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National Health Service Corps to Get Overhaul
WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”
The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”
The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
WASHINGTON — With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. “But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers.”
The shortfall was even more dire for nurses—9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, “beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model.” Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
“That was designed to help with distribution of practitioners across the nation,” Dr. Wakefield said. “But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty.”
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. “I don't think this opportunity, of this magnitude and this importance, will come along very often,” Dr. Wakefield said. “It won't solve all of our problems, but it's going to help to buy us some time.”
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
Natl. Health Service Corps to Get Overhaul
WASHINGTON With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. "But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers."
The shortfall was even more dire for nurses9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, "beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model." Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
"That was designed to help with distribution of practitioners across the nation," Dr. Wakefield said. "But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty."
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. "I don't think this opportunity, of this magnitude and this importance, will come along very often," Dr. Wakefield said. "It won't solve all of our problems, but it's going to help to buy us some time."
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
WASHINGTON With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. "But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers."
The shortfall was even more dire for nurses9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, "beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model." Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
"That was designed to help with distribution of practitioners across the nation," Dr. Wakefield said. "But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty."
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. "I don't think this opportunity, of this magnitude and this importance, will come along very often," Dr. Wakefield said. "It won't solve all of our problems, but it's going to help to buy us some time."
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
WASHINGTON With $2.5 billion in Recovery Act funding, major changes are in the works for the National Health Service Corps.
And according to new Health Resources and Services Administration director Mary Wakefield, Ph.D., R.N., the money comes just in time.
Last year, 14,000 medical and nursing school graduates applied to the National Health Service Corps, the division of HRSA that recruits health professionals to shortage areas by offering full or partial repayment of their student loans, said Dr. Wakefield at a recent physician workforce conference sponsored by the Association of American Medical Colleges. "But the agency was only budgeted to respond to one out of every seven requests, in spite of a tremendous need for those providers."
The shortfall was even more dire for nurses9,000 applications were received for 600 budgeted slots.
But this year, with an extra $300 million from the American Recovery and Reinvestment Act specifically allocated to the agency's health professions programs, the corps will accept about 4,100 more doctors, dentists, and nurses than last year.
The application and placement processes for the corps are also being overhauled, according to Dr. Wakefield. Previously, applicants had a fixed, annual, 30-day window to apply; however, "beginning in May, HRSA will suspend that requirement for the 2-year duration of the Recovery Act, and switch to a rolling application model." Dr. Wakefield added that she will push for this open enrollment model to continue even after the Recovery Act money runs out.
A provisional prequalification program will also be put into place, so that medical and nursing school students can apply and receive notification of acceptance while still in their final year of school. Previously, only licensed graduates were eligible, resulting in a lag between graduation and corps service.
HRSA-approved health care sites will also be able to post more jobs to the online corps job board. Until now, only two vacancies per specialty were allowed per site, no matter the actual need.
"That was designed to help with distribution of practitioners across the nation," Dr. Wakefield said. "But now, with the incredible expansion of the corps under the Recovery Act, HRSA will allow eligible sites to advertise up to six vacancies per specialty."
The changes should add up to an infusion of health care workers in rural and shortage areas in 2009 and 2010. "I don't think this opportunity, of this magnitude and this importance, will come along very often," Dr. Wakefield said. "It won't solve all of our problems, but it's going to help to buy us some time."
Dr. Wakefield was appointed to her current position in February by President Obama. Prior to joining the government, she was an associate dean for rural health at the University of North Dakota School of Medicine and Health Sciences, Grand Forks.
Knowledge Gaps Wide On MMRV Vaccine
BALTIMORE — In a survey, just 26% of family physicians, compared with 71% of pediatricians, were aware of the known link between febrile seizure and the combination measles, mumps, rubella, and varicella vaccine in children aged 12-15 months.
Moreover, 18% of family physicians, versus 65% of pediatricians, were aware that the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) had withdrawn its preference for the combination vaccine in this population in February 2008, based on the increased seizure risk.
The MMRV vaccine, manufactured by Merck, was licensed in the United States in 2005, with an initial dose recommended at 12-15 months of age, and a second dose at 4-6 years. Postlicensure studies from 2007 showed that the risk for febrile seizures 5-12 days post vaccination was roughly twofold greater in children who had received the combination vaccine, compared with children who had received the MMR and varicella (MMR+V) vaccines separately.
The findings, presented by Dr. Christina Suh in a late-breaking abstract session at the annual meeting of the Pediatric Academic Societies, are based on a random sample of physicians in the American Academy of Family Physicians and the American Academy of Pediatrics membership databases. The survey was conducted via regular mail and over the Internet between October 2008 and January 2009. A total of 321 pediatricians and 299 family medicine physicians responded.
Dr. Suh, of the department of pediatrics at the University of Colorado, Denver, and colleagues, found that 43% of family physicians and 74% of pediatricians had offered the MMRV combination vaccine in the past 2 years to patients aged 12-15 months.
After being apprised of the risk data, 21% of pediatricians and 9% of family physicians indicated that they would give the combination MMRV to a healthy 12- to 15-month-old; 38% of pediatricians and 20% of family physicians would give the combination vaccine to a healthy 4- to 6-year-old.
The investigators disclosed no conflicts of interest.
BALTIMORE — In a survey, just 26% of family physicians, compared with 71% of pediatricians, were aware of the known link between febrile seizure and the combination measles, mumps, rubella, and varicella vaccine in children aged 12-15 months.
Moreover, 18% of family physicians, versus 65% of pediatricians, were aware that the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) had withdrawn its preference for the combination vaccine in this population in February 2008, based on the increased seizure risk.
The MMRV vaccine, manufactured by Merck, was licensed in the United States in 2005, with an initial dose recommended at 12-15 months of age, and a second dose at 4-6 years. Postlicensure studies from 2007 showed that the risk for febrile seizures 5-12 days post vaccination was roughly twofold greater in children who had received the combination vaccine, compared with children who had received the MMR and varicella (MMR+V) vaccines separately.
The findings, presented by Dr. Christina Suh in a late-breaking abstract session at the annual meeting of the Pediatric Academic Societies, are based on a random sample of physicians in the American Academy of Family Physicians and the American Academy of Pediatrics membership databases. The survey was conducted via regular mail and over the Internet between October 2008 and January 2009. A total of 321 pediatricians and 299 family medicine physicians responded.
Dr. Suh, of the department of pediatrics at the University of Colorado, Denver, and colleagues, found that 43% of family physicians and 74% of pediatricians had offered the MMRV combination vaccine in the past 2 years to patients aged 12-15 months.
After being apprised of the risk data, 21% of pediatricians and 9% of family physicians indicated that they would give the combination MMRV to a healthy 12- to 15-month-old; 38% of pediatricians and 20% of family physicians would give the combination vaccine to a healthy 4- to 6-year-old.
The investigators disclosed no conflicts of interest.
BALTIMORE — In a survey, just 26% of family physicians, compared with 71% of pediatricians, were aware of the known link between febrile seizure and the combination measles, mumps, rubella, and varicella vaccine in children aged 12-15 months.
Moreover, 18% of family physicians, versus 65% of pediatricians, were aware that the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) had withdrawn its preference for the combination vaccine in this population in February 2008, based on the increased seizure risk.
The MMRV vaccine, manufactured by Merck, was licensed in the United States in 2005, with an initial dose recommended at 12-15 months of age, and a second dose at 4-6 years. Postlicensure studies from 2007 showed that the risk for febrile seizures 5-12 days post vaccination was roughly twofold greater in children who had received the combination vaccine, compared with children who had received the MMR and varicella (MMR+V) vaccines separately.
The findings, presented by Dr. Christina Suh in a late-breaking abstract session at the annual meeting of the Pediatric Academic Societies, are based on a random sample of physicians in the American Academy of Family Physicians and the American Academy of Pediatrics membership databases. The survey was conducted via regular mail and over the Internet between October 2008 and January 2009. A total of 321 pediatricians and 299 family medicine physicians responded.
Dr. Suh, of the department of pediatrics at the University of Colorado, Denver, and colleagues, found that 43% of family physicians and 74% of pediatricians had offered the MMRV combination vaccine in the past 2 years to patients aged 12-15 months.
After being apprised of the risk data, 21% of pediatricians and 9% of family physicians indicated that they would give the combination MMRV to a healthy 12- to 15-month-old; 38% of pediatricians and 20% of family physicians would give the combination vaccine to a healthy 4- to 6-year-old.
The investigators disclosed no conflicts of interest.
Weight Loss Surgery Trumps Other Methods
Bariatric surgery is more effective than is conventional weight loss management in terms of weight lost, improved quality of life, and decreased comorbidities, according to an updated review by the Cochrane Collaboration.
The goal of the review, according to the authors, was twofold.
First, they set out to evaluate the effectiveness of surgery compared with nonsurgical weight loss methods.
Second, they compared the different types of weight loss surgery to each other, including gastric bypass surgery, vertical banded gastroplasty, adjustable gastric banding, and isolated sleevegastrectomy.
Unfortunately, only 26 trials met the researchers' qualifications for inclusion, according to the authors, led by Prof. Jill L. Colquitt of the University of Southampton, England (Cochrane Database Syst. Rev. 2009 April 15 [doi: 10.1002/14651858.CD003641.pub3]).
Furthermore, even among those trials, “The risk of bias of many trials was uncertain; just five had adequate allocation concealment,” wrote the authors, adding that they were unable to conduct a meta-analysis for that reason.
Also, because of the limited data, they could not assess the safety of the various procedures.
Among the review's other notable findings:
▸ Surgical intervention led to greater improvements in comorbidities such as diabetes, metabolic syndrome, and hypertension than did nonsurgical intervention at follow-up periods between 2 and 10 years. In the most definitive example of this, one study that specifically enrolled type 2 diabetes patients found that 2 years after laparoscopic adjustable gastric banding surgery there was significantly higher remission of the disease compared with conventional therapy (73% versus 13%) (JAMA 2008;299:316-23).
▸ Although there is limited good-quality evidence comparing types of surgery, the data suggest that weight loss following gastric bypass is “greater than vertical banded gastroplasty or adjustable gastric banding, but similar to isolated sleeve gastrectomy and banded gastric bypass,” according to the authors. They added, however, that few, if any, trials examined this or any procedure in young people, adults with either class I or class II obesity (body mass index 30-34.9 and 35-39.9 kg/m
▸ There is a lack of data comparing the safety of each procedure. “All procedures were associated with adverse events, but few trials compared data statistically and none were powered to do so,” the authors wrote. Overall, the proportion of deaths reported in the surgery cohorts of the studies ranged from 0.25% to 10%.
The authors recommended that, for the sake of future studies, a core set of important adverse outcomes in this type of surgery should be identified.
They also recommended that future studies be undertaken to assess the effects of presurgery counseling and education on outcomes, and to “identify providers at different stages of the learning curve and to document the impact of experience on the safety, effectiveness, and efficiency of surgery.”
The analysis is the second update of bariatric surgery by the Cochrane Collaboration. The first review was published in 2003, and a previous update was published in 2005.
The authors indicated that they did not have any conflicts of interest with regard to this review.
The study was sponsored by the United Kingdom's National Institute for Health Research.
Bariatric surgery is more effective than is conventional weight loss management in terms of weight lost, improved quality of life, and decreased comorbidities, according to an updated review by the Cochrane Collaboration.
The goal of the review, according to the authors, was twofold.
First, they set out to evaluate the effectiveness of surgery compared with nonsurgical weight loss methods.
Second, they compared the different types of weight loss surgery to each other, including gastric bypass surgery, vertical banded gastroplasty, adjustable gastric banding, and isolated sleevegastrectomy.
Unfortunately, only 26 trials met the researchers' qualifications for inclusion, according to the authors, led by Prof. Jill L. Colquitt of the University of Southampton, England (Cochrane Database Syst. Rev. 2009 April 15 [doi: 10.1002/14651858.CD003641.pub3]).
Furthermore, even among those trials, “The risk of bias of many trials was uncertain; just five had adequate allocation concealment,” wrote the authors, adding that they were unable to conduct a meta-analysis for that reason.
Also, because of the limited data, they could not assess the safety of the various procedures.
Among the review's other notable findings:
▸ Surgical intervention led to greater improvements in comorbidities such as diabetes, metabolic syndrome, and hypertension than did nonsurgical intervention at follow-up periods between 2 and 10 years. In the most definitive example of this, one study that specifically enrolled type 2 diabetes patients found that 2 years after laparoscopic adjustable gastric banding surgery there was significantly higher remission of the disease compared with conventional therapy (73% versus 13%) (JAMA 2008;299:316-23).
▸ Although there is limited good-quality evidence comparing types of surgery, the data suggest that weight loss following gastric bypass is “greater than vertical banded gastroplasty or adjustable gastric banding, but similar to isolated sleeve gastrectomy and banded gastric bypass,” according to the authors. They added, however, that few, if any, trials examined this or any procedure in young people, adults with either class I or class II obesity (body mass index 30-34.9 and 35-39.9 kg/m
▸ There is a lack of data comparing the safety of each procedure. “All procedures were associated with adverse events, but few trials compared data statistically and none were powered to do so,” the authors wrote. Overall, the proportion of deaths reported in the surgery cohorts of the studies ranged from 0.25% to 10%.
The authors recommended that, for the sake of future studies, a core set of important adverse outcomes in this type of surgery should be identified.
They also recommended that future studies be undertaken to assess the effects of presurgery counseling and education on outcomes, and to “identify providers at different stages of the learning curve and to document the impact of experience on the safety, effectiveness, and efficiency of surgery.”
The analysis is the second update of bariatric surgery by the Cochrane Collaboration. The first review was published in 2003, and a previous update was published in 2005.
The authors indicated that they did not have any conflicts of interest with regard to this review.
The study was sponsored by the United Kingdom's National Institute for Health Research.
Bariatric surgery is more effective than is conventional weight loss management in terms of weight lost, improved quality of life, and decreased comorbidities, according to an updated review by the Cochrane Collaboration.
The goal of the review, according to the authors, was twofold.
First, they set out to evaluate the effectiveness of surgery compared with nonsurgical weight loss methods.
Second, they compared the different types of weight loss surgery to each other, including gastric bypass surgery, vertical banded gastroplasty, adjustable gastric banding, and isolated sleevegastrectomy.
Unfortunately, only 26 trials met the researchers' qualifications for inclusion, according to the authors, led by Prof. Jill L. Colquitt of the University of Southampton, England (Cochrane Database Syst. Rev. 2009 April 15 [doi: 10.1002/14651858.CD003641.pub3]).
Furthermore, even among those trials, “The risk of bias of many trials was uncertain; just five had adequate allocation concealment,” wrote the authors, adding that they were unable to conduct a meta-analysis for that reason.
Also, because of the limited data, they could not assess the safety of the various procedures.
Among the review's other notable findings:
▸ Surgical intervention led to greater improvements in comorbidities such as diabetes, metabolic syndrome, and hypertension than did nonsurgical intervention at follow-up periods between 2 and 10 years. In the most definitive example of this, one study that specifically enrolled type 2 diabetes patients found that 2 years after laparoscopic adjustable gastric banding surgery there was significantly higher remission of the disease compared with conventional therapy (73% versus 13%) (JAMA 2008;299:316-23).
▸ Although there is limited good-quality evidence comparing types of surgery, the data suggest that weight loss following gastric bypass is “greater than vertical banded gastroplasty or adjustable gastric banding, but similar to isolated sleeve gastrectomy and banded gastric bypass,” according to the authors. They added, however, that few, if any, trials examined this or any procedure in young people, adults with either class I or class II obesity (body mass index 30-34.9 and 35-39.9 kg/m
▸ There is a lack of data comparing the safety of each procedure. “All procedures were associated with adverse events, but few trials compared data statistically and none were powered to do so,” the authors wrote. Overall, the proportion of deaths reported in the surgery cohorts of the studies ranged from 0.25% to 10%.
The authors recommended that, for the sake of future studies, a core set of important adverse outcomes in this type of surgery should be identified.
They also recommended that future studies be undertaken to assess the effects of presurgery counseling and education on outcomes, and to “identify providers at different stages of the learning curve and to document the impact of experience on the safety, effectiveness, and efficiency of surgery.”
The analysis is the second update of bariatric surgery by the Cochrane Collaboration. The first review was published in 2003, and a previous update was published in 2005.
The authors indicated that they did not have any conflicts of interest with regard to this review.
The study was sponsored by the United Kingdom's National Institute for Health Research.
State Coverage Expansion a Casualty of Recession
WASHINGTON — Massive budget shortfalls in 40 states, coupled with greater demand for Medicaid coverage, made it tough for states to expand health care coverage for their residents last year, according to the annual survey of state health care and insurance legislation done by the Blue Cross and Blue Shield Association.
However, the Recovery Act (formally known as the American Recovery and Reinvestment Act of 2009)—promises to make things easier in 2009, according to Susan Laudicina, director of state policy and research at the Blue Cross and Blue Shield Association. “The money in the [recovery] act is certainly going to help states avoid deep cuts to the Medicaid program. Is it adequate? Probably more money is needed.”
Nevertheless, according to Ms. Laudicina, states see better times ahead. “What's happening right now is governors are actually redoing their budgets.
“States are immediately factoring in [the stimulus money]. In many cases, it is closing the budget gap, and in some cases, they are avoiding cuts. “Is it going to close all gaps? No.”
According to the annual State of the States report, the economic crisis meant that most expansion efforts fell short in 2008, even in high-profile states with governor backing, like California, New Mexico, and Pennsylvania.
“There has not been a consensus [to mandate universal coverage] since Massachusetts, now going on 3 years ago,” said Ms. Laudicina. Still, some states, including Connecticut, Hawaii, Minnesota, Oregon, and Washington, are now developing universal care strategies that they will try to pass into law in 2009.
“Now that Obama is pledging to reform some things this year, and put $634 billion in his budget for use in future reforms, does that mean the states are going to hold off [on these plans]?” said Ms. Laudicina in an interview.
“Frankly, since we don't know when a national health care reform bill will be enacted, we don't know the tools that will be used. … I expect that states such as Oregon … and Minnesota and Connecticut that are interested in creating commissions are going to go ahead with their plans. They're going to plan all they can. They're going to assume that they're going to be big players in whatever national bill comes down the pike.”
The State of the States report also showed that expansion of coverage for children was not spared from states' fiscal problems last year, according to the report.
However, some states, including Colorado, Florida, Kansas, and Minnesota, did modestly expand their Children's Health Insurance Programs (CHIP).
In New Jersey, the Health Care Reform Act (S. 1537) mandated coverage for all children under age 18 years, though without any minimum benefit requirements. “Parents can comply with the mandate program by purchasing a licensed private product or by enrolling in Medicaid or CHIP,” according to the report. However, the funding source for such an expansion has yet to be determined, as does the enforcement mechanism.
The survey also reported on health care transparency efforts. In the 20 states that introduced such bills in 2008, nine laws were enacted, Ms. Laudicina said. Some of these, like H.B. 1393 in Colorado, require hospitals to display charges for common inpatient procedures on a publicly accessible Web site.
Others, like Louisiana's Right to Know Act (S. 287), require that the state's department of health and hospitals display not only cost information, but also data on quality measures among medical facilities, individual physicians, and health plans.
Regarding health information technology measures, Ms. Laudicina said that over the past 3 years, 33 states have enacted legislation promoting the adoption of electronic medical records, and bills are pending in 12 more. And the financial incentives for electronic medical records adoption in the stimulus package should mean that even more physicians and facilities implement them voluntarily.
Other proposals considered by states in 2008 included mandated coverage of adult dependent children until age 25, 26, or even 30 years, said Alissa Fox, senior vice president of the Office of Policy and Representation at the Blue Cross and Blue Shield Association. This possibility will remain on states' agendas in 2009.
The report is based on a survey of the 39 independent Blue Cross and Blue Shield companies across the nation.
For details on how individual states will implement stimulus funds, Ms. Laudicina recommended the National Governor's Association Web site, at www.nga.org/arra
WASHINGTON — Massive budget shortfalls in 40 states, coupled with greater demand for Medicaid coverage, made it tough for states to expand health care coverage for their residents last year, according to the annual survey of state health care and insurance legislation done by the Blue Cross and Blue Shield Association.
However, the Recovery Act (formally known as the American Recovery and Reinvestment Act of 2009)—promises to make things easier in 2009, according to Susan Laudicina, director of state policy and research at the Blue Cross and Blue Shield Association. “The money in the [recovery] act is certainly going to help states avoid deep cuts to the Medicaid program. Is it adequate? Probably more money is needed.”
Nevertheless, according to Ms. Laudicina, states see better times ahead. “What's happening right now is governors are actually redoing their budgets.
“States are immediately factoring in [the stimulus money]. In many cases, it is closing the budget gap, and in some cases, they are avoiding cuts. “Is it going to close all gaps? No.”
According to the annual State of the States report, the economic crisis meant that most expansion efforts fell short in 2008, even in high-profile states with governor backing, like California, New Mexico, and Pennsylvania.
“There has not been a consensus [to mandate universal coverage] since Massachusetts, now going on 3 years ago,” said Ms. Laudicina. Still, some states, including Connecticut, Hawaii, Minnesota, Oregon, and Washington, are now developing universal care strategies that they will try to pass into law in 2009.
“Now that Obama is pledging to reform some things this year, and put $634 billion in his budget for use in future reforms, does that mean the states are going to hold off [on these plans]?” said Ms. Laudicina in an interview.
“Frankly, since we don't know when a national health care reform bill will be enacted, we don't know the tools that will be used. … I expect that states such as Oregon … and Minnesota and Connecticut that are interested in creating commissions are going to go ahead with their plans. They're going to plan all they can. They're going to assume that they're going to be big players in whatever national bill comes down the pike.”
The State of the States report also showed that expansion of coverage for children was not spared from states' fiscal problems last year, according to the report.
However, some states, including Colorado, Florida, Kansas, and Minnesota, did modestly expand their Children's Health Insurance Programs (CHIP).
In New Jersey, the Health Care Reform Act (S. 1537) mandated coverage for all children under age 18 years, though without any minimum benefit requirements. “Parents can comply with the mandate program by purchasing a licensed private product or by enrolling in Medicaid or CHIP,” according to the report. However, the funding source for such an expansion has yet to be determined, as does the enforcement mechanism.
The survey also reported on health care transparency efforts. In the 20 states that introduced such bills in 2008, nine laws were enacted, Ms. Laudicina said. Some of these, like H.B. 1393 in Colorado, require hospitals to display charges for common inpatient procedures on a publicly accessible Web site.
Others, like Louisiana's Right to Know Act (S. 287), require that the state's department of health and hospitals display not only cost information, but also data on quality measures among medical facilities, individual physicians, and health plans.
Regarding health information technology measures, Ms. Laudicina said that over the past 3 years, 33 states have enacted legislation promoting the adoption of electronic medical records, and bills are pending in 12 more. And the financial incentives for electronic medical records adoption in the stimulus package should mean that even more physicians and facilities implement them voluntarily.
Other proposals considered by states in 2008 included mandated coverage of adult dependent children until age 25, 26, or even 30 years, said Alissa Fox, senior vice president of the Office of Policy and Representation at the Blue Cross and Blue Shield Association. This possibility will remain on states' agendas in 2009.
The report is based on a survey of the 39 independent Blue Cross and Blue Shield companies across the nation.
For details on how individual states will implement stimulus funds, Ms. Laudicina recommended the National Governor's Association Web site, at www.nga.org/arra
WASHINGTON — Massive budget shortfalls in 40 states, coupled with greater demand for Medicaid coverage, made it tough for states to expand health care coverage for their residents last year, according to the annual survey of state health care and insurance legislation done by the Blue Cross and Blue Shield Association.
However, the Recovery Act (formally known as the American Recovery and Reinvestment Act of 2009)—promises to make things easier in 2009, according to Susan Laudicina, director of state policy and research at the Blue Cross and Blue Shield Association. “The money in the [recovery] act is certainly going to help states avoid deep cuts to the Medicaid program. Is it adequate? Probably more money is needed.”
Nevertheless, according to Ms. Laudicina, states see better times ahead. “What's happening right now is governors are actually redoing their budgets.
“States are immediately factoring in [the stimulus money]. In many cases, it is closing the budget gap, and in some cases, they are avoiding cuts. “Is it going to close all gaps? No.”
According to the annual State of the States report, the economic crisis meant that most expansion efforts fell short in 2008, even in high-profile states with governor backing, like California, New Mexico, and Pennsylvania.
“There has not been a consensus [to mandate universal coverage] since Massachusetts, now going on 3 years ago,” said Ms. Laudicina. Still, some states, including Connecticut, Hawaii, Minnesota, Oregon, and Washington, are now developing universal care strategies that they will try to pass into law in 2009.
“Now that Obama is pledging to reform some things this year, and put $634 billion in his budget for use in future reforms, does that mean the states are going to hold off [on these plans]?” said Ms. Laudicina in an interview.
“Frankly, since we don't know when a national health care reform bill will be enacted, we don't know the tools that will be used. … I expect that states such as Oregon … and Minnesota and Connecticut that are interested in creating commissions are going to go ahead with their plans. They're going to plan all they can. They're going to assume that they're going to be big players in whatever national bill comes down the pike.”
The State of the States report also showed that expansion of coverage for children was not spared from states' fiscal problems last year, according to the report.
However, some states, including Colorado, Florida, Kansas, and Minnesota, did modestly expand their Children's Health Insurance Programs (CHIP).
In New Jersey, the Health Care Reform Act (S. 1537) mandated coverage for all children under age 18 years, though without any minimum benefit requirements. “Parents can comply with the mandate program by purchasing a licensed private product or by enrolling in Medicaid or CHIP,” according to the report. However, the funding source for such an expansion has yet to be determined, as does the enforcement mechanism.
The survey also reported on health care transparency efforts. In the 20 states that introduced such bills in 2008, nine laws were enacted, Ms. Laudicina said. Some of these, like H.B. 1393 in Colorado, require hospitals to display charges for common inpatient procedures on a publicly accessible Web site.
Others, like Louisiana's Right to Know Act (S. 287), require that the state's department of health and hospitals display not only cost information, but also data on quality measures among medical facilities, individual physicians, and health plans.
Regarding health information technology measures, Ms. Laudicina said that over the past 3 years, 33 states have enacted legislation promoting the adoption of electronic medical records, and bills are pending in 12 more. And the financial incentives for electronic medical records adoption in the stimulus package should mean that even more physicians and facilities implement them voluntarily.
Other proposals considered by states in 2008 included mandated coverage of adult dependent children until age 25, 26, or even 30 years, said Alissa Fox, senior vice president of the Office of Policy and Representation at the Blue Cross and Blue Shield Association. This possibility will remain on states' agendas in 2009.
The report is based on a survey of the 39 independent Blue Cross and Blue Shield companies across the nation.
For details on how individual states will implement stimulus funds, Ms. Laudicina recommended the National Governor's Association Web site, at www.nga.org/arra
Screening at Health Fairs Could Identify Early RA
The combination of the connective tissue diseases questionnaire plus rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity had a 95% sensitivity and 32% specificity for identifying people with at least one swollen joint at free community health fairs.
The study, presented at the Western regional meeting of the American Federation for Medical Research, is one of few to examine rheumatoid arthritis screening techniques in the community health fair setting, where more prevalent conditions, such as diabetes and hypertension, receive more attention. The nonprofit 9Health administers volunteer-driven health fairs in Colorado that offer a variety of free or low-cost screenings to more than 90,000 people per year.
In all, 601 participants (16% of total attendees) were screened at five sites in the Denver area. The researchers administered the 30-item questionnaire (Ann. Epidemiol. 1995;5:297-302) as well as blood tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP). The patients' joints were examined by a rheumatologist who was unaware of the assay and questionnaire results.
Of those screened, 84 people (14%) had one or more swollen joints that would be consistent with possible inflammatory arthritis, said Dr. Kevin Deane of the division of rheumatology of the University of Colorado, Denver. “Nine met at least four ACR criteria for RA but never had a prior diagnosis,” he said in an interview.
“An additional 15 people had a swollen joint and RF or CCP positivity, but met fewer than four ACR RA criteria. They may have early RA,” he added. And another 41 people had either RF or anti-CCP positivity but didn't have any arthritis. “So something is going on immunologically, but no arthritis yet,” he said.
“The importance of identifying RA early is growing,” Dr. Deane said, but finding people with early disease remains difficult. “We thought we would try to utilize the health fair to screen a pretty large population.”
The cost of the screening effort is $42 per person screened, which does not include salaries because the study relied on volunteers. “If you count person-hours into this, this health fair screen cost about $2,000 to identify each person with RA or inflammatory arthritis,” said Dr. Deane.
“What we don't know is, is that worth it? We think so; if you identify and treat RA early, you should reduce disability and lost work time. More study is needed to find out the true cost/benefit of this approach,” he said.
A follow-up study aiming to screen 5,000 health fair attendees is planned for later this year. Abbott Laboratories supported the cost of screening and assays, and was a cosponsor of the 9Health Fair, along with Quest Diagnostics Inc. and GE Healthcare. The authors disclosed no relevant conflicts of interest.
The combination of the connective tissue diseases questionnaire plus rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity had a 95% sensitivity and 32% specificity for identifying people with at least one swollen joint at free community health fairs.
The study, presented at the Western regional meeting of the American Federation for Medical Research, is one of few to examine rheumatoid arthritis screening techniques in the community health fair setting, where more prevalent conditions, such as diabetes and hypertension, receive more attention. The nonprofit 9Health administers volunteer-driven health fairs in Colorado that offer a variety of free or low-cost screenings to more than 90,000 people per year.
In all, 601 participants (16% of total attendees) were screened at five sites in the Denver area. The researchers administered the 30-item questionnaire (Ann. Epidemiol. 1995;5:297-302) as well as blood tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP). The patients' joints were examined by a rheumatologist who was unaware of the assay and questionnaire results.
Of those screened, 84 people (14%) had one or more swollen joints that would be consistent with possible inflammatory arthritis, said Dr. Kevin Deane of the division of rheumatology of the University of Colorado, Denver. “Nine met at least four ACR criteria for RA but never had a prior diagnosis,” he said in an interview.
“An additional 15 people had a swollen joint and RF or CCP positivity, but met fewer than four ACR RA criteria. They may have early RA,” he added. And another 41 people had either RF or anti-CCP positivity but didn't have any arthritis. “So something is going on immunologically, but no arthritis yet,” he said.
“The importance of identifying RA early is growing,” Dr. Deane said, but finding people with early disease remains difficult. “We thought we would try to utilize the health fair to screen a pretty large population.”
The cost of the screening effort is $42 per person screened, which does not include salaries because the study relied on volunteers. “If you count person-hours into this, this health fair screen cost about $2,000 to identify each person with RA or inflammatory arthritis,” said Dr. Deane.
“What we don't know is, is that worth it? We think so; if you identify and treat RA early, you should reduce disability and lost work time. More study is needed to find out the true cost/benefit of this approach,” he said.
A follow-up study aiming to screen 5,000 health fair attendees is planned for later this year. Abbott Laboratories supported the cost of screening and assays, and was a cosponsor of the 9Health Fair, along with Quest Diagnostics Inc. and GE Healthcare. The authors disclosed no relevant conflicts of interest.
The combination of the connective tissue diseases questionnaire plus rheumatoid factor and anti-cyclic citrullinated peptide antibody positivity had a 95% sensitivity and 32% specificity for identifying people with at least one swollen joint at free community health fairs.
The study, presented at the Western regional meeting of the American Federation for Medical Research, is one of few to examine rheumatoid arthritis screening techniques in the community health fair setting, where more prevalent conditions, such as diabetes and hypertension, receive more attention. The nonprofit 9Health administers volunteer-driven health fairs in Colorado that offer a variety of free or low-cost screenings to more than 90,000 people per year.
In all, 601 participants (16% of total attendees) were screened at five sites in the Denver area. The researchers administered the 30-item questionnaire (Ann. Epidemiol. 1995;5:297-302) as well as blood tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP). The patients' joints were examined by a rheumatologist who was unaware of the assay and questionnaire results.
Of those screened, 84 people (14%) had one or more swollen joints that would be consistent with possible inflammatory arthritis, said Dr. Kevin Deane of the division of rheumatology of the University of Colorado, Denver. “Nine met at least four ACR criteria for RA but never had a prior diagnosis,” he said in an interview.
“An additional 15 people had a swollen joint and RF or CCP positivity, but met fewer than four ACR RA criteria. They may have early RA,” he added. And another 41 people had either RF or anti-CCP positivity but didn't have any arthritis. “So something is going on immunologically, but no arthritis yet,” he said.
“The importance of identifying RA early is growing,” Dr. Deane said, but finding people with early disease remains difficult. “We thought we would try to utilize the health fair to screen a pretty large population.”
The cost of the screening effort is $42 per person screened, which does not include salaries because the study relied on volunteers. “If you count person-hours into this, this health fair screen cost about $2,000 to identify each person with RA or inflammatory arthritis,” said Dr. Deane.
“What we don't know is, is that worth it? We think so; if you identify and treat RA early, you should reduce disability and lost work time. More study is needed to find out the true cost/benefit of this approach,” he said.
A follow-up study aiming to screen 5,000 health fair attendees is planned for later this year. Abbott Laboratories supported the cost of screening and assays, and was a cosponsor of the 9Health Fair, along with Quest Diagnostics Inc. and GE Healthcare. The authors disclosed no relevant conflicts of interest.
On the Beat
Cardiologists on the Move
As a cardiac electrophysio-logist, Dr. Tomaselli has worked to determine what factors are predictive of success with implanted cardiac defibrillators.
In his new role, Dr. Tomaselli is expected to concentrate on early detection of arrhythmia using imaging, genetic screening, and applications of stem cell technology in damaged heart tissue.
After earning an undergraduate degree at the State University of New York at Buffalo and a medical degree from Albert Einstein College of Medicine in the Bronx, N.Y., Dr. Tomaselli completed a residency at University of California at San Francisco. He went on to join the Cardiovascular Research Institute there before moving to the fellowship program at the Johns Hopkins School of Medicine in 1986. He joined the faculty at Hopkins 3 years later.
Dr. Tomaselli will continue as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center at Hopkins. In his new post, he succeeds Dr. Eduardo Marbán, who led the division since 2002 and will remain active as adjunct faculty.
Dr. Kasper received his undergraduate degree from Johns Hopkins in 1979. After receiving his medical degree at the University of Connecticut, Farmington, he returned to his alma mater in 1987 to be a faculty instructor in medicine. He completed his cardiology specialization at JHU in 1991 and—after another brief sojourn at Vanderbilt University in Nashville, Tenn.—returned to Hopkins for good in 1993 to head up the university's transplant program—transplant and organ rejection issues being one of Dr. Kasper's primary fields of interest. Another area of research for Dr. Kasper is the biological origins of heart failure.
For the last 5 years, Dr. Kasper has been the director of cardiology at Johns Hopkins Bayview Medical Center, the second-largest hospital in the Johns Hopkins Health System, where he tripled the number of faculty and staff.
In his new position, Dr. Kasper succeeds Dr. Richard Lange, who will remain on staff as adjunct faculty.
Dr. Ronald G. Victor has been named associate director for clinical research in the Cedars-Sinai Heart Institute in Los Angeles. He will also serve as director of the Cedars-Sinai Hypertension Center.
A primary area of research for Dr Victor is in hypertension in African Americans. Most recently he has been involved in a Dallas-area study to evaluate whether barbershops can be used for community health promotion programs targeting hypertension in African American men.
Dr. Victor also is well known for his work with the National Institute on Drug Abuse, attempting to find an emergency antidote for cocaine overdose patients.
Dr. Victor earned his medical degree from Tulane University in New Orleans, and completed his residency in internal medicine at University of California, Los Angeles.
He completed fellowships in cardiology, cardiovascular research, and neurophysiology at Duke University, Durham, N.C.; the University of Iowa, Iowa City; and the University of Uppsala in Sweden, respectively.
Since 1986, Dr. Victor has been a member of the faculty and then a professor of medicine at the University of Texas Southwestern Medical Center in Dallas. Most recently, he has held the title of codirector at Donald W. Reynolds Cardiovascular Clinical Research Center there.
Cardiologists on the Move
As a cardiac electrophysio-logist, Dr. Tomaselli has worked to determine what factors are predictive of success with implanted cardiac defibrillators.
In his new role, Dr. Tomaselli is expected to concentrate on early detection of arrhythmia using imaging, genetic screening, and applications of stem cell technology in damaged heart tissue.
After earning an undergraduate degree at the State University of New York at Buffalo and a medical degree from Albert Einstein College of Medicine in the Bronx, N.Y., Dr. Tomaselli completed a residency at University of California at San Francisco. He went on to join the Cardiovascular Research Institute there before moving to the fellowship program at the Johns Hopkins School of Medicine in 1986. He joined the faculty at Hopkins 3 years later.
Dr. Tomaselli will continue as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center at Hopkins. In his new post, he succeeds Dr. Eduardo Marbán, who led the division since 2002 and will remain active as adjunct faculty.
Dr. Kasper received his undergraduate degree from Johns Hopkins in 1979. After receiving his medical degree at the University of Connecticut, Farmington, he returned to his alma mater in 1987 to be a faculty instructor in medicine. He completed his cardiology specialization at JHU in 1991 and—after another brief sojourn at Vanderbilt University in Nashville, Tenn.—returned to Hopkins for good in 1993 to head up the university's transplant program—transplant and organ rejection issues being one of Dr. Kasper's primary fields of interest. Another area of research for Dr. Kasper is the biological origins of heart failure.
For the last 5 years, Dr. Kasper has been the director of cardiology at Johns Hopkins Bayview Medical Center, the second-largest hospital in the Johns Hopkins Health System, where he tripled the number of faculty and staff.
In his new position, Dr. Kasper succeeds Dr. Richard Lange, who will remain on staff as adjunct faculty.
Dr. Ronald G. Victor has been named associate director for clinical research in the Cedars-Sinai Heart Institute in Los Angeles. He will also serve as director of the Cedars-Sinai Hypertension Center.
A primary area of research for Dr Victor is in hypertension in African Americans. Most recently he has been involved in a Dallas-area study to evaluate whether barbershops can be used for community health promotion programs targeting hypertension in African American men.
Dr. Victor also is well known for his work with the National Institute on Drug Abuse, attempting to find an emergency antidote for cocaine overdose patients.
Dr. Victor earned his medical degree from Tulane University in New Orleans, and completed his residency in internal medicine at University of California, Los Angeles.
He completed fellowships in cardiology, cardiovascular research, and neurophysiology at Duke University, Durham, N.C.; the University of Iowa, Iowa City; and the University of Uppsala in Sweden, respectively.
Since 1986, Dr. Victor has been a member of the faculty and then a professor of medicine at the University of Texas Southwestern Medical Center in Dallas. Most recently, he has held the title of codirector at Donald W. Reynolds Cardiovascular Clinical Research Center there.
Cardiologists on the Move
As a cardiac electrophysio-logist, Dr. Tomaselli has worked to determine what factors are predictive of success with implanted cardiac defibrillators.
In his new role, Dr. Tomaselli is expected to concentrate on early detection of arrhythmia using imaging, genetic screening, and applications of stem cell technology in damaged heart tissue.
After earning an undergraduate degree at the State University of New York at Buffalo and a medical degree from Albert Einstein College of Medicine in the Bronx, N.Y., Dr. Tomaselli completed a residency at University of California at San Francisco. He went on to join the Cardiovascular Research Institute there before moving to the fellowship program at the Johns Hopkins School of Medicine in 1986. He joined the faculty at Hopkins 3 years later.
Dr. Tomaselli will continue as codirector of the Donald W. Reynolds Cardiovascular Clinical Research Center at Hopkins. In his new post, he succeeds Dr. Eduardo Marbán, who led the division since 2002 and will remain active as adjunct faculty.
Dr. Kasper received his undergraduate degree from Johns Hopkins in 1979. After receiving his medical degree at the University of Connecticut, Farmington, he returned to his alma mater in 1987 to be a faculty instructor in medicine. He completed his cardiology specialization at JHU in 1991 and—after another brief sojourn at Vanderbilt University in Nashville, Tenn.—returned to Hopkins for good in 1993 to head up the university's transplant program—transplant and organ rejection issues being one of Dr. Kasper's primary fields of interest. Another area of research for Dr. Kasper is the biological origins of heart failure.
For the last 5 years, Dr. Kasper has been the director of cardiology at Johns Hopkins Bayview Medical Center, the second-largest hospital in the Johns Hopkins Health System, where he tripled the number of faculty and staff.
In his new position, Dr. Kasper succeeds Dr. Richard Lange, who will remain on staff as adjunct faculty.
Dr. Ronald G. Victor has been named associate director for clinical research in the Cedars-Sinai Heart Institute in Los Angeles. He will also serve as director of the Cedars-Sinai Hypertension Center.
A primary area of research for Dr Victor is in hypertension in African Americans. Most recently he has been involved in a Dallas-area study to evaluate whether barbershops can be used for community health promotion programs targeting hypertension in African American men.
Dr. Victor also is well known for his work with the National Institute on Drug Abuse, attempting to find an emergency antidote for cocaine overdose patients.
Dr. Victor earned his medical degree from Tulane University in New Orleans, and completed his residency in internal medicine at University of California, Los Angeles.
He completed fellowships in cardiology, cardiovascular research, and neurophysiology at Duke University, Durham, N.C.; the University of Iowa, Iowa City; and the University of Uppsala in Sweden, respectively.
Since 1986, Dr. Victor has been a member of the faculty and then a professor of medicine at the University of Texas Southwestern Medical Center in Dallas. Most recently, he has held the title of codirector at Donald W. Reynolds Cardiovascular Clinical Research Center there.
Peanut, Tree Nut Allergies in Kids Warrant Investigation for Asthma
WASHINGTON — Among children with reported food allergies, peanut and tree nut allergy were significantly associated with having asthma, even after adjusting for several confounding factors.
“A diagnosis of asthma should be kept in mind for any child with food allergies,” Dr. Jonathan M. Gaffin said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. However, “Children with peanut or tree nut allergy may be at particular risk,” he added in his poster presentation.
Data were collected on a cohort of 1,240 children treated for food allergy at allergy referral centers around Boston. The mean age of the cohort was 6 years (range 2 months to 20 years).
The overall prevalence of asthma was 48% (592 children)—higher than the 29% of children with food allergy and asthma reported in the 2007 National Health Interview Survey from the Centers for Disease Control and Prevention's National Center for Health Statistics.
Because his study included only children at subspecialty allergy clinics, those with food allergies may have been more likely to have physician-verified food allergies, said Dr. Gaffin, a pulmonary fellow in the division of immunology at Children's Hospital, Boston. Regional trends in food allergy, asthma, or diagnosis of food allergy and asthma may be other reasons for the discrepancy.
In any case, after controlling for patients having never tried each food allergen, age, gender, parents' asthma diagnosis, pollen allergy, and maternal education level, there was a significantly higher prevalence of asthma for peanut and tree nut allergy, as well as for pet allergy, pollen allergy, and eczema.
However, after a second multivariate analysis of those 1,027 children who had their food allergies tested (as opposed to never having tried the food), only peanut allergy (odds ratio 1.8) and tree nut allergy (OR 1.9) still had significantly greater association with asthma.
Dr. Gaffin recommended that a careful history on suspected or known asthma or food allergy also include questions about the other condition.
The study was funded by the Jordan Family Fund for Allergy Research. Dr. Gaffin said there were no other disclosures to make.
WASHINGTON — Among children with reported food allergies, peanut and tree nut allergy were significantly associated with having asthma, even after adjusting for several confounding factors.
“A diagnosis of asthma should be kept in mind for any child with food allergies,” Dr. Jonathan M. Gaffin said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. However, “Children with peanut or tree nut allergy may be at particular risk,” he added in his poster presentation.
Data were collected on a cohort of 1,240 children treated for food allergy at allergy referral centers around Boston. The mean age of the cohort was 6 years (range 2 months to 20 years).
The overall prevalence of asthma was 48% (592 children)—higher than the 29% of children with food allergy and asthma reported in the 2007 National Health Interview Survey from the Centers for Disease Control and Prevention's National Center for Health Statistics.
Because his study included only children at subspecialty allergy clinics, those with food allergies may have been more likely to have physician-verified food allergies, said Dr. Gaffin, a pulmonary fellow in the division of immunology at Children's Hospital, Boston. Regional trends in food allergy, asthma, or diagnosis of food allergy and asthma may be other reasons for the discrepancy.
In any case, after controlling for patients having never tried each food allergen, age, gender, parents' asthma diagnosis, pollen allergy, and maternal education level, there was a significantly higher prevalence of asthma for peanut and tree nut allergy, as well as for pet allergy, pollen allergy, and eczema.
However, after a second multivariate analysis of those 1,027 children who had their food allergies tested (as opposed to never having tried the food), only peanut allergy (odds ratio 1.8) and tree nut allergy (OR 1.9) still had significantly greater association with asthma.
Dr. Gaffin recommended that a careful history on suspected or known asthma or food allergy also include questions about the other condition.
The study was funded by the Jordan Family Fund for Allergy Research. Dr. Gaffin said there were no other disclosures to make.
WASHINGTON — Among children with reported food allergies, peanut and tree nut allergy were significantly associated with having asthma, even after adjusting for several confounding factors.
“A diagnosis of asthma should be kept in mind for any child with food allergies,” Dr. Jonathan M. Gaffin said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. However, “Children with peanut or tree nut allergy may be at particular risk,” he added in his poster presentation.
Data were collected on a cohort of 1,240 children treated for food allergy at allergy referral centers around Boston. The mean age of the cohort was 6 years (range 2 months to 20 years).
The overall prevalence of asthma was 48% (592 children)—higher than the 29% of children with food allergy and asthma reported in the 2007 National Health Interview Survey from the Centers for Disease Control and Prevention's National Center for Health Statistics.
Because his study included only children at subspecialty allergy clinics, those with food allergies may have been more likely to have physician-verified food allergies, said Dr. Gaffin, a pulmonary fellow in the division of immunology at Children's Hospital, Boston. Regional trends in food allergy, asthma, or diagnosis of food allergy and asthma may be other reasons for the discrepancy.
In any case, after controlling for patients having never tried each food allergen, age, gender, parents' asthma diagnosis, pollen allergy, and maternal education level, there was a significantly higher prevalence of asthma for peanut and tree nut allergy, as well as for pet allergy, pollen allergy, and eczema.
However, after a second multivariate analysis of those 1,027 children who had their food allergies tested (as opposed to never having tried the food), only peanut allergy (odds ratio 1.8) and tree nut allergy (OR 1.9) still had significantly greater association with asthma.
Dr. Gaffin recommended that a careful history on suspected or known asthma or food allergy also include questions about the other condition.
The study was funded by the Jordan Family Fund for Allergy Research. Dr. Gaffin said there were no other disclosures to make.
Adult Asthmatics Do Not Understand Their Disease
WASHINGTON — Nearly half (42%) of adult asthma patients incorrectly believed they could stop taking their controller medications when their symptoms subside, according to a recent survey.
Furthermore, even though 94% of patients indicated that they understood the difference between controller medications and quick-relief medications, 69% also believed that quick-relief medications could be taken on a daily basis.
The findings, from the General Awareness and Perceptions II (GAP II) survey, were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
According to the authors, led by Dr. Reynold A. Panettieri of the University of Pennsylvania, Philadelphia, the survey results underscore a need for more asthma education among both physicians and patients.
“It is never appropriate to stop or taper controlled asthma medication,” he said in an interview. “Asthma is a chronic disease that requires long-term control even when symptoms are not present.”
A total of 1,001 adult patients and 300 primary care physicians completed the survey between June 27 and Aug. 18, 2008. Among the physicians, 41% indicated that they treated 15 or more asthma patients per week, and 26% indicated that they had been in practice for more than 20 years. Among patients, the mean age was 47 years, slightly more than one-third had completed college or graduate study, and 62% used controller medications. A total of 59% used rescue medications.
The survey findings also revealed that 55% of patients believed their asthma was well-controlled if they logged just one emergency department visit per year, and 56% believed that their asthma could qualify as well controlled even with two urgent doctor visits per year. “It's important for patients to realize that regular visits to the emergency room do not indicate control and that they don't have to accept these visits as part of a life with asthma,” Dr. Panettieri said.
The survey results emphasize the need for strong patient-physician relationships.
The study was conducted under the auspices of the Asthma and Allergy Foundation of America with support from AstraZeneca.
WASHINGTON — Nearly half (42%) of adult asthma patients incorrectly believed they could stop taking their controller medications when their symptoms subside, according to a recent survey.
Furthermore, even though 94% of patients indicated that they understood the difference between controller medications and quick-relief medications, 69% also believed that quick-relief medications could be taken on a daily basis.
The findings, from the General Awareness and Perceptions II (GAP II) survey, were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
According to the authors, led by Dr. Reynold A. Panettieri of the University of Pennsylvania, Philadelphia, the survey results underscore a need for more asthma education among both physicians and patients.
“It is never appropriate to stop or taper controlled asthma medication,” he said in an interview. “Asthma is a chronic disease that requires long-term control even when symptoms are not present.”
A total of 1,001 adult patients and 300 primary care physicians completed the survey between June 27 and Aug. 18, 2008. Among the physicians, 41% indicated that they treated 15 or more asthma patients per week, and 26% indicated that they had been in practice for more than 20 years. Among patients, the mean age was 47 years, slightly more than one-third had completed college or graduate study, and 62% used controller medications. A total of 59% used rescue medications.
The survey findings also revealed that 55% of patients believed their asthma was well-controlled if they logged just one emergency department visit per year, and 56% believed that their asthma could qualify as well controlled even with two urgent doctor visits per year. “It's important for patients to realize that regular visits to the emergency room do not indicate control and that they don't have to accept these visits as part of a life with asthma,” Dr. Panettieri said.
The survey results emphasize the need for strong patient-physician relationships.
The study was conducted under the auspices of the Asthma and Allergy Foundation of America with support from AstraZeneca.
WASHINGTON — Nearly half (42%) of adult asthma patients incorrectly believed they could stop taking their controller medications when their symptoms subside, according to a recent survey.
Furthermore, even though 94% of patients indicated that they understood the difference between controller medications and quick-relief medications, 69% also believed that quick-relief medications could be taken on a daily basis.
The findings, from the General Awareness and Perceptions II (GAP II) survey, were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
According to the authors, led by Dr. Reynold A. Panettieri of the University of Pennsylvania, Philadelphia, the survey results underscore a need for more asthma education among both physicians and patients.
“It is never appropriate to stop or taper controlled asthma medication,” he said in an interview. “Asthma is a chronic disease that requires long-term control even when symptoms are not present.”
A total of 1,001 adult patients and 300 primary care physicians completed the survey between June 27 and Aug. 18, 2008. Among the physicians, 41% indicated that they treated 15 or more asthma patients per week, and 26% indicated that they had been in practice for more than 20 years. Among patients, the mean age was 47 years, slightly more than one-third had completed college or graduate study, and 62% used controller medications. A total of 59% used rescue medications.
The survey findings also revealed that 55% of patients believed their asthma was well-controlled if they logged just one emergency department visit per year, and 56% believed that their asthma could qualify as well controlled even with two urgent doctor visits per year. “It's important for patients to realize that regular visits to the emergency room do not indicate control and that they don't have to accept these visits as part of a life with asthma,” Dr. Panettieri said.
The survey results emphasize the need for strong patient-physician relationships.
The study was conducted under the auspices of the Asthma and Allergy Foundation of America with support from AstraZeneca.
Flu Vaccine May Be Safe in Those With Egg Allergy
WASHINGTON — Among 349 pediatric patients with egg allergy who received the influenza vaccine under a graded-dose protocol, 96% had no reaction, according to a retrospective study.
These patients “can safely receive the influenza vaccine based on the graded-dose protocol under appropriate medical supervision,” researchers from the Children's Hospital of Philadelphia reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
A history of egg allergy has traditionally been a contraindication for flu vaccine, because the viruses in the vaccine are grown in chicken eggs
The study included 349 patients with egg allergy who received influenza vaccine in 2007. Egg allergy was confirmed with skin testing or oral challenge, and all patients were given skin tests to full-strength influenza vaccine. The 58 patients with positive skin tests to influenza underwent desensitization with graded vaccination doses (patients under 36 months of age: 0.05 mL, 0.1 mL, and 0.1 mL; patients 36 months and older: 0.05 mL, 0.1 mL, 0.15 mL, and 0.2 mL).
Among these 58 patients, there were no cases of anaphylaxis, and Dr. Rushani Saltzman and her associates reported that there was no need for epinephrine administration in any case.
There were eight cases of urticaria, four cases of local erythema at the injection site, two cases of atopic dermatitis flare, and one case of urticaria-related wheezing. All reactions were mild.
“No reactions were noted in the 43 remaining influenza skin test-positive patients,” noted the authors.
WASHINGTON — Among 349 pediatric patients with egg allergy who received the influenza vaccine under a graded-dose protocol, 96% had no reaction, according to a retrospective study.
These patients “can safely receive the influenza vaccine based on the graded-dose protocol under appropriate medical supervision,” researchers from the Children's Hospital of Philadelphia reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
A history of egg allergy has traditionally been a contraindication for flu vaccine, because the viruses in the vaccine are grown in chicken eggs
The study included 349 patients with egg allergy who received influenza vaccine in 2007. Egg allergy was confirmed with skin testing or oral challenge, and all patients were given skin tests to full-strength influenza vaccine. The 58 patients with positive skin tests to influenza underwent desensitization with graded vaccination doses (patients under 36 months of age: 0.05 mL, 0.1 mL, and 0.1 mL; patients 36 months and older: 0.05 mL, 0.1 mL, 0.15 mL, and 0.2 mL).
Among these 58 patients, there were no cases of anaphylaxis, and Dr. Rushani Saltzman and her associates reported that there was no need for epinephrine administration in any case.
There were eight cases of urticaria, four cases of local erythema at the injection site, two cases of atopic dermatitis flare, and one case of urticaria-related wheezing. All reactions were mild.
“No reactions were noted in the 43 remaining influenza skin test-positive patients,” noted the authors.
WASHINGTON — Among 349 pediatric patients with egg allergy who received the influenza vaccine under a graded-dose protocol, 96% had no reaction, according to a retrospective study.
These patients “can safely receive the influenza vaccine based on the graded-dose protocol under appropriate medical supervision,” researchers from the Children's Hospital of Philadelphia reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
A history of egg allergy has traditionally been a contraindication for flu vaccine, because the viruses in the vaccine are grown in chicken eggs
The study included 349 patients with egg allergy who received influenza vaccine in 2007. Egg allergy was confirmed with skin testing or oral challenge, and all patients were given skin tests to full-strength influenza vaccine. The 58 patients with positive skin tests to influenza underwent desensitization with graded vaccination doses (patients under 36 months of age: 0.05 mL, 0.1 mL, and 0.1 mL; patients 36 months and older: 0.05 mL, 0.1 mL, 0.15 mL, and 0.2 mL).
Among these 58 patients, there were no cases of anaphylaxis, and Dr. Rushani Saltzman and her associates reported that there was no need for epinephrine administration in any case.
There were eight cases of urticaria, four cases of local erythema at the injection site, two cases of atopic dermatitis flare, and one case of urticaria-related wheezing. All reactions were mild.
“No reactions were noted in the 43 remaining influenza skin test-positive patients,” noted the authors.