua non of the Joint Commission and others – doesn’t seem to prevent deep vein thrombosis or pulmonary embolism in hospitalized medical patients, but it does make them more likely to bleed, according to investigators from the Michigan Hospital Medicine Safety Consortium.
The findings are prompting one of those investigators to reassess his own approach. In an interview at the Society of Hospital Medicine’s 2014 meeting, Dr. Scott Kaatz, chief quality officer at Hurley Medical Center in Flint, Mich., told us how he’s thinking a bit differently these days when it comes to VTE prophylaxis in medical inpatients.
AT HOSPITAL MEDICINE 2014
More than half eligible opted out of PQRS and eRx incentives in 2012
More than half of eligible providers did not participate in either the Physician Quality Reporting System or the Electronic Prescriber program in 2012, according to a comprehensive report released by the Centers for Medicare & Medicaid Services April 3.
The Physician Quality Reporting System (PQRS) was created by the Tax Relief and Health Care Act of 2006; the first reporting year was 2007. Physicians will be penalized beginning in 2015 if they do not successfully report the required quality measures.
In 2012, 64% of more than 1.2 million eligible health care providers did not participate in PQRS. The approximately 436,000 who did participate received incentives equal to 0.5% of their Medicare Part B allowable charges for the year. Participation in the program increased 36% from 2011 to 2012*, according to the CMS report.
The Electronic Prescriber (eRx) program was created by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, and began in 2009.
Eligible health care providers had to report for at least the first 6 months of 2013 to avoid a penalty in 2014. Prescribers also could be penalized in 2012 and 2013 if they were not deemed successful e-prescribers.
Just over half (56%) of about 779,000 eligible health care providers opted out of the eRx program in 2012, while the 345,000 who participated received a bonus payment. That represented a 22% increase in participation from 2011. About 60,000 of those who were eligible did not receive an incentive and were instead penalized. Most (75%) eligible providers were penalized because they did not participate at all. In 2012, e-prescriptions were submitted for 13 million Medicare beneficiaries.
Overall, the CMS paid $503 million in incentives through the two programs in 2012, with $167 million going to PQRS participants, and $335 million to eRx participants. The average PQRS payment was $457 and the average eRx payment was $1,474.
These totals do not include an additional 0.5% incentive payment for participation in maintenance of certification (MOC) efforts. In 2012, some 5,600 physicians received a bonus for participating in MOC. Emergency physicians led the effort, accounting for more than 3,200 of the 5,600 bonus earners. They received $1 million in incentives overall.
Emergency physicians also had the highest number of eligible providers participating in the two incentive programs – some 65% of all eligible. Other hospital-based health care providers also had high participating rates, including radiologists and nurse anesthetists.
Internists, family physicians, and cardiologists led in reporting through claims, registries, EHRs, and accountable care organizations. About 20% of eligible internists and family practice physicians participated.
The top five measures reported to the programs were on the adoption and/or use of electronic health records; tobacco screening and cessation intervention; documentation of current medications in the medical record; pneumonia vaccination for patients aged 65 years and older; and electrocardiogram for nontraumatic chest pain (emergency medicine).
On Twitter @aliciaault
*This article has been updated 4/25/2014.
More than half of eligible providers did not participate in either the Physician Quality Reporting System or the Electronic Prescriber program in 2012, according to a comprehensive report released by the Centers for Medicare & Medicaid Services April 3.
The Physician Quality Reporting System (PQRS) was created by the Tax Relief and Health Care Act of 2006; the first reporting year was 2007. Physicians will be penalized beginning in 2015 if they do not successfully report the required quality measures.
In 2012, 64% of more than 1.2 million eligible health care providers did not participate in PQRS. The approximately 436,000 who did participate received incentives equal to 0.5% of their Medicare Part B allowable charges for the year. Participation in the program increased 36% from 2011 to 2012*, according to the CMS report.
The Electronic Prescriber (eRx) program was created by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, and began in 2009.
Eligible health care providers had to report for at least the first 6 months of 2013 to avoid a penalty in 2014. Prescribers also could be penalized in 2012 and 2013 if they were not deemed successful e-prescribers.
Just over half (56%) of about 779,000 eligible health care providers opted out of the eRx program in 2012, while the 345,000 who participated received a bonus payment. That represented a 22% increase in participation from 2011. About 60,000 of those who were eligible did not receive an incentive and were instead penalized. Most (75%) eligible providers were penalized because they did not participate at all. In 2012, e-prescriptions were submitted for 13 million Medicare beneficiaries.
Overall, the CMS paid $503 million in incentives through the two programs in 2012, with $167 million going to PQRS participants, and $335 million to eRx participants. The average PQRS payment was $457 and the average eRx payment was $1,474.
These totals do not include an additional 0.5% incentive payment for participation in maintenance of certification (MOC) efforts. In 2012, some 5,600 physicians received a bonus for participating in MOC. Emergency physicians led the effort, accounting for more than 3,200 of the 5,600 bonus earners. They received $1 million in incentives overall.
Emergency physicians also had the highest number of eligible providers participating in the two incentive programs – some 65% of all eligible. Other hospital-based health care providers also had high participating rates, including radiologists and nurse anesthetists.
Internists, family physicians, and cardiologists led in reporting through claims, registries, EHRs, and accountable care organizations. About 20% of eligible internists and family practice physicians participated.
The top five measures reported to the programs were on the adoption and/or use of electronic health records; tobacco screening and cessation intervention; documentation of current medications in the medical record; pneumonia vaccination for patients aged 65 years and older; and electrocardiogram for nontraumatic chest pain (emergency medicine).
On Twitter @aliciaault
*This article has been updated 4/25/2014.
More than half of eligible providers did not participate in either the Physician Quality Reporting System or the Electronic Prescriber program in 2012, according to a comprehensive report released by the Centers for Medicare & Medicaid Services April 3.
The Physician Quality Reporting System (PQRS) was created by the Tax Relief and Health Care Act of 2006; the first reporting year was 2007. Physicians will be penalized beginning in 2015 if they do not successfully report the required quality measures.
In 2012, 64% of more than 1.2 million eligible health care providers did not participate in PQRS. The approximately 436,000 who did participate received incentives equal to 0.5% of their Medicare Part B allowable charges for the year. Participation in the program increased 36% from 2011 to 2012*, according to the CMS report.
The Electronic Prescriber (eRx) program was created by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, and began in 2009.
Eligible health care providers had to report for at least the first 6 months of 2013 to avoid a penalty in 2014. Prescribers also could be penalized in 2012 and 2013 if they were not deemed successful e-prescribers.
Just over half (56%) of about 779,000 eligible health care providers opted out of the eRx program in 2012, while the 345,000 who participated received a bonus payment. That represented a 22% increase in participation from 2011. About 60,000 of those who were eligible did not receive an incentive and were instead penalized. Most (75%) eligible providers were penalized because they did not participate at all. In 2012, e-prescriptions were submitted for 13 million Medicare beneficiaries.
Overall, the CMS paid $503 million in incentives through the two programs in 2012, with $167 million going to PQRS participants, and $335 million to eRx participants. The average PQRS payment was $457 and the average eRx payment was $1,474.
These totals do not include an additional 0.5% incentive payment for participation in maintenance of certification (MOC) efforts. In 2012, some 5,600 physicians received a bonus for participating in MOC. Emergency physicians led the effort, accounting for more than 3,200 of the 5,600 bonus earners. They received $1 million in incentives overall.
Emergency physicians also had the highest number of eligible providers participating in the two incentive programs – some 65% of all eligible. Other hospital-based health care providers also had high participating rates, including radiologists and nurse anesthetists.
Internists, family physicians, and cardiologists led in reporting through claims, registries, EHRs, and accountable care organizations. About 20% of eligible internists and family practice physicians participated.
The top five measures reported to the programs were on the adoption and/or use of electronic health records; tobacco screening and cessation intervention; documentation of current medications in the medical record; pneumonia vaccination for patients aged 65 years and older; and electrocardiogram for nontraumatic chest pain (emergency medicine).
On Twitter @aliciaault
*This article has been updated 4/25/2014.
Medicare to release physician pay data in April
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
Medicare officials are preparing to publish data on the specific services and procedures performed by individual physicians and how much they were paid by the program. The data could be posted on the Medicare website as early as April 9.
This will be the first time the federal government has published data on individual physicians.
But the news is being greeted cautiously by physicians. The American Medical Association is asking the Centers for Medicare & Medicaid Services to let physicians review and correct their data before it is publicly released.
"This safeguard is not only practical but was recognized and included in other data release proposals," Dr. Ardis Dee Hoven, AMA president, said in a statement. "Additionally, any analysis of the data released should note methodologies to ensure understanding of its limitations. Taking an approach that provides no assurances of accuracy of the data or explanations of its limitations will not allow patients to draw meaningful conclusions about the quality of care."
Dr. Reid Blackwelder, president of the American Academy of Family Physicians, agreed. While the AAFP is generally supportive of greater transparency of physician payment data, Dr. Blackwelder said the context can often be missed when releasing this type of data.
"It may not be quite as straightforward as it might appear," he said.
The CMS announced in January that it would reverse more than 30 years of policy that restricted the release of that information. The policy shift came after a federal court lifted an injunction that had previously barred the agency from making its database of Medicare physician claims public. Agency officials said then that they would use a "case-by-case" approach when reviewing the data requests.
Since then, the CMS has received multiple Freedom of Information Act requests seeking Medicare physician data, according to Jonathan Blum, principal deputy administrator for CMS.
In an April 2 letter to the American Medical Association, the CMS said that it would begin releasing the data on its web site no sooner than April 9. The information will be organized by National Provider Identifier, Healthcare Common Procedure Coding System (HCPCS) code, and by place of service. The data set will include the average and the standard deviation for submitted charges, allowed amounts, and Medicare payments for services performed in 2012.
"Data like these can shine a light on how care is delivered in the Medicare program," Mr. Blum wrote in a blog post "They can help consumers compare the services provided and payments received by individual health care providers. Businesses and consumers alike can use these data to drive decision-making and reward quality, cost-effective care."
The data being released will provide information on more than 880,000 health care providers in all states. Collectively, these providers received $77 billion from Medicare Part B in 2012.
The CMS will not release personally identifiable information about beneficiaries and will redact all data in cases in which a data set has fewer than 11 beneficiaries.
On Twitter @maryellenny
