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AGA Patient INFO Center now offers gMed instructions
The Patient INFO Center, AGA’s digital library of patient education, continues to grow and expand. As new topics and educational resources are added, there are also opportunities to enhance the experience of using the library to better connect with patients.
In addition to electronic health record systems Athena, Cerner, and EPIC, you can now integrate AGA’s patient education materials into gMed. Based on member feedback and popular demand, AGA created instructions with gMed consultants and tested them with members to ensure accuracy and ease of use.
Check out the newly added gMed instructions and everything else the Patient INFO Center has to offer.
Have thoughts on the Patient INFO Center? Email [email protected].
The Patient INFO Center, AGA’s digital library of patient education, continues to grow and expand. As new topics and educational resources are added, there are also opportunities to enhance the experience of using the library to better connect with patients.
In addition to electronic health record systems Athena, Cerner, and EPIC, you can now integrate AGA’s patient education materials into gMed. Based on member feedback and popular demand, AGA created instructions with gMed consultants and tested them with members to ensure accuracy and ease of use.
Check out the newly added gMed instructions and everything else the Patient INFO Center has to offer.
Have thoughts on the Patient INFO Center? Email [email protected].
The Patient INFO Center, AGA’s digital library of patient education, continues to grow and expand. As new topics and educational resources are added, there are also opportunities to enhance the experience of using the library to better connect with patients.
In addition to electronic health record systems Athena, Cerner, and EPIC, you can now integrate AGA’s patient education materials into gMed. Based on member feedback and popular demand, AGA created instructions with gMed consultants and tested them with members to ensure accuracy and ease of use.
Check out the newly added gMed instructions and everything else the Patient INFO Center has to offer.
Have thoughts on the Patient INFO Center? Email [email protected].
Addressing Patient Concerns About Treatment Safety Data
Mutations missed in early-onset colorectal cancer
As many as one in six patients with early-onset colorectal cancer (CRC) have a pathogenic genetic mutation, but around one-third of these patients may not have met the criteria for genetic testing for at least one of their mutations under current guidelines, researchers say.
Rachel Pearlman, MS, CGC, of The Ohio State University Comprehensive Cancer Center, and her coauthors reported the results of multigene panel testing of 450 patients aged under 50 years, from 51 institutions, who had been diagnosed with CRC (JAMA Oncol 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5194).
Overall, 16% of patients were found to have a pathogenic or likely pathogenic cancer susceptibility gene mutations, with 83.3% having at least one gene mutation.
Thirty-seven patients had Lynch syndrome; 13 were MLH1, 16 were LSH2, 1 patient was MSH2/monoallelic MUTYH; 2 were MSH6, and 5 were PMS2.
“While the prevalence of Lynch syndrome reported herein (8.4%) is consistent with previous publications, this is the first study to our knowledge to determine the prevalence and spectrum of other hereditary cancer syndromes (8%) found in an unselected series of patients with early-onset CRC,” the authors wrote.
Forty-eight patients (10.7%) had mismatch repair–deficient tumors, nine of which were in high-penetrance genes linked to CRC risk.
But for 145 patients, their genetic variants were of uncertain significance. Thirteen patients had mutations in high- or moderate-penetrance genes not traditionally associated with CRC, including ATM, ATM/ CHEK2, BRCA1, BRCA2, CDKN2A, and PALB2.
The authors pointed out that the multigene panel testing approach enables identification of hereditary cancer syndromes in patients who might not have otherwise met the criteria for testing.
“Importantly, 24 of 72 patients (33.3%) with pathogenic mutations did not meet NCCN Guidelines for at least 1 of the gene(s) in which they were found to have a mutation,” the researchers noted. These included three patients with MMR-deficient tumors who had additional mutations in genes that would not have been assessed, one patient with an MMR-proficient tumor who was also found to have Lynch syndrome, and six patients with BRCA1/2 mutations.
“Previous studies have reported early-onset CRC in women with BRCA1 mutations and BRCA2 mutations in families with familial colorectal cancer type X,” they noted.
The Ohio Colorectal Cancer Prevention Initiative (OCCPI) is supported by a grant from Pelotonia, and by the National Cancer Institute. Myriad Genetics Inc. donated next-generation sequencing testing. Nine authors disclosed ties with private industry, including Myriad Genetics.
This study illustrates the shortcomings of current algorithms for diagnosing and managing younger patients with CRC. First, although family history is one of the main components used to stratify an individual’s risk for CRC, it is imperfect because only one in five younger patients with CRC reported having a first-degree relative with CRC. Second, although clinical criteria define the phenotypes typically associated with specific gene mutations, variability in penetrance and expressivity can result in overlap among the different hereditary cancer syndromes (e.g., BRCA germline mutations in younger patients with CRC).
The findings of this large population-based study demonstrate that the incorporation of multigene panel genetic testing in the evaluation of patients with CRC will increase the diagnosis of individuals with genetic predisposition to cancer and will expand current knowledge regarding the associated phenotypes, further supporting the cost-effectiveness of testing that can guide management for patients with cancer and their at-risk relatives. The study found germline mutations in one in six patients with CRC and has argued for comprehensive germline genetic testing of patients diagnosed at younger than 50 years.
Eduardo Vilar-Sanchez, MD, PhD, is in the department of clinical cancer prevention and clinical cancer genetics program at The University of Texas MD Anderson Cancer Center, Houston. Elena M. Stoffel, MD, is in the department of internal medicine at the University of Michigan, Ann Arbor. These comments are adapted from an editorial (JAMA Oncology 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5193). No conflicts of interest were declared.
This study illustrates the shortcomings of current algorithms for diagnosing and managing younger patients with CRC. First, although family history is one of the main components used to stratify an individual’s risk for CRC, it is imperfect because only one in five younger patients with CRC reported having a first-degree relative with CRC. Second, although clinical criteria define the phenotypes typically associated with specific gene mutations, variability in penetrance and expressivity can result in overlap among the different hereditary cancer syndromes (e.g., BRCA germline mutations in younger patients with CRC).
The findings of this large population-based study demonstrate that the incorporation of multigene panel genetic testing in the evaluation of patients with CRC will increase the diagnosis of individuals with genetic predisposition to cancer and will expand current knowledge regarding the associated phenotypes, further supporting the cost-effectiveness of testing that can guide management for patients with cancer and their at-risk relatives. The study found germline mutations in one in six patients with CRC and has argued for comprehensive germline genetic testing of patients diagnosed at younger than 50 years.
Eduardo Vilar-Sanchez, MD, PhD, is in the department of clinical cancer prevention and clinical cancer genetics program at The University of Texas MD Anderson Cancer Center, Houston. Elena M. Stoffel, MD, is in the department of internal medicine at the University of Michigan, Ann Arbor. These comments are adapted from an editorial (JAMA Oncology 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5193). No conflicts of interest were declared.
This study illustrates the shortcomings of current algorithms for diagnosing and managing younger patients with CRC. First, although family history is one of the main components used to stratify an individual’s risk for CRC, it is imperfect because only one in five younger patients with CRC reported having a first-degree relative with CRC. Second, although clinical criteria define the phenotypes typically associated with specific gene mutations, variability in penetrance and expressivity can result in overlap among the different hereditary cancer syndromes (e.g., BRCA germline mutations in younger patients with CRC).
The findings of this large population-based study demonstrate that the incorporation of multigene panel genetic testing in the evaluation of patients with CRC will increase the diagnosis of individuals with genetic predisposition to cancer and will expand current knowledge regarding the associated phenotypes, further supporting the cost-effectiveness of testing that can guide management for patients with cancer and their at-risk relatives. The study found germline mutations in one in six patients with CRC and has argued for comprehensive germline genetic testing of patients diagnosed at younger than 50 years.
Eduardo Vilar-Sanchez, MD, PhD, is in the department of clinical cancer prevention and clinical cancer genetics program at The University of Texas MD Anderson Cancer Center, Houston. Elena M. Stoffel, MD, is in the department of internal medicine at the University of Michigan, Ann Arbor. These comments are adapted from an editorial (JAMA Oncology 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5193). No conflicts of interest were declared.
As many as one in six patients with early-onset colorectal cancer (CRC) have a pathogenic genetic mutation, but around one-third of these patients may not have met the criteria for genetic testing for at least one of their mutations under current guidelines, researchers say.
Rachel Pearlman, MS, CGC, of The Ohio State University Comprehensive Cancer Center, and her coauthors reported the results of multigene panel testing of 450 patients aged under 50 years, from 51 institutions, who had been diagnosed with CRC (JAMA Oncol 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5194).
Overall, 16% of patients were found to have a pathogenic or likely pathogenic cancer susceptibility gene mutations, with 83.3% having at least one gene mutation.
Thirty-seven patients had Lynch syndrome; 13 were MLH1, 16 were LSH2, 1 patient was MSH2/monoallelic MUTYH; 2 were MSH6, and 5 were PMS2.
“While the prevalence of Lynch syndrome reported herein (8.4%) is consistent with previous publications, this is the first study to our knowledge to determine the prevalence and spectrum of other hereditary cancer syndromes (8%) found in an unselected series of patients with early-onset CRC,” the authors wrote.
Forty-eight patients (10.7%) had mismatch repair–deficient tumors, nine of which were in high-penetrance genes linked to CRC risk.
But for 145 patients, their genetic variants were of uncertain significance. Thirteen patients had mutations in high- or moderate-penetrance genes not traditionally associated with CRC, including ATM, ATM/ CHEK2, BRCA1, BRCA2, CDKN2A, and PALB2.
The authors pointed out that the multigene panel testing approach enables identification of hereditary cancer syndromes in patients who might not have otherwise met the criteria for testing.
“Importantly, 24 of 72 patients (33.3%) with pathogenic mutations did not meet NCCN Guidelines for at least 1 of the gene(s) in which they were found to have a mutation,” the researchers noted. These included three patients with MMR-deficient tumors who had additional mutations in genes that would not have been assessed, one patient with an MMR-proficient tumor who was also found to have Lynch syndrome, and six patients with BRCA1/2 mutations.
“Previous studies have reported early-onset CRC in women with BRCA1 mutations and BRCA2 mutations in families with familial colorectal cancer type X,” they noted.
The Ohio Colorectal Cancer Prevention Initiative (OCCPI) is supported by a grant from Pelotonia, and by the National Cancer Institute. Myriad Genetics Inc. donated next-generation sequencing testing. Nine authors disclosed ties with private industry, including Myriad Genetics.
As many as one in six patients with early-onset colorectal cancer (CRC) have a pathogenic genetic mutation, but around one-third of these patients may not have met the criteria for genetic testing for at least one of their mutations under current guidelines, researchers say.
Rachel Pearlman, MS, CGC, of The Ohio State University Comprehensive Cancer Center, and her coauthors reported the results of multigene panel testing of 450 patients aged under 50 years, from 51 institutions, who had been diagnosed with CRC (JAMA Oncol 2016 Dec 15. doi: 10.1001/jamaoncol.2016.5194).
Overall, 16% of patients were found to have a pathogenic or likely pathogenic cancer susceptibility gene mutations, with 83.3% having at least one gene mutation.
Thirty-seven patients had Lynch syndrome; 13 were MLH1, 16 were LSH2, 1 patient was MSH2/monoallelic MUTYH; 2 were MSH6, and 5 were PMS2.
“While the prevalence of Lynch syndrome reported herein (8.4%) is consistent with previous publications, this is the first study to our knowledge to determine the prevalence and spectrum of other hereditary cancer syndromes (8%) found in an unselected series of patients with early-onset CRC,” the authors wrote.
Forty-eight patients (10.7%) had mismatch repair–deficient tumors, nine of which were in high-penetrance genes linked to CRC risk.
But for 145 patients, their genetic variants were of uncertain significance. Thirteen patients had mutations in high- or moderate-penetrance genes not traditionally associated with CRC, including ATM, ATM/ CHEK2, BRCA1, BRCA2, CDKN2A, and PALB2.
The authors pointed out that the multigene panel testing approach enables identification of hereditary cancer syndromes in patients who might not have otherwise met the criteria for testing.
“Importantly, 24 of 72 patients (33.3%) with pathogenic mutations did not meet NCCN Guidelines for at least 1 of the gene(s) in which they were found to have a mutation,” the researchers noted. These included three patients with MMR-deficient tumors who had additional mutations in genes that would not have been assessed, one patient with an MMR-proficient tumor who was also found to have Lynch syndrome, and six patients with BRCA1/2 mutations.
“Previous studies have reported early-onset CRC in women with BRCA1 mutations and BRCA2 mutations in families with familial colorectal cancer type X,” they noted.
The Ohio Colorectal Cancer Prevention Initiative (OCCPI) is supported by a grant from Pelotonia, and by the National Cancer Institute. Myriad Genetics Inc. donated next-generation sequencing testing. Nine authors disclosed ties with private industry, including Myriad Genetics.
FROM JAMA ONCOLOGY
Key clinical point: As many as one in six patients with early-onset colorectal cancer have a pathogenic genetic mutation but around one-third of these patients may not have met the criteria for genetic testing for at least one of their mutations, under current guidelines.
Major finding: 16% of patients with early-onset colorectal cancer were found to have a pathogenic or likely pathogenic cancer susceptibility gene mutation.
Data source: Cohort study of 450 patients aged under 50 years diagnosed with colorectal cancer.
Disclosures: The Ohio Colorectal Cancer Prevention Initiative (OCCPI) is supported by a grant from Pelotonia, and by the National Cancer Institute. Myriad Genetics Inc. donated next-generation sequencing testing. Nine authors disclosed ties with private industry, including Myriad Genetics.
Role of the Kidney in Type 2 Diabetes and Mechanism of Action of Sodium Glucose Cotransporter-2 Inhibitors
While type 2 diabetes (T2D) is commonly seen in primary care, it is difficult to manage successfully over time. This series offers brief eNewsletters written by clinical experts that are designed to assist in the clinical management of patients with T2D.
While type 2 diabetes (T2D) is commonly seen in primary care, it is difficult to manage successfully over time. This series offers brief eNewsletters written by clinical experts that are designed to assist in the clinical management of patients with T2D.
While type 2 diabetes (T2D) is commonly seen in primary care, it is difficult to manage successfully over time. This series offers brief eNewsletters written by clinical experts that are designed to assist in the clinical management of patients with T2D.
Idle intravenous catheters are associated with preventable complications
Intravenous catheters (ICs) are common and necessary for inpatient care. However, peripheral and especially central venous catheters (CVCs) are associated with increased risk for local and systemic complications, including bloodstream infections and endocarditis.
Prevention of these complications is important and should be a major focus of infection control and patient safety practices. There are three main points of focus on infection prevention with regard to ICs – proper insertion techniques, proper care of the catheter, and prompt removal when it is no longer necessary.
We focused our review, published in the American Journal of Infection Control (2016 Oct. doi: 10.1016/j.ajic.2016.03.073), on the final point – determining the prevalence, risk factors, and outcomes related to idle intravenous catheters. To accomplish this, we conducted an integrative review of published studies related to idle catheters, excluding reviews, abstracts, and commentaries. Thirteen studies met the inclusion criteria and four of these focused on CVCs.
Generally, an idle catheter is one that remains in place even though it is not being used for patient care. However, the definition of an “idle” catheter varied amongst the reviewed studies, as did the unit of measure, especially for peripheral catheters. Central venous catheter-focused studies were more consistent in using “idle catheter days” and “catheter days.”
Studies of peripheral catheters revealed that 16%-50% of patients had an idle catheter of some type. For the studies focused on CVCs, the percentage of patients with idle catheters ranged from 2.7% in one intensive care unit to 26.2% in a different study. Interestingly, in the study with 2.7% idle CVCs in the ICU, there was a higher percentage of idle CVCs outside of the ICU in the same hospital.
The major reasons for leaving catheters in place in studies where reasons were noted were convenience, future intention to use intravenous medication, and inappropriate use of intravenous medications when oral could be used.
Although data are scarce, complications in the reviewed studies were relatively common with idle peripheral catheters, where 9%-12% suffered thrombophlebitis. Obviously, the risk for catheter-related bloodstream infection increases as the number of catheter days increases – this is especially important with regard to idle CVCs.
Decreasing the prevalence of idle catheters is likely to decrease the risk for infection and improve patient safety. Based on our review of the data, a standardized definition of an “idle catheter” is needed. At the very least, a standard definition should be developed at each institution. This would allow an individual hospital the ability to identify and track the presence of these lines, and implement targeted interventions to decrease the proportion of idle lines. Ideally, a common definition would be created and validated so that data and interventions could be comparable across institutions and guidelines could be developed.
The goal of targeted interventions should be zero idle lines. Prevention of idle peripheral catheters should also be pursued, but because CVC-related complications are often more serious, these lines are often the focus of efforts. Use of peripherally inserted central catheters (PICCs) has increased and while these catheters in some settings may have decreased complication risk, compared with femoral/internal jugular/subclavian CVCs, prevention of idle catheter days is paramount for these catheters as well.
Many ICUs, including at our own institution, have instituted programs to closely monitor for ongoing need for CVCs. This increased focus on the CVC likely explains the lower rates of idle catheters in ICUs noted in the reviewed studies. This close surveillance can be done outside of the ICU as well, and could include peripheral catheters.
At our own institution, the need for catheters is reviewed on some units as part of formalized patient safety rounds. Another potential group of interventions could focus on electronic medical record (EMR)-based changes such as limits on the duration of the order, requirement for renewal of the order, or on-screen reminders of the presence of a catheter. This sort of intervention could possibly be expanded as EMR use becomes more common and robust. For instance, if intravenous medications have not been ordered or given in a certain amount of time, an alert might be triggered. Another EMR-based mechanism could be to require an indication for ongoing catheter use.
Education about the potential adverse outcomes of idle catheters is important. Promoting a team-based approach to interventions, where all involved team members can discuss patient safety issues on equal ground is paramount to successfully decreasing idle catheters and improving patient care and safety in general. As with other hospital-wide initiatives, engagement of hospital administration is important to decrease barriers to implementation.
Intravenous catheter use will remain an integral part of patient care, but efforts should be made to create standardization around the definition of an idle catheter, standardize units of measure, and institute programs to prevent idle catheters.
Daniel Shirley, MD, MS, is assistant professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital. Nasia Safdar, MD, PhD, is associate professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital.
Intravenous catheters (ICs) are common and necessary for inpatient care. However, peripheral and especially central venous catheters (CVCs) are associated with increased risk for local and systemic complications, including bloodstream infections and endocarditis.
Prevention of these complications is important and should be a major focus of infection control and patient safety practices. There are three main points of focus on infection prevention with regard to ICs – proper insertion techniques, proper care of the catheter, and prompt removal when it is no longer necessary.
We focused our review, published in the American Journal of Infection Control (2016 Oct. doi: 10.1016/j.ajic.2016.03.073), on the final point – determining the prevalence, risk factors, and outcomes related to idle intravenous catheters. To accomplish this, we conducted an integrative review of published studies related to idle catheters, excluding reviews, abstracts, and commentaries. Thirteen studies met the inclusion criteria and four of these focused on CVCs.
Generally, an idle catheter is one that remains in place even though it is not being used for patient care. However, the definition of an “idle” catheter varied amongst the reviewed studies, as did the unit of measure, especially for peripheral catheters. Central venous catheter-focused studies were more consistent in using “idle catheter days” and “catheter days.”
Studies of peripheral catheters revealed that 16%-50% of patients had an idle catheter of some type. For the studies focused on CVCs, the percentage of patients with idle catheters ranged from 2.7% in one intensive care unit to 26.2% in a different study. Interestingly, in the study with 2.7% idle CVCs in the ICU, there was a higher percentage of idle CVCs outside of the ICU in the same hospital.
The major reasons for leaving catheters in place in studies where reasons were noted were convenience, future intention to use intravenous medication, and inappropriate use of intravenous medications when oral could be used.
Although data are scarce, complications in the reviewed studies were relatively common with idle peripheral catheters, where 9%-12% suffered thrombophlebitis. Obviously, the risk for catheter-related bloodstream infection increases as the number of catheter days increases – this is especially important with regard to idle CVCs.
Decreasing the prevalence of idle catheters is likely to decrease the risk for infection and improve patient safety. Based on our review of the data, a standardized definition of an “idle catheter” is needed. At the very least, a standard definition should be developed at each institution. This would allow an individual hospital the ability to identify and track the presence of these lines, and implement targeted interventions to decrease the proportion of idle lines. Ideally, a common definition would be created and validated so that data and interventions could be comparable across institutions and guidelines could be developed.
The goal of targeted interventions should be zero idle lines. Prevention of idle peripheral catheters should also be pursued, but because CVC-related complications are often more serious, these lines are often the focus of efforts. Use of peripherally inserted central catheters (PICCs) has increased and while these catheters in some settings may have decreased complication risk, compared with femoral/internal jugular/subclavian CVCs, prevention of idle catheter days is paramount for these catheters as well.
Many ICUs, including at our own institution, have instituted programs to closely monitor for ongoing need for CVCs. This increased focus on the CVC likely explains the lower rates of idle catheters in ICUs noted in the reviewed studies. This close surveillance can be done outside of the ICU as well, and could include peripheral catheters.
At our own institution, the need for catheters is reviewed on some units as part of formalized patient safety rounds. Another potential group of interventions could focus on electronic medical record (EMR)-based changes such as limits on the duration of the order, requirement for renewal of the order, or on-screen reminders of the presence of a catheter. This sort of intervention could possibly be expanded as EMR use becomes more common and robust. For instance, if intravenous medications have not been ordered or given in a certain amount of time, an alert might be triggered. Another EMR-based mechanism could be to require an indication for ongoing catheter use.
Education about the potential adverse outcomes of idle catheters is important. Promoting a team-based approach to interventions, where all involved team members can discuss patient safety issues on equal ground is paramount to successfully decreasing idle catheters and improving patient care and safety in general. As with other hospital-wide initiatives, engagement of hospital administration is important to decrease barriers to implementation.
Intravenous catheter use will remain an integral part of patient care, but efforts should be made to create standardization around the definition of an idle catheter, standardize units of measure, and institute programs to prevent idle catheters.
Daniel Shirley, MD, MS, is assistant professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital. Nasia Safdar, MD, PhD, is associate professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital.
Intravenous catheters (ICs) are common and necessary for inpatient care. However, peripheral and especially central venous catheters (CVCs) are associated with increased risk for local and systemic complications, including bloodstream infections and endocarditis.
Prevention of these complications is important and should be a major focus of infection control and patient safety practices. There are three main points of focus on infection prevention with regard to ICs – proper insertion techniques, proper care of the catheter, and prompt removal when it is no longer necessary.
We focused our review, published in the American Journal of Infection Control (2016 Oct. doi: 10.1016/j.ajic.2016.03.073), on the final point – determining the prevalence, risk factors, and outcomes related to idle intravenous catheters. To accomplish this, we conducted an integrative review of published studies related to idle catheters, excluding reviews, abstracts, and commentaries. Thirteen studies met the inclusion criteria and four of these focused on CVCs.
Generally, an idle catheter is one that remains in place even though it is not being used for patient care. However, the definition of an “idle” catheter varied amongst the reviewed studies, as did the unit of measure, especially for peripheral catheters. Central venous catheter-focused studies were more consistent in using “idle catheter days” and “catheter days.”
Studies of peripheral catheters revealed that 16%-50% of patients had an idle catheter of some type. For the studies focused on CVCs, the percentage of patients with idle catheters ranged from 2.7% in one intensive care unit to 26.2% in a different study. Interestingly, in the study with 2.7% idle CVCs in the ICU, there was a higher percentage of idle CVCs outside of the ICU in the same hospital.
The major reasons for leaving catheters in place in studies where reasons were noted were convenience, future intention to use intravenous medication, and inappropriate use of intravenous medications when oral could be used.
Although data are scarce, complications in the reviewed studies were relatively common with idle peripheral catheters, where 9%-12% suffered thrombophlebitis. Obviously, the risk for catheter-related bloodstream infection increases as the number of catheter days increases – this is especially important with regard to idle CVCs.
Decreasing the prevalence of idle catheters is likely to decrease the risk for infection and improve patient safety. Based on our review of the data, a standardized definition of an “idle catheter” is needed. At the very least, a standard definition should be developed at each institution. This would allow an individual hospital the ability to identify and track the presence of these lines, and implement targeted interventions to decrease the proportion of idle lines. Ideally, a common definition would be created and validated so that data and interventions could be comparable across institutions and guidelines could be developed.
The goal of targeted interventions should be zero idle lines. Prevention of idle peripheral catheters should also be pursued, but because CVC-related complications are often more serious, these lines are often the focus of efforts. Use of peripherally inserted central catheters (PICCs) has increased and while these catheters in some settings may have decreased complication risk, compared with femoral/internal jugular/subclavian CVCs, prevention of idle catheter days is paramount for these catheters as well.
Many ICUs, including at our own institution, have instituted programs to closely monitor for ongoing need for CVCs. This increased focus on the CVC likely explains the lower rates of idle catheters in ICUs noted in the reviewed studies. This close surveillance can be done outside of the ICU as well, and could include peripheral catheters.
At our own institution, the need for catheters is reviewed on some units as part of formalized patient safety rounds. Another potential group of interventions could focus on electronic medical record (EMR)-based changes such as limits on the duration of the order, requirement for renewal of the order, or on-screen reminders of the presence of a catheter. This sort of intervention could possibly be expanded as EMR use becomes more common and robust. For instance, if intravenous medications have not been ordered or given in a certain amount of time, an alert might be triggered. Another EMR-based mechanism could be to require an indication for ongoing catheter use.
Education about the potential adverse outcomes of idle catheters is important. Promoting a team-based approach to interventions, where all involved team members can discuss patient safety issues on equal ground is paramount to successfully decreasing idle catheters and improving patient care and safety in general. As with other hospital-wide initiatives, engagement of hospital administration is important to decrease barriers to implementation.
Intravenous catheter use will remain an integral part of patient care, but efforts should be made to create standardization around the definition of an idle catheter, standardize units of measure, and institute programs to prevent idle catheters.
Daniel Shirley, MD, MS, is assistant professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital. Nasia Safdar, MD, PhD, is associate professor in the division of infectious disease at the University of Wisconsin–Madison School of Medicine and Public Health and the William S. Middleton Memorial Veterans Hospital.
Gastros pleased with fee schedule update related to moderate sedation services
Gastroenterologists will now have a separate billing code for the use of moderate sedation services under provisions finalized in the 2017 update to the physician fee schedule.
The change comes as a result of billing trends, with the Centers for Medicare & Medicaid Services noting in a statement announcing the final PFS update that anesthesia is “increasingly being separately reported for [certain endoscopic] procedures even though payment for sedation was built-in to the payment to the physician furnishing the primary procedure.”
As such, the agency finalized new billing codes for moderate sedation, along with a uniform methodology for valuating procedure codes that currently include moderate sedation as an inherent part of the procedure. Additionally, CMS finalized a separate endoscopy-specific moderate sedation code with valuations that reflect the differences in physician survey data between gastroenterology and other specialties.
She acknowledged CMS’ goal of valuating moderate sedation was that, when it was used, “it could be billed with that service, but when it was not used it would not be reimbursed. This meant that, for gastroenterology procedures, there would be a reduction in the physician fee when billed with anesthesia services.” The three societies’ main goal was to be sure that “the valuation of moderate sedation services was accurate in the setting of GI procedures.”
Dr. Francis said that the change is not expected to have any meaningful impact on the performance of GI procedures regarding the location of where procedures are performed or the type of sedation that is used.
Gastroenterologists will now have a separate billing code for the use of moderate sedation services under provisions finalized in the 2017 update to the physician fee schedule.
The change comes as a result of billing trends, with the Centers for Medicare & Medicaid Services noting in a statement announcing the final PFS update that anesthesia is “increasingly being separately reported for [certain endoscopic] procedures even though payment for sedation was built-in to the payment to the physician furnishing the primary procedure.”
As such, the agency finalized new billing codes for moderate sedation, along with a uniform methodology for valuating procedure codes that currently include moderate sedation as an inherent part of the procedure. Additionally, CMS finalized a separate endoscopy-specific moderate sedation code with valuations that reflect the differences in physician survey data between gastroenterology and other specialties.
She acknowledged CMS’ goal of valuating moderate sedation was that, when it was used, “it could be billed with that service, but when it was not used it would not be reimbursed. This meant that, for gastroenterology procedures, there would be a reduction in the physician fee when billed with anesthesia services.” The three societies’ main goal was to be sure that “the valuation of moderate sedation services was accurate in the setting of GI procedures.”
Dr. Francis said that the change is not expected to have any meaningful impact on the performance of GI procedures regarding the location of where procedures are performed or the type of sedation that is used.
Gastroenterologists will now have a separate billing code for the use of moderate sedation services under provisions finalized in the 2017 update to the physician fee schedule.
The change comes as a result of billing trends, with the Centers for Medicare & Medicaid Services noting in a statement announcing the final PFS update that anesthesia is “increasingly being separately reported for [certain endoscopic] procedures even though payment for sedation was built-in to the payment to the physician furnishing the primary procedure.”
As such, the agency finalized new billing codes for moderate sedation, along with a uniform methodology for valuating procedure codes that currently include moderate sedation as an inherent part of the procedure. Additionally, CMS finalized a separate endoscopy-specific moderate sedation code with valuations that reflect the differences in physician survey data between gastroenterology and other specialties.
She acknowledged CMS’ goal of valuating moderate sedation was that, when it was used, “it could be billed with that service, but when it was not used it would not be reimbursed. This meant that, for gastroenterology procedures, there would be a reduction in the physician fee when billed with anesthesia services.” The three societies’ main goal was to be sure that “the valuation of moderate sedation services was accurate in the setting of GI procedures.”
Dr. Francis said that the change is not expected to have any meaningful impact on the performance of GI procedures regarding the location of where procedures are performed or the type of sedation that is used.
Five tips to prepare for MACRA
As we start off 2017, you’re probably thinking about how to plan for the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which begins Jan. 1. While the process might seem overwhelming, AGA is here to provide five steps that you can take to prepare yourself and your practice.
1. Meet 2016 Physician Quality Reporting System (PQRS) reporting requirements.
2. Review your practice’s Quality and Resource Use Reports (QRURs) for 2015 and the first part of 2016. The QRUR will help you understand how you are currently being rated on cost and quality.
3. Watch your mail for a CMS letter alerting you if you’ll be considered a low-volume provider for 2017 under the Merit-based Incentive Program (MIPs) and exempt from MACRA in 2017.
4. Check Medicare Physician Compare, which will allow patients to compare providers in ways they haven’t been able to before. Brainstorm ways to improve patient communication and discover whether outside resources may need to be added to help patients stay healthy ... and happy.
5. Visit www.gastro.org/MACRA for prerecorded webinars and other AGA resources designed to help make MACRA implementation as seamless as possible.
To learn more about MACRA, visit www.gastro.org/MACRA.
As we start off 2017, you’re probably thinking about how to plan for the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which begins Jan. 1. While the process might seem overwhelming, AGA is here to provide five steps that you can take to prepare yourself and your practice.
1. Meet 2016 Physician Quality Reporting System (PQRS) reporting requirements.
2. Review your practice’s Quality and Resource Use Reports (QRURs) for 2015 and the first part of 2016. The QRUR will help you understand how you are currently being rated on cost and quality.
3. Watch your mail for a CMS letter alerting you if you’ll be considered a low-volume provider for 2017 under the Merit-based Incentive Program (MIPs) and exempt from MACRA in 2017.
4. Check Medicare Physician Compare, which will allow patients to compare providers in ways they haven’t been able to before. Brainstorm ways to improve patient communication and discover whether outside resources may need to be added to help patients stay healthy ... and happy.
5. Visit www.gastro.org/MACRA for prerecorded webinars and other AGA resources designed to help make MACRA implementation as seamless as possible.
To learn more about MACRA, visit www.gastro.org/MACRA.
As we start off 2017, you’re probably thinking about how to plan for the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which begins Jan. 1. While the process might seem overwhelming, AGA is here to provide five steps that you can take to prepare yourself and your practice.
1. Meet 2016 Physician Quality Reporting System (PQRS) reporting requirements.
2. Review your practice’s Quality and Resource Use Reports (QRURs) for 2015 and the first part of 2016. The QRUR will help you understand how you are currently being rated on cost and quality.
3. Watch your mail for a CMS letter alerting you if you’ll be considered a low-volume provider for 2017 under the Merit-based Incentive Program (MIPs) and exempt from MACRA in 2017.
4. Check Medicare Physician Compare, which will allow patients to compare providers in ways they haven’t been able to before. Brainstorm ways to improve patient communication and discover whether outside resources may need to be added to help patients stay healthy ... and happy.
5. Visit www.gastro.org/MACRA for prerecorded webinars and other AGA resources designed to help make MACRA implementation as seamless as possible.
To learn more about MACRA, visit www.gastro.org/MACRA.
Apply for These 2017 Research Grants Before They Close
Round out 2016 by preparing for a 2017 AGA Research Foundation grant. Eight grants are currently open for both established and young investigators, but all will close in January 2017. Make sure you’re prepared to submit your application before the deadline.
Complete information about these and other research awards is available on gastro.org. All recipients will be acknowledged at the Research Recognition Celebration at Digestive Disease Week® 2017 (www.ddw.org) in Chicago, IL.
Jan 6. 2017
- The AGA-Elsevier Gut Microbiome Pilot Research Award will provide $25,000 to support pilot research projects pertaining to the gut microbiome.
- The AGA-Elsevier Pilot Research Award is a 1-year grant providing young investigators, instructors, research associates, or equivalents $25,000 to support pilot research projects in gastroenterology- or hepatology-related areas.
- The AGA-Medtronic Research & Development Pilot Award in Technology grants $31,000 for 1 year to investigators to support the research and development of novel devices or technologies that will potentially impact the diagnosis or treatment of digestive disease.
Jan. 13, 2017
- The AGA-Rome Foundation Functional GI and Motility Disorders Pilot Research Award offers $50,000 for 1 year to early-stage investigators, established investigators, postdoctoral research fellows and combined research and clinical fellows to support pilot research projects pertaining to functional GI and motility disorders.
- The AGA Microbiome Junior Investigator Research Award is a 2-year award of $60,000 for junior investigators engaged in basic, translational, clinical, or health services research related to the gut microbiome.
- The AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease is a 1-year, $30,000 award offered to established and young investigators to support pilot research projects related to IBD.
Jan. 20, 2017
- The AGA-June & Donald O. Castell, MD, Esophageal Clinical Research Award is a 1-year, $25,000 grant that provides research or salary support for junior faculty involved in clinical research in esophageal diseases.
- The AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer is a 1-year, $40,000 award designed to support a young investigator, instructor, research associate or equivalent who currently holds a federal or nonfederal career development award devoted to conducting research related to digestive cancer.
Round out 2016 by preparing for a 2017 AGA Research Foundation grant. Eight grants are currently open for both established and young investigators, but all will close in January 2017. Make sure you’re prepared to submit your application before the deadline.
Complete information about these and other research awards is available on gastro.org. All recipients will be acknowledged at the Research Recognition Celebration at Digestive Disease Week® 2017 (www.ddw.org) in Chicago, IL.
Jan 6. 2017
- The AGA-Elsevier Gut Microbiome Pilot Research Award will provide $25,000 to support pilot research projects pertaining to the gut microbiome.
- The AGA-Elsevier Pilot Research Award is a 1-year grant providing young investigators, instructors, research associates, or equivalents $25,000 to support pilot research projects in gastroenterology- or hepatology-related areas.
- The AGA-Medtronic Research & Development Pilot Award in Technology grants $31,000 for 1 year to investigators to support the research and development of novel devices or technologies that will potentially impact the diagnosis or treatment of digestive disease.
Jan. 13, 2017
- The AGA-Rome Foundation Functional GI and Motility Disorders Pilot Research Award offers $50,000 for 1 year to early-stage investigators, established investigators, postdoctoral research fellows and combined research and clinical fellows to support pilot research projects pertaining to functional GI and motility disorders.
- The AGA Microbiome Junior Investigator Research Award is a 2-year award of $60,000 for junior investigators engaged in basic, translational, clinical, or health services research related to the gut microbiome.
- The AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease is a 1-year, $30,000 award offered to established and young investigators to support pilot research projects related to IBD.
Jan. 20, 2017
- The AGA-June & Donald O. Castell, MD, Esophageal Clinical Research Award is a 1-year, $25,000 grant that provides research or salary support for junior faculty involved in clinical research in esophageal diseases.
- The AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer is a 1-year, $40,000 award designed to support a young investigator, instructor, research associate or equivalent who currently holds a federal or nonfederal career development award devoted to conducting research related to digestive cancer.
Round out 2016 by preparing for a 2017 AGA Research Foundation grant. Eight grants are currently open for both established and young investigators, but all will close in January 2017. Make sure you’re prepared to submit your application before the deadline.
Complete information about these and other research awards is available on gastro.org. All recipients will be acknowledged at the Research Recognition Celebration at Digestive Disease Week® 2017 (www.ddw.org) in Chicago, IL.
Jan 6. 2017
- The AGA-Elsevier Gut Microbiome Pilot Research Award will provide $25,000 to support pilot research projects pertaining to the gut microbiome.
- The AGA-Elsevier Pilot Research Award is a 1-year grant providing young investigators, instructors, research associates, or equivalents $25,000 to support pilot research projects in gastroenterology- or hepatology-related areas.
- The AGA-Medtronic Research & Development Pilot Award in Technology grants $31,000 for 1 year to investigators to support the research and development of novel devices or technologies that will potentially impact the diagnosis or treatment of digestive disease.
Jan. 13, 2017
- The AGA-Rome Foundation Functional GI and Motility Disorders Pilot Research Award offers $50,000 for 1 year to early-stage investigators, established investigators, postdoctoral research fellows and combined research and clinical fellows to support pilot research projects pertaining to functional GI and motility disorders.
- The AGA Microbiome Junior Investigator Research Award is a 2-year award of $60,000 for junior investigators engaged in basic, translational, clinical, or health services research related to the gut microbiome.
- The AGA-Pfizer Pilot Research Award in Inflammatory Bowel Disease is a 1-year, $30,000 award offered to established and young investigators to support pilot research projects related to IBD.
Jan. 20, 2017
- The AGA-June & Donald O. Castell, MD, Esophageal Clinical Research Award is a 1-year, $25,000 grant that provides research or salary support for junior faculty involved in clinical research in esophageal diseases.
- The AGA-Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer is a 1-year, $40,000 award designed to support a young investigator, instructor, research associate or equivalent who currently holds a federal or nonfederal career development award devoted to conducting research related to digestive cancer.
Memorial and honorary gifts: A special tribute
Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the work of our mission through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit:
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $25,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one. A gift of $50,000 or more in your will qualifies for membership in the AGA Legacy Society.
- Named DDW Sessions. A named DDW session is established with a minimum gift of $125,000 over the course of 5 years or through an irrevocable planned gift. Gifts of cash, appreciated securities, life insurance, or property are gift vehicles that may be used to establish a named session. Donors will be eligible for naming recognition of a DDW AGA Institute Council session for 10 years. A gift at that level will qualifies for membership in the AGA Legacy Society.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].
Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the work of our mission through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit:
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $25,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one. A gift of $50,000 or more in your will qualifies for membership in the AGA Legacy Society.
- Named DDW Sessions. A named DDW session is established with a minimum gift of $125,000 over the course of 5 years or through an irrevocable planned gift. Gifts of cash, appreciated securities, life insurance, or property are gift vehicles that may be used to establish a named session. Donors will be eligible for naming recognition of a DDW AGA Institute Council session for 10 years. A gift at that level will qualifies for membership in the AGA Legacy Society.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].
Did you know you can honor a family member, friend, or colleague whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the work of our mission through a gift to the AGA Research Foundation? Your gift will honor a loved one or yourself and support the AGA Research Awards Program, while giving you a tax benefit:
- Giving now or later. Any charitable gift can be made in honor or memory of someone.
- A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research, which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax. A cash gift of $25,000 or more qualifies for membership in the AGA Legacy Society, which recognizes the foundation’s most generous individual donors.
- A gift through your will or living trust. You can include a bequest in your will or living trust stating that a specific asset, certain dollar amount, or more commonly a percentage of your estate will pass to the AGA Research Foundation at your death in honor of your loved one. A gift of $50,000 or more in your will qualifies for membership in the AGA Legacy Society.
- Named DDW Sessions. A named DDW session is established with a minimum gift of $125,000 over the course of 5 years or through an irrevocable planned gift. Gifts of cash, appreciated securities, life insurance, or property are gift vehicles that may be used to establish a named session. Donors will be eligible for naming recognition of a DDW AGA Institute Council session for 10 years. A gift at that level will qualifies for membership in the AGA Legacy Society.
Your next step
An honorary gift is a wonderful way to acknowledge someone’s vision for the future. To learn more about ways to recognize your honoree, visit our website at www.gastro.org/contribute or contact Harmony Excellent at 301-272-1602 or [email protected].