Denise Napoli

Tooth decay is a disease. That is what Dr. David Krol, chair of the department of pediatrics at the University of Toledo, tries to impress upon his patients.

“It is an infection in the mouth that can be passed from caregiver to child—most often, mother to child,” he said. “This is important, and something that I'm not sure everyone understands.”

For families who have private dental insurance plans and who keep up with appointments and take care of toothaches and cavities right away, Dr. Krol's warning may not be something they need to think about.

But for families on Medicaid, getting a dental checkup isn't quite so simple. Many dentists don't accept Medicaid at all because of historically poor reimbursement rates.

Often, any dental clinics that do accept Medicaid patients are few and far between, or perform a limited range of services, and patients can expect long wait times for an appointment.

Small Smiles is a national organization of dental clinics that are run by FORBA (For Better Access), a management company based in Pueblo, Colo., that counteracts those unfortunate trends. The 52 Small Smiles clinics in 17 states accept nothing but Medicaid-qualified patients.

That makes it the largest provider of Medicaid dental services in the country, according to Dr. Aldred Williams, the lead dentist at Small Smiles of Washington.

On the inside, this Small Smiles looks like many of its private-practice counterparts in the affluent suburbs surrounding the District of Columbia. There is a spacious waiting room filled with toys and decorated with colorful professional murals, plus a television.

The examination rooms are also bright and inviting, and there are plenty of them—nine treatment rooms, plus separate consultation rooms, hygiene rooms, x-ray rooms, and doctor offices. They, too, are outfitted with high-tech, top-of-the-line equipment.

Dr. Williams—or “Dr. Al,” as his colleagues call him—is happy to give a tour. In a Medicaid-only setting, one might expect a bare-bones, cost-cutting setup.

But Dr. Williams, a retired military dentist who received a commendation for emergency service at the Pentagon on September 11, 2001, proudly shows off his clinic's themed Winnie the Pooh and sports rooms, on which no expense has been spared.

In high contrast to the inside décor, the Small Smiles of Washington building exterior is a converted nightclub that used to be called “The Black Hole.” Dollar stores and pawnshops abound up and down the stretch of Georgia Avenue where the clinic is located. A security guard, employed by the clinic, circles the block.

But this is a perfect location for Small Smiles. Its patients, after all, aren't coming from the wealthy suburbs. This is their neighborhood dentist.

And in fact, the neighborhood's high concentration of Medicaid-qualified patients enables the clinic to stay financially afloat despite Medicaid's poor reimbursement rate. The sheer volume of billing—anywhere from 60 to 90 visits per day (up to 150 appointments, as many as 40% of which are canceled or result in no-shows, for which Small Smiles charges no punitive fee)—brings in just enough revenue.

The place is busy, but not overwhelmed. Five front-office personnel, five dentists, 12 assistants, and three hygienists keep the clinic running smoothly. The average wait for an appointment at Small Smiles is just 2 weeks, and the practice accepts walk-ins and emergency cases.

Its staff—although not necessarily trained as pediatric dentists—is fully qualified to perform complicated pediatric procedures as well as routine cleanings.

Dr. Williams said in an interview that they are paid a competitive wage, and although turnover is high, advantages like regular working hours and FORBA's handling of reimbursement and human resources lure new graduates and former retirees, like himself, to the clinic.

Often, area clinics send their developmentally disabled or autistic patients to Small Smiles, which is trained and equipped to treat these special needs children.

At its opening last November, there were already 1,000 confirmed patients. Todd Cruse, vice president of development and government affairs for FORBA, said in an interview that last year there was a total of 697,000 patient visits at Small Smiles clinics around the country. (For locations, visit www.smallsmilesusa.com

In areas without a clinic like Small Smiles, “It is difficult for many low-income families to find or afford a dentist,” said Dr. Krol, who listed multiple problems that can arise following lax dental care. “Imagine trying to concentrate in school with a toothache, or trying to eat when it hurts to chew. If a child isn't eating, think of how hard it is to get the calories needed to grow.”

“In older children, especially older adolescents, I sometimes see periodontal [gum] disease. We are learning that gum disease may have effects on diabetes, heart disease, and preterm birth,” he said in an interview.

The mouth and the teeth also can be indicators of systemic diseases, said Dr. Krol. “Problems such as anemia, leukemia, Crohn's disease, and others can manifest themselves in the mouth. In addition, some children are more susceptible to problems if they have dental or oral disease.

“Children who are undergoing bone marrow transplant and chemotherapy can have significant problems if they have oral fungal infections or mucositis, and children with heart problems can be especially at risk for problems if they have dental disease.”

Martha Ann Keels, D.D.S., division chief in pediatric dentistry at Duke Children's Hospital in Durham, N.C., pointed out that more serious problems can occur in conjunction with dental disease.

“We recently had a child die at Duke of a brain abscess caused by his untreated dental caries,” Dr. Keels said in an interview.

“He had Down syndrome and a cyanotic heart condition in addition to severe gastroesophageal reflux disease. He was on Medicaid and had been on a waiting list to be seen for several months. His infection spread from his teeth to his brain. By the time he got to Duke, it was too late for me to be able to fix his teeth and rectify his brain abscess.”

At Small Smiles, Dr. Williams told a similar story of dental caries out of control. “The worst case involved an 18-year-old who presented with a substantial radiographic abscess subjacent to a lower molar. The infection was rapidly spreading through the soft tissue of the neck from the angle of the mandible, approaching the midline of the neck,” he said.

“This is ultraserious because once the infection hits the midline there is a direct path to the heart.”

In this case, however, the clinic intervened in time to refer the patient to nearby Children's National Medical Center. “Children's immediately put the patient on massive amounts of IV antibiotics, with good result,” Dr. Williams reported.

The Small Smiles dental clinic in Washington had 1,000 patients pre-enrolled when it opened in November 2006.

Dr. Williams with his commendation for service on 9/11 at the Pentagon. Denise Napoli/Elsevier Global Medical News

Mouth 'Is Part of Our Responsibility' in Well-Child Visits

So how can pediatricians and family physicians ensure that their patients' mouths stay healthy?

“At every well-child visit [a physician] should be asking about how patients take care of their teeth, if they have a dentist, and looking at the teeth and the rest of the oral structures to see if there are problems that need to be referred to the dentist,” said Dr. Krol. “The mouth is a part of the body. There is no reason why the mouth should be separate. It is part of our responsibility, just like the heart and the lungs.”

Dr. Keels pointed out that many physicians feel too unfamiliar with the mouth to know whether what they see there is normal or unhealthy.

“Certainly, large brown or black holes in the teeth should be easily recognizable as severe caries. It is the subtle findings such as white spots or dental defects that should trigger the doctor to help find a dental home for the child so aggressive prevention strategies can be employed to reverse the disease process,” she said.

“There are also other red flags such as [a] toddler's consumption of juice or frequent carbohydrate snacking, lack of adequate toothbrushing and flossing, and/or a family history of dental disease.” These things all warrant referral to a dentist, Dr. Keels said.

But what if patients lack access to dental insurance, or are on Medicaid and are having trouble finding a provider? “[Physicians] can help families find a dentist by knowing where the dentists are that see children, see children on Medicaid, or see children who may not have insurance,” said Dr. Krol.

“They can also find ways to build a relationship with dentists who will see needy children when requested by the physician.”

Dr. Keels agreed. “Many of my Medicaid recipients have special needs, such as cerebral palsy, autism, or cleft lip and palate. These families have so many challenges to deal with, as many times it is their child's illness that resulted in the family's need for Medicaid. We have to be creative and come up with techniques to help make oral hygiene successful. That takes time to get to know each child and their unique issues.”

Tooth decay is a disease. That is what Dr. David Krol, chair of the department of pediatrics at the University of Toledo, tries to impress upon his patients.

“It is an infection in the mouth that can be passed from caregiver to child—most often, mother to child,” he said. “This is important, and something that I'm not sure everyone understands.”

For families who have private dental insurance plans and who keep up with appointments and take care of toothaches and cavities right away, Dr. Krol's warning may not be something they need to think about.

But for families on Medicaid, getting a dental checkup isn't quite so simple. Many dentists don't accept Medicaid at all because of historically poor reimbursement rates.

Often, any dental clinics that do accept Medicaid patients are few and far between, or perform a limited range of services, and patients can expect long wait times for an appointment.

Small Smiles is a national organization of dental clinics that are run by FORBA (For Better Access), a management company based in Pueblo, Colo., that counteracts those unfortunate trends. The 52 Small Smiles clinics in 17 states accept nothing but Medicaid-qualified patients.

That makes it the largest provider of Medicaid dental services in the country, according to Dr. Aldred Williams, the lead dentist at Small Smiles of Washington.

On the inside, this Small Smiles looks like many of its private-practice counterparts in the affluent suburbs surrounding the District of Columbia. There is a spacious waiting room filled with toys and decorated with colorful professional murals, plus a television.

The examination rooms are also bright and inviting, and there are plenty of them—nine treatment rooms, plus separate consultation rooms, hygiene rooms, x-ray rooms, and doctor offices. They, too, are outfitted with high-tech, top-of-the-line equipment.

Dr. Williams—or “Dr. Al,” as his colleagues call him—is happy to give a tour. In a Medicaid-only setting, one might expect a bare-bones, cost-cutting setup.

But Dr. Williams, a retired military dentist who received a commendation for emergency service at the Pentagon on September 11, 2001, proudly shows off his clinic's themed Winnie the Pooh and sports rooms, on which no expense has been spared.

In high contrast to the inside décor, the Small Smiles of Washington building exterior is a converted nightclub that used to be called “The Black Hole.” Dollar stores and pawnshops abound up and down the stretch of Georgia Avenue where the clinic is located. A security guard, employed by the clinic, circles the block.

But this is a perfect location for Small Smiles. Its patients, after all, aren't coming from the wealthy suburbs. This is their neighborhood dentist.

And in fact, the neighborhood's high concentration of Medicaid-qualified patients enables the clinic to stay financially afloat despite Medicaid's poor reimbursement rate. The sheer volume of billing—anywhere from 60 to 90 visits per day (up to 150 appointments, as many as 40% of which are canceled or result in no-shows, for which Small Smiles charges no punitive fee)—brings in just enough revenue.

The place is busy, but not overwhelmed. Five front-office personnel, five dentists, 12 assistants, and three hygienists keep the clinic running smoothly. The average wait for an appointment at Small Smiles is just 2 weeks, and the practice accepts walk-ins and emergency cases.

Its staff—although not necessarily trained as pediatric dentists—is fully qualified to perform complicated pediatric procedures as well as routine cleanings.

Dr. Williams said in an interview that they are paid a competitive wage, and although turnover is high, advantages like regular working hours and FORBA's handling of reimbursement and human resources lure new graduates and former retirees, like himself, to the clinic.

Often, area clinics send their developmentally disabled or autistic patients to Small Smiles, which is trained and equipped to treat these special needs children.

At its opening last November, there were already 1,000 confirmed patients. Todd Cruse, vice president of development and government affairs for FORBA, said in an interview that last year there was a total of 697,000 patient visits at Small Smiles clinics around the country. (For locations, visit www.smallsmilesusa.com

In areas without a clinic like Small Smiles, “It is difficult for many low-income families to find or afford a dentist,” said Dr. Krol, who listed multiple problems that can arise following lax dental care. “Imagine trying to concentrate in school with a toothache, or trying to eat when it hurts to chew. If a child isn't eating, think of how hard it is to get the calories needed to grow.”

“In older children, especially older adolescents, I sometimes see periodontal [gum] disease. We are learning that gum disease may have effects on diabetes, heart disease, and preterm birth,” he said in an interview.

The mouth and the teeth also can be indicators of systemic diseases, said Dr. Krol. “Problems such as anemia, leukemia, Crohn's disease, and others can manifest themselves in the mouth. In addition, some children are more susceptible to problems if they have dental or oral disease.

“Children who are undergoing bone marrow transplant and chemotherapy can have significant problems if they have oral fungal infections or mucositis, and children with heart problems can be especially at risk for problems if they have dental disease.”

Martha Ann Keels, D.D.S., division chief in pediatric dentistry at Duke Children's Hospital in Durham, N.C., pointed out that more serious problems can occur in conjunction with dental disease.

“We recently had a child die at Duke of a brain abscess caused by his untreated dental caries,” Dr. Keels said in an interview.

“He had Down syndrome and a cyanotic heart condition in addition to severe gastroesophageal reflux disease. He was on Medicaid and had been on a waiting list to be seen for several months. His infection spread from his teeth to his brain. By the time he got to Duke, it was too late for me to be able to fix his teeth and rectify his brain abscess.”

At Small Smiles, Dr. Williams told a similar story of dental caries out of control. “The worst case involved an 18-year-old who presented with a substantial radiographic abscess subjacent to a lower molar. The infection was rapidly spreading through the soft tissue of the neck from the angle of the mandible, approaching the midline of the neck,” he said.

“This is ultraserious because once the infection hits the midline there is a direct path to the heart.”

In this case, however, the clinic intervened in time to refer the patient to nearby Children's National Medical Center. “Children's immediately put the patient on massive amounts of IV antibiotics, with good result,” Dr. Williams reported.

The Small Smiles dental clinic in Washington had 1,000 patients pre-enrolled when it opened in November 2006.

Dr. Williams with his commendation for service on 9/11 at the Pentagon. Denise Napoli/Elsevier Global Medical News

Mouth 'Is Part of Our Responsibility' in Well-Child Visits

So how can pediatricians and family physicians ensure that their patients' mouths stay healthy?

“At every well-child visit [a physician] should be asking about how patients take care of their teeth, if they have a dentist, and looking at the teeth and the rest of the oral structures to see if there are problems that need to be referred to the dentist,” said Dr. Krol. “The mouth is a part of the body. There is no reason why the mouth should be separate. It is part of our responsibility, just like the heart and the lungs.”

Dr. Keels pointed out that many physicians feel too unfamiliar with the mouth to know whether what they see there is normal or unhealthy.

“Certainly, large brown or black holes in the teeth should be easily recognizable as severe caries. It is the subtle findings such as white spots or dental defects that should trigger the doctor to help find a dental home for the child so aggressive prevention strategies can be employed to reverse the disease process,” she said.

“There are also other red flags such as [a] toddler's consumption of juice or frequent carbohydrate snacking, lack of adequate toothbrushing and flossing, and/or a family history of dental disease.” These things all warrant referral to a dentist, Dr. Keels said.

But what if patients lack access to dental insurance, or are on Medicaid and are having trouble finding a provider? “[Physicians] can help families find a dentist by knowing where the dentists are that see children, see children on Medicaid, or see children who may not have insurance,” said Dr. Krol.

“They can also find ways to build a relationship with dentists who will see needy children when requested by the physician.”

Dr. Keels agreed. “Many of my Medicaid recipients have special needs, such as cerebral palsy, autism, or cleft lip and palate. These families have so many challenges to deal with, as many times it is their child's illness that resulted in the family's need for Medicaid. We have to be creative and come up with techniques to help make oral hygiene successful. That takes time to get to know each child and their unique issues.”

Tooth decay is a disease. That is what Dr. David Krol, chair of the department of pediatrics at the University of Toledo, tries to impress upon his patients.

“It is an infection in the mouth that can be passed from caregiver to child—most often, mother to child,” he said. “This is important, and something that I'm not sure everyone understands.”

For families who have private dental insurance plans and who keep up with appointments and take care of toothaches and cavities right away, Dr. Krol's warning may not be something they need to think about.

But for families on Medicaid, getting a dental checkup isn't quite so simple. Many dentists don't accept Medicaid at all because of historically poor reimbursement rates.

Often, any dental clinics that do accept Medicaid patients are few and far between, or perform a limited range of services, and patients can expect long wait times for an appointment.

Small Smiles is a national organization of dental clinics that are run by FORBA (For Better Access), a management company based in Pueblo, Colo., that counteracts those unfortunate trends. The 52 Small Smiles clinics in 17 states accept nothing but Medicaid-qualified patients.

That makes it the largest provider of Medicaid dental services in the country, according to Dr. Aldred Williams, the lead dentist at Small Smiles of Washington.

On the inside, this Small Smiles looks like many of its private-practice counterparts in the affluent suburbs surrounding the District of Columbia. There is a spacious waiting room filled with toys and decorated with colorful professional murals, plus a television.

The examination rooms are also bright and inviting, and there are plenty of them—nine treatment rooms, plus separate consultation rooms, hygiene rooms, x-ray rooms, and doctor offices. They, too, are outfitted with high-tech, top-of-the-line equipment.

Dr. Williams—or “Dr. Al,” as his colleagues call him—is happy to give a tour. In a Medicaid-only setting, one might expect a bare-bones, cost-cutting setup.

But Dr. Williams, a retired military dentist who received a commendation for emergency service at the Pentagon on September 11, 2001, proudly shows off his clinic's themed Winnie the Pooh and sports rooms, on which no expense has been spared.

In high contrast to the inside décor, the Small Smiles of Washington building exterior is a converted nightclub that used to be called “The Black Hole.” Dollar stores and pawnshops abound up and down the stretch of Georgia Avenue where the clinic is located. A security guard, employed by the clinic, circles the block.

But this is a perfect location for Small Smiles. Its patients, after all, aren't coming from the wealthy suburbs. This is their neighborhood dentist.

And in fact, the neighborhood's high concentration of Medicaid-qualified patients enables the clinic to stay financially afloat despite Medicaid's poor reimbursement rate. The sheer volume of billing—anywhere from 60 to 90 visits per day (up to 150 appointments, as many as 40% of which are canceled or result in no-shows, for which Small Smiles charges no punitive fee)—brings in just enough revenue.

The place is busy, but not overwhelmed. Five front-office personnel, five dentists, 12 assistants, and three hygienists keep the clinic running smoothly. The average wait for an appointment at Small Smiles is just 2 weeks, and the practice accepts walk-ins and emergency cases.

Its staff—although not necessarily trained as pediatric dentists—is fully qualified to perform complicated pediatric procedures as well as routine cleanings.

Dr. Williams said in an interview that they are paid a competitive wage, and although turnover is high, advantages like regular working hours and FORBA's handling of reimbursement and human resources lure new graduates and former retirees, like himself, to the clinic.

Often, area clinics send their developmentally disabled or autistic patients to Small Smiles, which is trained and equipped to treat these special needs children.

At its opening last November, there were already 1,000 confirmed patients. Todd Cruse, vice president of development and government affairs for FORBA, said in an interview that last year there was a total of 697,000 patient visits at Small Smiles clinics around the country. (For locations, visit www.smallsmilesusa.com

In areas without a clinic like Small Smiles, “It is difficult for many low-income families to find or afford a dentist,” said Dr. Krol, who listed multiple problems that can arise following lax dental care. “Imagine trying to concentrate in school with a toothache, or trying to eat when it hurts to chew. If a child isn't eating, think of how hard it is to get the calories needed to grow.”

“In older children, especially older adolescents, I sometimes see periodontal [gum] disease. We are learning that gum disease may have effects on diabetes, heart disease, and preterm birth,” he said in an interview.

The mouth and the teeth also can be indicators of systemic diseases, said Dr. Krol. “Problems such as anemia, leukemia, Crohn's disease, and others can manifest themselves in the mouth. In addition, some children are more susceptible to problems if they have dental or oral disease.

“Children who are undergoing bone marrow transplant and chemotherapy can have significant problems if they have oral fungal infections or mucositis, and children with heart problems can be especially at risk for problems if they have dental disease.”

Martha Ann Keels, D.D.S., division chief in pediatric dentistry at Duke Children's Hospital in Durham, N.C., pointed out that more serious problems can occur in conjunction with dental disease.

“We recently had a child die at Duke of a brain abscess caused by his untreated dental caries,” Dr. Keels said in an interview.

“He had Down syndrome and a cyanotic heart condition in addition to severe gastroesophageal reflux disease. He was on Medicaid and had been on a waiting list to be seen for several months. His infection spread from his teeth to his brain. By the time he got to Duke, it was too late for me to be able to fix his teeth and rectify his brain abscess.”

At Small Smiles, Dr. Williams told a similar story of dental caries out of control. “The worst case involved an 18-year-old who presented with a substantial radiographic abscess subjacent to a lower molar. The infection was rapidly spreading through the soft tissue of the neck from the angle of the mandible, approaching the midline of the neck,” he said.

“This is ultraserious because once the infection hits the midline there is a direct path to the heart.”

In this case, however, the clinic intervened in time to refer the patient to nearby Children's National Medical Center. “Children's immediately put the patient on massive amounts of IV antibiotics, with good result,” Dr. Williams reported.

The Small Smiles dental clinic in Washington had 1,000 patients pre-enrolled when it opened in November 2006.

Dr. Williams with his commendation for service on 9/11 at the Pentagon. Denise Napoli/Elsevier Global Medical News

Mouth 'Is Part of Our Responsibility' in Well-Child Visits

So how can pediatricians and family physicians ensure that their patients' mouths stay healthy?

“At every well-child visit [a physician] should be asking about how patients take care of their teeth, if they have a dentist, and looking at the teeth and the rest of the oral structures to see if there are problems that need to be referred to the dentist,” said Dr. Krol. “The mouth is a part of the body. There is no reason why the mouth should be separate. It is part of our responsibility, just like the heart and the lungs.”

Dr. Keels pointed out that many physicians feel too unfamiliar with the mouth to know whether what they see there is normal or unhealthy.

“Certainly, large brown or black holes in the teeth should be easily recognizable as severe caries. It is the subtle findings such as white spots or dental defects that should trigger the doctor to help find a dental home for the child so aggressive prevention strategies can be employed to reverse the disease process,” she said.

“There are also other red flags such as [a] toddler's consumption of juice or frequent carbohydrate snacking, lack of adequate toothbrushing and flossing, and/or a family history of dental disease.” These things all warrant referral to a dentist, Dr. Keels said.

But what if patients lack access to dental insurance, or are on Medicaid and are having trouble finding a provider? “[Physicians] can help families find a dentist by knowing where the dentists are that see children, see children on Medicaid, or see children who may not have insurance,” said Dr. Krol.

“They can also find ways to build a relationship with dentists who will see needy children when requested by the physician.”

Dr. Keels agreed. “Many of my Medicaid recipients have special needs, such as cerebral palsy, autism, or cleft lip and palate. These families have so many challenges to deal with, as many times it is their child's illness that resulted in the family's need for Medicaid. We have to be creative and come up with techniques to help make oral hygiene successful. That takes time to get to know each child and their unique issues.”

Pet turtles, especially those with shells less than 4 inches in length, are often natural hosts to Salmonella bacteria, and handling them or coming into contact with their habitats can lead to salmonellosis, the Food and Drug Administration has warned.

The recent death of a 4-week-old infant in Florida following an infection traced to the serotype Salmonella pomona from a pet turtle kept in the infant's home highlighted this risk and prompted the FDA to issue the warning. The FDA has banned the sale of under-4-inch turtles in the United States since 1975. According to an April 23 FDA consumer update, the size factor was based on the agency's judgment that larger turtles did not pose the same health threat because young children would not likely try to fit them into their mouths.

Salmonella bacteria are shed in the feces of infected turtles, then may spread to outer skin and shell surfaces. An infected turtle typically does not look or act sick. Testing may not prove a turtle is Salmonella free, since its feces may not always contain bacterial discharge.

The risk of mortality from salmonellosis is highest in infants, young children, the elderly, and any person whose immune system is weakened by pregnancy, disease, or cancer treatment.

To minimize potential contamination, the FDA recommends vigorous handwashing after touching pet turtles or any objects they have come into contact with, such as water dishes. For more information on the risks of turtle ownership, visit www.fda.gov/cvm/documents/turtlesflier.pdfwww.cdc.gov/healthypets/spotlight_an_turtles.htm

Pet turtles, especially those with shells less than 4 inches in length, are often natural hosts to Salmonella bacteria, and handling them or coming into contact with their habitats can lead to salmonellosis, the Food and Drug Administration has warned.

The recent death of a 4-week-old infant in Florida following an infection traced to the serotype Salmonella pomona from a pet turtle kept in the infant's home highlighted this risk and prompted the FDA to issue the warning. The FDA has banned the sale of under-4-inch turtles in the United States since 1975. According to an April 23 FDA consumer update, the size factor was based on the agency's judgment that larger turtles did not pose the same health threat because young children would not likely try to fit them into their mouths.

Salmonella bacteria are shed in the feces of infected turtles, then may spread to outer skin and shell surfaces. An infected turtle typically does not look or act sick. Testing may not prove a turtle is Salmonella free, since its feces may not always contain bacterial discharge.

The risk of mortality from salmonellosis is highest in infants, young children, the elderly, and any person whose immune system is weakened by pregnancy, disease, or cancer treatment.

To minimize potential contamination, the FDA recommends vigorous handwashing after touching pet turtles or any objects they have come into contact with, such as water dishes. For more information on the risks of turtle ownership, visit www.fda.gov/cvm/documents/turtlesflier.pdfwww.cdc.gov/healthypets/spotlight_an_turtles.htm

Pet turtles, especially those with shells less than 4 inches in length, are often natural hosts to Salmonella bacteria, and handling them or coming into contact with their habitats can lead to salmonellosis, the Food and Drug Administration has warned.

The recent death of a 4-week-old infant in Florida following an infection traced to the serotype Salmonella pomona from a pet turtle kept in the infant's home highlighted this risk and prompted the FDA to issue the warning. The FDA has banned the sale of under-4-inch turtles in the United States since 1975. According to an April 23 FDA consumer update, the size factor was based on the agency's judgment that larger turtles did not pose the same health threat because young children would not likely try to fit them into their mouths.

Salmonella bacteria are shed in the feces of infected turtles, then may spread to outer skin and shell surfaces. An infected turtle typically does not look or act sick. Testing may not prove a turtle is Salmonella free, since its feces may not always contain bacterial discharge.

The risk of mortality from salmonellosis is highest in infants, young children, the elderly, and any person whose immune system is weakened by pregnancy, disease, or cancer treatment.

To minimize potential contamination, the FDA recommends vigorous handwashing after touching pet turtles or any objects they have come into contact with, such as water dishes. For more information on the risks of turtle ownership, visit www.fda.gov/cvm/documents/turtlesflier.pdfwww.cdc.gov/healthypets/spotlight_an_turtles.htm

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, director of pediatric dermatology at Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, "How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment," Dr. Prose said at an annual meeting of the American Academy of Dermatology.

"Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond, and so a whole half of our lives is neglected," he added.

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake, on the health care provider's behalf.

Dr. Prose stressed that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a botched biopsy or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, "I'm sorry that your family has been through so much pain this last week as a result of this procedure" is preferable to "I'm sorry this happened."

Dr. Prose added, "saying, 'I wish things were different' is a wonderful way to create an alliance with the patient and his or her family."

▸ Have a plan. A pledge to correct the mistake also is important. "People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room," he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. "Wanting to run away is a natural response. You have to be aware of how you're feeling before you walk in the room [with a patient]. We have to be knowledgeable about ourselves and our own natural tendencies." Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. "Seek a balance by knowing who you are and what you tend to do," he advised, including knowing "what kinds of patients drive you crazy."

"For those of us who internalize [mistakes] and lose sleep over them, you have to be able to talk to yourself and say, 'I'm trying to be a good doctor, and now I'm going to try and do my best to make the situation right.' It's hard sometimes. It's a struggle," said Dr. Prose.

▸ Be a good listener. "Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling," he said. "Listen before giving advice, and relisten to the story, as much as you don't want to hear it."

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, "you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect," said Dr. Prose.

'Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling.' DR. PROSE

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, director of pediatric dermatology at Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, "How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment," Dr. Prose said at an annual meeting of the American Academy of Dermatology.

"Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond, and so a whole half of our lives is neglected," he added.

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake, on the health care provider's behalf.

Dr. Prose stressed that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a botched biopsy or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, "I'm sorry that your family has been through so much pain this last week as a result of this procedure" is preferable to "I'm sorry this happened."

Dr. Prose added, "saying, 'I wish things were different' is a wonderful way to create an alliance with the patient and his or her family."

▸ Have a plan. A pledge to correct the mistake also is important. "People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room," he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. "Wanting to run away is a natural response. You have to be aware of how you're feeling before you walk in the room [with a patient]. We have to be knowledgeable about ourselves and our own natural tendencies." Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. "Seek a balance by knowing who you are and what you tend to do," he advised, including knowing "what kinds of patients drive you crazy."

"For those of us who internalize [mistakes] and lose sleep over them, you have to be able to talk to yourself and say, 'I'm trying to be a good doctor, and now I'm going to try and do my best to make the situation right.' It's hard sometimes. It's a struggle," said Dr. Prose.

▸ Be a good listener. "Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling," he said. "Listen before giving advice, and relisten to the story, as much as you don't want to hear it."

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, "you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect," said Dr. Prose.

'Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling.' DR. PROSE

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, director of pediatric dermatology at Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, "How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment," Dr. Prose said at an annual meeting of the American Academy of Dermatology.

"Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond, and so a whole half of our lives is neglected," he added.

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake, on the health care provider's behalf.

Dr. Prose stressed that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a botched biopsy or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, "I'm sorry that your family has been through so much pain this last week as a result of this procedure" is preferable to "I'm sorry this happened."

Dr. Prose added, "saying, 'I wish things were different' is a wonderful way to create an alliance with the patient and his or her family."

▸ Have a plan. A pledge to correct the mistake also is important. "People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room," he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. "Wanting to run away is a natural response. You have to be aware of how you're feeling before you walk in the room [with a patient]. We have to be knowledgeable about ourselves and our own natural tendencies." Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. "Seek a balance by knowing who you are and what you tend to do," he advised, including knowing "what kinds of patients drive you crazy."

"For those of us who internalize [mistakes] and lose sleep over them, you have to be able to talk to yourself and say, 'I'm trying to be a good doctor, and now I'm going to try and do my best to make the situation right.' It's hard sometimes. It's a struggle," said Dr. Prose.

▸ Be a good listener. "Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling," he said. "Listen before giving advice, and relisten to the story, as much as you don't want to hear it."

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, "you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect," said Dr. Prose.

'Our biggest pitfall [as physicians] is trying to talk people out of the way they're feeling.' DR. PROSE

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the American Academy of Family Physicians, the ACP, and the Society for Thoracic Surgery, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the American Academy of Family Physicians, the ACP, and the Society for Thoracic Surgery, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the American Academy of Family Physicians, the ACP, and the Society for Thoracic Surgery, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

WASHINGTON — Asian patients treated with 0.1% adapalene gel showed significantly greater clearance of acne than did white and black acne patients after 6 weeks, Dr. Fran E. Cook-Bolden reported in a poster at the annual meeting of the American Academy of Dermatology.

The open-label, multicenter, observational phase IV trial also showed significant improvement among Hispanic patients with acne, compared with their white counterparts, reported Dr. Cook-Bolden, of the Skin Specialty Group in New York.

“With the changing demographics of the U.S. population, there is a need to understand the variety of dermatologic disorders that affect patients with nonwhite skin types,” Dr. Cook-Bolden and her associates wrote. “Patients with darker pigmentation are at a greater risk from developing postinflammatory hyperpigmentation both from their acne lesions [and] also potentially from their treatment—particularly when the treatment causes irritation.”

Patients aged 12–72 years old were grouped by race into the following categories: Asian (78 patients), black (169 patients), Hispanic (222 patients), white (1,215 patients), and American Indian/Alaskan Native/Pacific Islander/other (36 patients). Acne severity was rated moderate to moderately severe.

The investigators used a global assessment scale on which a score of 0 was equivalent to complete clearing and a score of 6 meant that the acne was actually worse after treatment.

By week 12, all racial groups had shown at least some improvement, compared with baseline.

At week 6, significantly more Asian patients (44%) achieved successful treatment (defined as a score of 0–2), compared with black patients (34%) and white patients (29%). At week 12, the difference was significant only between Asian and white patients, 71% and 56%, respectively.

Hispanics showed greater reduction in inflammatory lesions, compared with whites at week 12 (75% vs. 67%).

Though the finding was not statistically significant, a greater proportion of black patients than whites showed success at week 6 (56% vs. 51%, respectively) and 12 (80% vs. 66.7%, respectively).

All patients tolerated the treatment—which included a once-daily application of adapalene gel 0.1% plus any other treatments deemed appropriate by their dermatologists—with minimal incidence of erythema, peeling, scaling, dryness, stinging and/or burning.

The study and poster were supported by Galderma Laboratories L.P.

WASHINGTON — Asian patients treated with 0.1% adapalene gel showed significantly greater clearance of acne than did white and black acne patients after 6 weeks, Dr. Fran E. Cook-Bolden reported in a poster at the annual meeting of the American Academy of Dermatology.

The open-label, multicenter, observational phase IV trial also showed significant improvement among Hispanic patients with acne, compared with their white counterparts, reported Dr. Cook-Bolden, of the Skin Specialty Group in New York.

“With the changing demographics of the U.S. population, there is a need to understand the variety of dermatologic disorders that affect patients with nonwhite skin types,” Dr. Cook-Bolden and her associates wrote. “Patients with darker pigmentation are at a greater risk from developing postinflammatory hyperpigmentation both from their acne lesions [and] also potentially from their treatment—particularly when the treatment causes irritation.”

Patients aged 12–72 years old were grouped by race into the following categories: Asian (78 patients), black (169 patients), Hispanic (222 patients), white (1,215 patients), and American Indian/Alaskan Native/Pacific Islander/other (36 patients). Acne severity was rated moderate to moderately severe.

The investigators used a global assessment scale on which a score of 0 was equivalent to complete clearing and a score of 6 meant that the acne was actually worse after treatment.

By week 12, all racial groups had shown at least some improvement, compared with baseline.

At week 6, significantly more Asian patients (44%) achieved successful treatment (defined as a score of 0–2), compared with black patients (34%) and white patients (29%). At week 12, the difference was significant only between Asian and white patients, 71% and 56%, respectively.

Hispanics showed greater reduction in inflammatory lesions, compared with whites at week 12 (75% vs. 67%).

Though the finding was not statistically significant, a greater proportion of black patients than whites showed success at week 6 (56% vs. 51%, respectively) and 12 (80% vs. 66.7%, respectively).

All patients tolerated the treatment—which included a once-daily application of adapalene gel 0.1% plus any other treatments deemed appropriate by their dermatologists—with minimal incidence of erythema, peeling, scaling, dryness, stinging and/or burning.

The study and poster were supported by Galderma Laboratories L.P.

WASHINGTON — Asian patients treated with 0.1% adapalene gel showed significantly greater clearance of acne than did white and black acne patients after 6 weeks, Dr. Fran E. Cook-Bolden reported in a poster at the annual meeting of the American Academy of Dermatology.

The open-label, multicenter, observational phase IV trial also showed significant improvement among Hispanic patients with acne, compared with their white counterparts, reported Dr. Cook-Bolden, of the Skin Specialty Group in New York.

“With the changing demographics of the U.S. population, there is a need to understand the variety of dermatologic disorders that affect patients with nonwhite skin types,” Dr. Cook-Bolden and her associates wrote. “Patients with darker pigmentation are at a greater risk from developing postinflammatory hyperpigmentation both from their acne lesions [and] also potentially from their treatment—particularly when the treatment causes irritation.”

Patients aged 12–72 years old were grouped by race into the following categories: Asian (78 patients), black (169 patients), Hispanic (222 patients), white (1,215 patients), and American Indian/Alaskan Native/Pacific Islander/other (36 patients). Acne severity was rated moderate to moderately severe.

The investigators used a global assessment scale on which a score of 0 was equivalent to complete clearing and a score of 6 meant that the acne was actually worse after treatment.

By week 12, all racial groups had shown at least some improvement, compared with baseline.

At week 6, significantly more Asian patients (44%) achieved successful treatment (defined as a score of 0–2), compared with black patients (34%) and white patients (29%). At week 12, the difference was significant only between Asian and white patients, 71% and 56%, respectively.

Hispanics showed greater reduction in inflammatory lesions, compared with whites at week 12 (75% vs. 67%).

Though the finding was not statistically significant, a greater proportion of black patients than whites showed success at week 6 (56% vs. 51%, respectively) and 12 (80% vs. 66.7%, respectively).

All patients tolerated the treatment—which included a once-daily application of adapalene gel 0.1% plus any other treatments deemed appropriate by their dermatologists—with minimal incidence of erythema, peeling, scaling, dryness, stinging and/or burning.

The study and poster were supported by Galderma Laboratories L.P.

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, of Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, “How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment,” Dr. Prose said at an annual meeting of the American Academy of Dermatology. “Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond.”

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake on the health care provider's behalf. He stressed, however, that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a small one or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, “I'm sorry that your family has been through so much pain this last week as a result of this procedure” is preferable to “I'm sorry this happened.”

▸ Have a plan. A pledge to correct the mistake also is important. “People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room,” he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. “Seek a balance by knowing who you are and what you tend to do,” he advised.

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, “you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect,” said Dr. Prose.

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, of Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, “How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment,” Dr. Prose said at an annual meeting of the American Academy of Dermatology. “Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond.”

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake on the health care provider's behalf. He stressed, however, that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a small one or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, “I'm sorry that your family has been through so much pain this last week as a result of this procedure” is preferable to “I'm sorry this happened.”

▸ Have a plan. A pledge to correct the mistake also is important. “People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room,” he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. “Seek a balance by knowing who you are and what you tend to do,” he advised.

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, “you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect,” said Dr. Prose.

WASHINGTON — An empathetic disclosure that a medical error has occurred, accompanied by a genuine apology, may help avoid a malpractice lawsuit, according to Dr. Neil S. Prose, of Duke University Medical Center, Durham, N.C.

On an almost daily basis, doctors are called upon to deal with patient disappointment. Some cases involve medical mistakes and others do not. In any case, “How we communicate with patients and their families is really half of the work we do as doctors, and the other half is diagnosis and treatment,” Dr. Prose said at an annual meeting of the American Academy of Dermatology. “Unfortunately, we spend a lot of time on diagnosis and treatment and never talk about what we say to patients and how they respond.”

In a presentation designed by the Institute for HealthcareCommunication (formerly the Bayer Institute), a nonprofit group dedicated to improving communication between physicians and patients, Dr. Prose discussed empathetic ways of speaking with patients when they have experienced disappointing outcomes, either with or without a medical mistake on the health care provider's behalf. He stressed, however, that his recommendations are generic skills and that, when appropriate, the counsel of a lawyer or risk management team should be heeded:

▸ Create the right setting. Close the door and make sure that the room is quiet. If possible, turn off any phones or pagers. Sit down. Offering the apology while seated, rather than standing, can aid in the patient's eventual acceptance of the apology.

▸ Be as sincere and specific as possible. In addition to telling the truth about what happened—whether the mistake is a small one or something more serious—Dr. Prose said that offering a sincere and simple apology can make a huge difference. Also, specificity is crucial. Saying, “I'm sorry that your family has been through so much pain this last week as a result of this procedure” is preferable to “I'm sorry this happened.”

▸ Have a plan. A pledge to correct the mistake also is important. “People want to know how you're going to prevent this from happening again. You want to have a plan before you go in the room,” he said.

▸ Be aware of your own feelings. Often, the fear of confrontation and the desire to rectify the situation as quickly as possible can prevent physicians from taking into account their own feelings about the situation. Being either defensive or overly despondent, for instance, can alienate the patient and his or her family. “Seek a balance by knowing who you are and what you tend to do,” he advised.

▸ Get permission to proceed. Finally, after telling the truth and listening patiently, “you reach a point where you actually ask permission before moving on. Say, 'Would this be an okay time for me to tell you what I think we should do next?' That process has a remarkable effect,” said Dr. Prose.

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the ACP, the Society for Thoracic Surgery, and the American Academy of Family Physicians, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change, and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

'This is a very significant change, and it requires people to work together collaboratively.' MR. LEAVITT

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the ACP, the Society for Thoracic Surgery, and the American Academy of Family Physicians, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change, and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

'This is a very significant change, and it requires people to work together collaboratively.' MR. LEAVITT

WASHINGTON — The Bush administration aims to move forward on its goal of health care price and quality transparency through its new Value-Driven Health Care Initiative.

The initiative, which will certify and support regional collaboratives of health care payers, providers, and purchasers, was announced by Health and Human Services Secretary Michael Leavitt at a press briefing sponsored by the journal Health Affairs.

Participants in the program's collaborative groups, called Value Exchanges, will be able to share practices for increasing quality with fellow members through a federally funded learning network, for which $4 million has been earmarked in the proposed 2008 federal budget. Providers who can demonstrate improved transparency and quality are also likely to reap rewards from payers.

Mr. Leavitt gave as an example one private insurer affiliated with a pilot Value Exchange in California that paid out as much as $50 million to physicians who'd met certain standards of quality care.

“[Insurers] rewarded the quality practice. But if you don't have a standard way of measuring [quality], then those [bonuses] are not able to be developed or executed,” he said.

Dr. John Tooker, executive vice president and chief executive officer of the American College of Physicians (ACP), said that it is too soon to determine the success of the pilot programs.

“I think the [level of physician] engagement in the program will determine how much value is to be derived from the program,” he said. However, “You've got to start somewhere. The ACP and many other medical societies have been supportive of moving the evidence-based performance measures into meaningful field testing. … These Value Exchanges provide an opportunity to test these measures.”

Quality standards by which care will be measured are being formulated by physician groups.

“The standards are being established by the medical family,” said Mr. Leavitt.

Leadership from groups such as the ACP, the Society for Thoracic Surgery, and the American Academy of Family Physicians, as well as the American Medical Association's Physician Consortium for Performance Improvement, will provide the basis, said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. “This is what the profession believes is the best science,” said Dr. Clancy at the meeting.

Though the program will use national measures of quality, it will be governed locally.

Local control is important for two reasons, Mr. Leavitt said. The first deals with the initial collection of medical records with which the program would develop comparisons between providers. “Until we have a robust system of electronic health records, the [process of acquiring] this information is essentially going in and looking at medical records—most of the time, paper records—to determine what quality is and when it occurs. That, by its very nature, is local.” The second reason why local facilitation is important has to do with trust, he said. “This is a very significant change, and it requires people to work together collaboratively in order to be comfortable. [Doctors] will be much less likely to work with Washington, where they can't affect the process, [rather than local networks].”

To become a Value Exchange, a collaborative must submit an application to HHS detailing its adherence to four “cornerstones” of the program. In addition to the adoption of an electronic medical records system, these include public reporting of performance; public reporting of price; and the support of incentives rewarding quality and value.

Mr. Leavitt sketched a rough timeline for widespread adoption of the program.

“Five years from now, the word 'value' will be a regular part of the medical lexicon,” he said. “Ten years from now, this network will have matured into a national network.” He added that in order for this widespread collection and pooling of data to occur, “electronic medical records, as you can see, have to be the backbone of this system.”

'This is a very significant change, and it requires people to work together collaboratively.' MR. LEAVITT

Age between 2 and 4 years and the existence of an underlying neurologic or neuromuscular disease are independent risk factors for influenza-related neurologic complications in children, Dr. Jason G. Newland and his colleagues reported.

In a retrospective cohort study conducted from June 2000 to May 2004, Dr. Newland, then of the Children's Hospital of Philadelphia, and his colleagues analyzed 842 patients aged 1 week to 21 years with laboratory-confirmed influenza. Of these, 72 patients experienced an influenza-related neurologic complication, including seizures (56), encephalopathy (8), postinfectious encephalopathy (2), stroke secondary to hypotension (4), and aseptic meningitis (2).

In the study based on an analysis of nine contiguous zip codes surrounding the hospital, the investigators also concluded that the incidence of influenza-related neurologic complications is approximately 4 cases per 100,000 child-years in the United States (J. Pediatr. 2007;150:306–10).

Dr. Newland, now of Children's Mercy Hospital in Kansas City, Mo., and his colleagues used logistic regression to determine that being an age between 6 months and 4 years put patients at elevated risk for developing neurologic complications, with the greatest risk occurring between 2 and 4 years—with an odds ratio of 10.

In addition, compared with patients who did not have a history of a neurologic or neuromuscular disease (NNMD), children who had such a history (including febrile seizures, an incident of encephalopathy, or developmental delay) also were more likely to have a seizure or other complication during influenza infection, with an odds ratio of 6.6. Although not previously reported in association with influenza, this is not entirely unexpected because patients with an NNMD—especially those with a history of seizures—are likely to have seizures during an acute illness, the investigators said.

Neither influenza type nor season put patients at any increased risk for neurologic complications.

Dr. Newland and his associates' findings are in contrast to reports from Japanese investigators during the past decade about severe and frequent influenza encephalopathy—including fatal encephalopathy rates reported as high as 25%–37%—in that country. Only 1% of patients in this study were hospitalized with influenza, and no deaths were reported in the U.S. investigation.

Limitations of this study included the fact that the areas surrounding the hospital represent a predominantly African American population, “and so our findings may not be generalizable to the rest of the country.” Another is that, because influenza testing is typically performed only on patients with cough and rhinorrhea, infected patients who did not present this way may not have been diagnosed and, therefore, tallied. Also, “the definition of acute encephalopathy is somewhat arbitrary and may both under- and overidentify patients with the acute onset of neurologic symptoms,” they wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Age between 2 and 4 years and the existence of an underlying neurologic or neuromuscular disease are independent risk factors for influenza-related neurologic complications in children, Dr. Jason G. Newland and his colleagues reported.

In a retrospective cohort study conducted from June 2000 to May 2004, Dr. Newland, then of the Children's Hospital of Philadelphia, and his colleagues analyzed 842 patients aged 1 week to 21 years with laboratory-confirmed influenza. Of these, 72 patients experienced an influenza-related neurologic complication, including seizures (56), encephalopathy (8), postinfectious encephalopathy (2), stroke secondary to hypotension (4), and aseptic meningitis (2).

In the study based on an analysis of nine contiguous zip codes surrounding the hospital, the investigators also concluded that the incidence of influenza-related neurologic complications is approximately 4 cases per 100,000 child-years in the United States (J. Pediatr. 2007;150:306–10).

Dr. Newland, now of Children's Mercy Hospital in Kansas City, Mo., and his colleagues used logistic regression to determine that being an age between 6 months and 4 years put patients at elevated risk for developing neurologic complications, with the greatest risk occurring between 2 and 4 years—with an odds ratio of 10.

In addition, compared with patients who did not have a history of a neurologic or neuromuscular disease (NNMD), children who had such a history (including febrile seizures, an incident of encephalopathy, or developmental delay) also were more likely to have a seizure or other complication during influenza infection, with an odds ratio of 6.6. Although not previously reported in association with influenza, this is not entirely unexpected because patients with an NNMD—especially those with a history of seizures—are likely to have seizures during an acute illness, the investigators said.

Neither influenza type nor season put patients at any increased risk for neurologic complications.

Dr. Newland and his associates' findings are in contrast to reports from Japanese investigators during the past decade about severe and frequent influenza encephalopathy—including fatal encephalopathy rates reported as high as 25%–37%—in that country. Only 1% of patients in this study were hospitalized with influenza, and no deaths were reported in the U.S. investigation.

Limitations of this study included the fact that the areas surrounding the hospital represent a predominantly African American population, “and so our findings may not be generalizable to the rest of the country.” Another is that, because influenza testing is typically performed only on patients with cough and rhinorrhea, infected patients who did not present this way may not have been diagnosed and, therefore, tallied. Also, “the definition of acute encephalopathy is somewhat arbitrary and may both under- and overidentify patients with the acute onset of neurologic symptoms,” they wrote.

ELSEVIER GLOBAL MEDICAL NEWS

Age between 2 and 4 years and the existence of an underlying neurologic or neuromuscular disease are independent risk factors for influenza-related neurologic complications in children, Dr. Jason G. Newland and his colleagues reported.

In a retrospective cohort study conducted from June 2000 to May 2004, Dr. Newland, then of the Children's Hospital of Philadelphia, and his colleagues analyzed 842 patients aged 1 week to 21 years with laboratory-confirmed influenza. Of these, 72 patients experienced an influenza-related neurologic complication, including seizures (56), encephalopathy (8), postinfectious encephalopathy (2), stroke secondary to hypotension (4), and aseptic meningitis (2).

In the study based on an analysis of nine contiguous zip codes surrounding the hospital, the investigators also concluded that the incidence of influenza-related neurologic complications is approximately 4 cases per 100,000 child-years in the United States (J. Pediatr. 2007;150:306–10).

Dr. Newland, now of Children's Mercy Hospital in Kansas City, Mo., and his colleagues used logistic regression to determine that being an age between 6 months and 4 years put patients at elevated risk for developing neurologic complications, with the greatest risk occurring between 2 and 4 years—with an odds ratio of 10.

In addition, compared with patients who did not have a history of a neurologic or neuromuscular disease (NNMD), children who had such a history (including febrile seizures, an incident of encephalopathy, or developmental delay) also were more likely to have a seizure or other complication during influenza infection, with an odds ratio of 6.6. Although not previously reported in association with influenza, this is not entirely unexpected because patients with an NNMD—especially those with a history of seizures—are likely to have seizures during an acute illness, the investigators said.

Neither influenza type nor season put patients at any increased risk for neurologic complications.

Dr. Newland and his associates' findings are in contrast to reports from Japanese investigators during the past decade about severe and frequent influenza encephalopathy—including fatal encephalopathy rates reported as high as 25%–37%—in that country. Only 1% of patients in this study were hospitalized with influenza, and no deaths were reported in the U.S. investigation.

Limitations of this study included the fact that the areas surrounding the hospital represent a predominantly African American population, “and so our findings may not be generalizable to the rest of the country.” Another is that, because influenza testing is typically performed only on patients with cough and rhinorrhea, infected patients who did not present this way may not have been diagnosed and, therefore, tallied. Also, “the definition of acute encephalopathy is somewhat arbitrary and may both under- and overidentify patients with the acute onset of neurologic symptoms,” they wrote.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Twice-daily application of 2% polyphenone (-)-epigallocatechin-3-gallate (ECGC [green tea extract]) in a hydrophilic cream significantly reduced inflammatory lesion counts in patients with papulopustular rosacea, Dr. Tanweer Syed and colleagues wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

In this double-blind study, Dr. Syed—partial owner of Syed Skin Care Inc., San Francisco, which sells a version of this product—and coworkers randomized 500 subjects (315 women) with papulopustular rosacea into two groups. One group received 50 g of a hydrophilic cream containing 2% polyphenone ECGC; the other received 50 g of a placebo cream.

The patients (average age 30 years) appplied the cream twice a day for 4 weeks, with a maximum of 56 applications. They were evaluated weekly using photographic and optical techniques. Tolerability and adverse effects were graded according to duration (in days) and severity (mild, moderate, or severe). Patients with connective tissue diseases or acne, on immunosuppressive regimens, and with use of topical steroids within the previous 12 weeks were excluded.

After 4 weeks, 74% of patients in the active treatment group showed success, meaning significant reduction in mean inflammatory lesion count, compared with 20% of those on placebo. Three-quarters of the funding for this study was provided by Syed Skin Care Inc., the authors said.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Twice-daily application of 2% polyphenone (-)-epigallocatechin-3-gallate (ECGC [green tea extract]) in a hydrophilic cream significantly reduced inflammatory lesion counts in patients with papulopustular rosacea, Dr. Tanweer Syed and colleagues wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

In this double-blind study, Dr. Syed—partial owner of Syed Skin Care Inc., San Francisco, which sells a version of this product—and coworkers randomized 500 subjects (315 women) with papulopustular rosacea into two groups. One group received 50 g of a hydrophilic cream containing 2% polyphenone ECGC; the other received 50 g of a placebo cream.

The patients (average age 30 years) appplied the cream twice a day for 4 weeks, with a maximum of 56 applications. They were evaluated weekly using photographic and optical techniques. Tolerability and adverse effects were graded according to duration (in days) and severity (mild, moderate, or severe). Patients with connective tissue diseases or acne, on immunosuppressive regimens, and with use of topical steroids within the previous 12 weeks were excluded.

After 4 weeks, 74% of patients in the active treatment group showed success, meaning significant reduction in mean inflammatory lesion count, compared with 20% of those on placebo. Three-quarters of the funding for this study was provided by Syed Skin Care Inc., the authors said.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Twice-daily application of 2% polyphenone (-)-epigallocatechin-3-gallate (ECGC [green tea extract]) in a hydrophilic cream significantly reduced inflammatory lesion counts in patients with papulopustular rosacea, Dr. Tanweer Syed and colleagues wrote in a poster presented at the annual meeting of the American Academy of Dermatology.

In this double-blind study, Dr. Syed—partial owner of Syed Skin Care Inc., San Francisco, which sells a version of this product—and coworkers randomized 500 subjects (315 women) with papulopustular rosacea into two groups. One group received 50 g of a hydrophilic cream containing 2% polyphenone ECGC; the other received 50 g of a placebo cream.

The patients (average age 30 years) appplied the cream twice a day for 4 weeks, with a maximum of 56 applications. They were evaluated weekly using photographic and optical techniques. Tolerability and adverse effects were graded according to duration (in days) and severity (mild, moderate, or severe). Patients with connective tissue diseases or acne, on immunosuppressive regimens, and with use of topical steroids within the previous 12 weeks were excluded.

After 4 weeks, 74% of patients in the active treatment group showed success, meaning significant reduction in mean inflammatory lesion count, compared with 20% of those on placebo. Three-quarters of the funding for this study was provided by Syed Skin Care Inc., the authors said.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Inhalant use remained stable for boys aged 12–17 years between 2002 and 2005, but use of inhalants by girls in that age range increased during that period, from 4.1% to 4.9%, a national survey shows.

The survey, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also showed that the type of inhalants used varied by gender. Boys aged 12–17 years were more likely to inhale nitrous oxide, sometimes sold in vials called whippets, to get high, but girls in that age range were more likely to use other forms of inhalants, including glue, shoe polish, spray paint, and aerosol hair sprays.

Even as the overall number of recent inhalant initiates (those “huffing” for the first time) remained relatively stable between 2002 and 2005–rising slightly from 591,000 youths to 605,000–most of the initiates were girls. In 2002, about 306,000 teen boys initiated inhalant use. That number fell to 268,000 in 2005. Among adolescent girls, however, the number rose from 285,000 to 337,000 new users.

Overall, combined data from 2002 to 2005 indicate that approximately 1.1 million adolescents aged 12–17 years had used inhalants in the past year to get high, or 4.5% of the population in that age range.

In a press briefing on inhalant abuse, neither Dr. H. Westley Clark, director of SAMSHA's center for substance abuse treatment, nor Harvey Weiss, executive director of the National Inhalant Prevention Coalition, could offer an explanation of why more teen girls are experimenting with this potentially fatal high. Mr. Weiss pointed out that other surveys show that girls start using inhalants before their male counterparts do–and the age difference is over a year.

The survey discussed at the meeting, called the National Survey on Drug Use and Health, is based on data collected between 2002 and 2005 from 91,145 persons aged 12–17 years, including 46,431 teen boys.

Dr. Timothy P. Condon, deputy director of the National Institute on Drug Abuse, also at the meeting, added that results from the 2006 Monitoring the Future survey show a decline in perceived risk among teenagers about the dangers of inhalant abuse. That perception could account for rising use among girls.

Several clinical signs and symptoms point to an addiction to inhalants, according to the National Inhalant Prevention Coalition (www.inhalants.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Inhalant use remained stable for boys aged 12–17 years between 2002 and 2005, but use of inhalants by girls in that age range increased during that period, from 4.1% to 4.9%, a national survey shows.

The survey, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also showed that the type of inhalants used varied by gender. Boys aged 12–17 years were more likely to inhale nitrous oxide, sometimes sold in vials called whippets, to get high, but girls in that age range were more likely to use other forms of inhalants, including glue, shoe polish, spray paint, and aerosol hair sprays.

Even as the overall number of recent inhalant initiates (those “huffing” for the first time) remained relatively stable between 2002 and 2005–rising slightly from 591,000 youths to 605,000–most of the initiates were girls. In 2002, about 306,000 teen boys initiated inhalant use. That number fell to 268,000 in 2005. Among adolescent girls, however, the number rose from 285,000 to 337,000 new users.

Overall, combined data from 2002 to 2005 indicate that approximately 1.1 million adolescents aged 12–17 years had used inhalants in the past year to get high, or 4.5% of the population in that age range.

In a press briefing on inhalant abuse, neither Dr. H. Westley Clark, director of SAMSHA's center for substance abuse treatment, nor Harvey Weiss, executive director of the National Inhalant Prevention Coalition, could offer an explanation of why more teen girls are experimenting with this potentially fatal high. Mr. Weiss pointed out that other surveys show that girls start using inhalants before their male counterparts do–and the age difference is over a year.

The survey discussed at the meeting, called the National Survey on Drug Use and Health, is based on data collected between 2002 and 2005 from 91,145 persons aged 12–17 years, including 46,431 teen boys.

Dr. Timothy P. Condon, deputy director of the National Institute on Drug Abuse, also at the meeting, added that results from the 2006 Monitoring the Future survey show a decline in perceived risk among teenagers about the dangers of inhalant abuse. That perception could account for rising use among girls.

Several clinical signs and symptoms point to an addiction to inhalants, according to the National Inhalant Prevention Coalition (www.inhalants.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Inhalant use remained stable for boys aged 12–17 years between 2002 and 2005, but use of inhalants by girls in that age range increased during that period, from 4.1% to 4.9%, a national survey shows.

The survey, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also showed that the type of inhalants used varied by gender. Boys aged 12–17 years were more likely to inhale nitrous oxide, sometimes sold in vials called whippets, to get high, but girls in that age range were more likely to use other forms of inhalants, including glue, shoe polish, spray paint, and aerosol hair sprays.

Even as the overall number of recent inhalant initiates (those “huffing” for the first time) remained relatively stable between 2002 and 2005–rising slightly from 591,000 youths to 605,000–most of the initiates were girls. In 2002, about 306,000 teen boys initiated inhalant use. That number fell to 268,000 in 2005. Among adolescent girls, however, the number rose from 285,000 to 337,000 new users.

Overall, combined data from 2002 to 2005 indicate that approximately 1.1 million adolescents aged 12–17 years had used inhalants in the past year to get high, or 4.5% of the population in that age range.

In a press briefing on inhalant abuse, neither Dr. H. Westley Clark, director of SAMSHA's center for substance abuse treatment, nor Harvey Weiss, executive director of the National Inhalant Prevention Coalition, could offer an explanation of why more teen girls are experimenting with this potentially fatal high. Mr. Weiss pointed out that other surveys show that girls start using inhalants before their male counterparts do–and the age difference is over a year.

The survey discussed at the meeting, called the National Survey on Drug Use and Health, is based on data collected between 2002 and 2005 from 91,145 persons aged 12–17 years, including 46,431 teen boys.

Dr. Timothy P. Condon, deputy director of the National Institute on Drug Abuse, also at the meeting, added that results from the 2006 Monitoring the Future survey show a decline in perceived risk among teenagers about the dangers of inhalant abuse. That perception could account for rising use among girls.

Several clinical signs and symptoms point to an addiction to inhalants, according to the National Inhalant Prevention Coalition (www.inhalants.org

ELSEVIER GLOBAL MEDICAL NEWS