Putting the updated ACCME criteria in perspective...

Check out Josh Callman's new CME blog! I think his latest post might help y'all put the new ACCME criteria in perspective. Click here to access (also one of my links).

Cutting the risk of HIV transmission

Looks like male circumcision as a HIV transmission risk reduction method has been validated by two additional African studies:

In 2,784 men ages 18 to 24 in Kisumu, Kenya, researchers found the two-year HIV incidence was 2.1% in the circumcised men and 4.2% among controls -- a difference that was statistically significant at P=0.0065.

The risk reduction in the Kenyan trial was 53%.

In 4,996 men ages 15 to 49 in the rural Rakai district of Uganda, researchers found a two-year HIV incidence of 0.66 cases per 100 person-years in circumcised men and 1.33 cases per 100 person-years among controls, which was significant at P=0.006.
The risk reduction in Uganda was 51%.

Click here to read the MEDPAGE TODAY brief.

ACCME issues call for comments

The ACCME has issued a call for comments on proposed changes relative to:

1) Written agreements for commercial support

2) Expanded definition of a "commercial interest"

Click here to access the document. Deadline for comments is March 30, 2007.

Merck suspends lobbying efforts on new vaccine

Click here for the press release.

CDC Immunization Schedules -- handheld downloads now available

Handheld versions of the immunization schedules are now available (Palm OS® and Pocket-PCs®):

2007 Childhood & Adolescent Immunization Schedule - Click here (and scroll down).

2006-2007 Adult Immunization Schedule - Click here (and scroll down).

Graphics (jpg images) are also available for Childhood & Adolescent schedules for those of you building presentations on this topic.

Health literacy matters!

The Joint Commission (formerly the Joint Commission on the Accreditation of Health Care Organizations) has published a white paper "What Did the Doctor Say?:’ Improving Health Literacy to Protect Patient Safety" -- every CME professional should read this (I'm entitled to my opinion).
:)
Thanks to the Alliance for CME for including this in their e-newsletter! Click here to read the white paper.

"Top Gun" surgical simulation...

Looks like younger surgeons with video game experience might have the advantage when it comes to learning laparoscopic surgery techniques:

"It is likely that video game skills are a better predictor of demonstrated laparoscopic skills and suturing than years of experience with laparoscopy because many laparoscopic procedures do not require the advanced skill sets as measured in the course," they said.

While the researchers acknowledged indiscriminant video game playing is not a panacea, they suggested that the visuospatial and other skills acquired through video games may help physicians through the "learning curve" for laparoscopic procedures and thus improve patient safety.

Seems fairly intuitive... Click here to read the MEDPAGE TODAY summary of the original Archives of Surgery article.

Do physicians need spiritual CME?

Tracy Balboni, a radiation oncologist, conducted a survey of terminally ill cancer patients about their spiritual needs:

...Balboni found that 88% of terminal cancer patients said religion was at least somewhat important to them. And about half had been visited by clergy. Yet Balboni's research also suggests that hospitals, doctors and even religious communities fail to support the spiritual needs of their cancer patients at the end of life.

In her survey of 230 people with less than a year to live, nearly half say they received little to no support for their spiritual needs from religious communities. More than 70% say their spiritual needs weren't met by hospital chaplains or others in the health care system, says the study, published Saturday in the Journal of Clinical Oncology.

Click here to read the USA Today article.

"One in Three"

Just read a New York Times book review on the new book entitled "One in Three" written by Adam Wishart. Mr. Wishart relates the story of his father bout with cancer and how he personally coped with his father's ordeal...he sought knowledge and wrote this book:

Mr. Wishart reports that during his years of writing and talking casually about cancer, he had a horrifying effect on others. Hearing him, listeners would shiver or quail or walk away. But his book does not prompt that kind of response: Mr. Wishart has done copious research and used it to shape a story more gripping than frightening. In tribute to the intellectually adventurous spirit of his father, who responded to debilitating neck surgery by wearing a starched 16th-century-style ruff to hide his plastic collar, Mr. Wishart remains too erudite and civilized to succumb to fear.

The book apparently contains a fair amount of interesting history about cancer; for instance, ever hear of the "Radium Girls" of New Jersey? Neither had I...click here to check out the book review.

"When the moon is in the Seventh House..."

Interesting survey conducted of hospital visits by Peter Austin and colleagues at the Institute for Clinical Evaluative Sciences in Toronto. They found that "Virgos have an increased risk of vomiting during pregnancy, Pisces have an increased risk of heart failure, and Libras have an increased risk of fracturing their pelvises." Looks like the real purpose of the survey was to make this important point:

Austin said he found that even though each astrological sign had its own unique disorders, his initial results were not reproduced when they were explicitly tested in a second population.

"Scientists take pains to make sure their clinical studies are conducted accurately," said Austin. "But sometimes erroneous conclusions will be obtained solely due to chance."

Statistical chance means that 5 percent of the time, scientists will incorrectly conclude that an association exists, when in reality no such association exists in the population that the scientists are studying.

One way to reduce the chances of drawing a wrong conclusion is to try and reproduce unexpected results in further studies.

Click here to read the entire news article.

ACPE updates noncommercialism criterion

The Accreditation Council for Pharmacy Education has issued an update to ACPE Criterion 17 - noncommercialism. Basically, they adopted the 2004 ACCME Standards for Commercial Support of CME (with ACCME's permission). "Providers will be first evaluated by these guidelines beginning January 1, 2008." Click here to read the updated criterion. Click here to read the guidance document.

Practice makes purrrrrfect...

A touch of whimsy for a Friday. Click here to access Nora the cat at the piano.
:)

Practice guidelines published in American Family Physician

The latest issue of American Family Physician includes two practice guidelines:

Updated CDC Guidelines for the Treatment of STDs
Diagnosis and Management of Cough

Did you know that, on average, a family physician sees a patient every day with a cough? (Can't help myself, please note the Cough guidelines byline is that of Laura Coughlin...coincidence?).
:)
Click here to access these guidelines.

HEART for Women Act

Fitting, perhaps, to tell you about this for Valentine's Day! Several health care organizations have endorsed this legislative bill which is designed to make women's heart health a national priority:

"We know that heart disease affects women and men differently, but research has yet to deliver optimal screenings and treatments for women," said Phyllis Greenberger, M.S.W., President and CEO, Society for Women's Health Research. "Understanding of the issue, even among doctors, is still not where it should be. As the president's budget for health and research declines, we need Congress to take action."

Endorsing organizations include the American Heart Association, Association of Black Cardiologists, Inc., and the Society for Women's Health Research. Click here to read the article.

Would physicians take a cut in pay for a cut in paperwork?

The University of Minnesota School of Public Health conducted a study which "found that 63.4 percent of state physicians believe that a single-payer universal health insurance system would offer the best health care to the greatest number of people."

Dr. Charles Oberg, the study's co-author and associate professor at the University of Minnesota School of Public Health, commented, "Many doctors are becoming increasingly disappointed and frustrated with the health care system as it stands. Insurance hassles, heavy paperwork, and patients' inability to get the care they need make it very problematic."

The study also found that 71 percent of Minnesota doctors said they would accept a 10 percent reduction in fees for a "very significant" reduction in paperwork, and 63.8 percent favored physician payment under a salary system.

Click here to read the entire article.

Finding the balance between paternalism and patient autonomy?

Interesting study published in the New England Journal of Medicine "Religion, Conscience, and Controversial Clinical Practices." I find those intersections between medicine and culture and/or religion fascinating. Click here to access the free article (registration required).

The Prescription Project

From the press release:

Supported by The Pew Charitable Trusts, The Prescription Project is an initiative of Community Catalyst, a Boston-based health care advocacy organization, in partnership with the Institute on Medicine as a Profession (IMAP). Funded by a $6 million grant from Pew, The Prescription Project will work over the next two years with medical and consumer stakeholders, policy makers and both public and private payers to:

• Document the scope of the problem and its impact on health care quality and cost;
• Collaborate with leading Academic Medical Centers (AMCs), physician organizations, public and private health plans, consumer organizations, and policy makers to promote best practices in prescribing;
• Assist AMCs and professional medical societies in adopting policy reforms; and
• Undertake a wide range of policy initiatives in partnership with public and private payers to increase the use of evidence-based systems and reduce conflicts of interest.

Click here to read the entire press release. Thanks to Anne and Lois!

Unintentional poisoning deaths on the rise...

Disturbing statistics from this week's MMWR indicate that unintentional death from poisoning is the second leading cause of unintentional death (#1 is motor-vehicle crashes):

The mortality increases might be the result of greater use and abuse of potentially lethal prescription drugs in recent years, behaviors that are more common among whites than nonwhites (6,7). The substantial increase in deaths among persons aged 15--24 years is consistent with substantial recent increases in recreational prescription drug and cocaine use among adolescents and young adults (8).

Studies by state health agencies have reported recent increases in prescription-drug--poisoning mortality in rural communities (9,10), despite historically higher rates in urban areas. The South and Midwest regions, which had the largest relative and absolute increases among regions in this study, are the most rural regions of the country (4). Further research is needed to determine how differences in drug use, drug-abuse--control measures, and demographic characteristics (e.g., race/ethnicity) contribute to this pattern.

As with any study, there are limitations; click here to read the report.

No record that biopsy forceps had been sterilised...

Hospital infection control measures, or lack thereof, are a serious issue as illustrated by a probably rare case discussed in The Australian article "Hospital tools put kids in HIV risk":

ALMOST 100 children may have been infected with HIV or hepatitis as a result of being treated at Canberra Hospital with surgical instruments that had not been sterilised.

Health authorities are searching for patients who had a colon biopsy at the hospital between 1987 and mid-October last year.
...
"This is an isolated rare event in healthcare. It's very unfortunate that it has occurred but occasionally things like this will happen in hospitals."

An investigation by hospital staff found two biopsy forceps used to take tissue samples were routinely washed but not sterilised as required by national standards.

A tracking system records the sterilisation of all hospital equipment. However, there was no record that the two forceps had been sterilised during the past 20 years.

Click here to read the article.

Do we need combo pills in order to be compliant?

An online survey was conducted last year by Harris Interactive for a capsule supplier on patient medication compliance. From the recent Pharmexec.com article discussing these study results:

The results are provocative, providing clues for drug developers and marketers to better understand the health consequences, as well as the business ramifications, of intentional noncompliance. To take just one example: A large number of patients who alter their regimen suffer from two or more medical problems. One way for drug makers to decrease noncompliance rates might be to reformulate therapies for different health complaints in a single pill. A combo pill that treats two widespread chronic conditions could take advantage of the higher compliance that often comes with one disease and "apply" it to the other—a case of two birds with one stone. With at least one in six Americans taking three or more prescription meds, tailoring drug delivery to more specific patterns may prove a valuable innovation.

Click here to read the article.

There are two ends to the stethoscope...

Ever wonder what physicians complain about regarding their patients and vice versa? A Washington Post article discusses the findings of a survey conducted by the Consumer Reports National Research Center:

Among patients' biggest grumbles, found the survey conducted by the nonprofit Consumer Reports National Research Center and published in the February issue of Consumer Reports: doctors' failure to divulge the cost of medications or office visits (cited by two-thirds of respondents); failure to mention medication side effects (cited by almost one-third); doctors who couldn't see them within a week (19 percent); and doctors who don't return tests results promptly (7 percent).

For their part, doctors took umbrage with patients for not "following their prescribed treatment," waiting too long to make an appointment and being reluctant to discuss their symptoms.

Click here for the article. Now I can't get that Joni Mitchell song, "Both Sides Now" out of my head.
:)

Effectiveness of CME...

The Evidence-based Practice Center at Johns Hopkins University prepared a report for the Agency for Healthcare Research and Quality entitled "Effectiveness of Continuing Medical Education." From the report (hey, I'm a bottom line type of gal):

Conclusion: Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.

Click here to access the 500+ page report. Of course, they didn't include my fabulous journal article published in 1997 in the Western Journal of Medicine. For those of you interested in "ancient" history, click here to read said article. With that article and $4, I can buy a Cafe Mocha!
:)

It's now the law in Texas...(effective September 2008)

Governor Richard Perry (R) has side stepped the Texas State Legislature and signed a new bill which requires sixth-grade girls in the state to be vaccinated with Gardasil. Gardasil, as you might already know, is Merck & Co.'s new vaccine for prevention of cervical cancer caused by strains of the human papillomavirus (HPV). From the International Herald Tribune article:

Texas allows parents to opt out of inoculations by filing an affidavit objecting to the vaccine on religious or philosophical reasons. Even with such provisions, however, conservative groups say such requirements interfere with parents' rights to make medical decisions for their children.

The federal government approved Gardasil in June, and a government advisory panel has recommended that all girls get the shots at 11 and 12, before they are likely to be sexually active.

Click here to read the entire article. What are your thoughts on this issue?

Resources on pandemic flu...

Here are some resources for information on pandemic influenza (in no particular order):

"Pandemic and Seasonal Influenza Principles for U.S. Action" from the Infectious Diseases Society of America. Click here.

PandemicFlu.gov..."One-stop access to U.S. Government avian and pandemic flu information. Managed by the Department of Health and Human Services". Click here.

"Epidemic and Pandemic Alert and Response" from the World Health Organization. Click here.

Women and heart disease...

The American Heart Association and several other national sponsors are urging women to “Go Red for Women” Day this Friday. Women can supposedly go to www.GoRedForWomen.org and complete an online assessment of their heart health; however, I couldn't get into the assessment. There is a “Go Red for Women” brochure available on steps to take for heart health and you can click here to access it.

On a personal note, the 60-year-old wife of a dear family friend visited her physician last week because she had a pain in her shoulder and was not feeling well. The physician sent her home; a few hours later she called her husband at work because she was feeling worse. He quickly drove home and transported her to the ER. Yes, you're correct in thinking that she was having a heart attack; unfortunately, she had a second heart attack shortly after being admitted. She did receive treatment (stents) and, I'm happy to report, is now in fair condition. Women, please educate yourselves on this important issue, click here for American Heart Association information on heart attack warning signs.