Bruce K. Dixon

INDIANAPOLIS — Adolescent women at high risk for acquiring sexually transmitted infections may not respond well to counseling and prevention efforts that focus on the fear of becoming infected, according to a study by researchers at Indiana University in Indianapolis.

Instead, programs and physicians may need to tailor their pregnancy and sexually transmitted infection (STI) counseling to recent patterns of sexual behavior, said Dr. Mary A. Ott of the university's section of adolescent medicine.

“Physicians and other counselors should be aware that fear related to being infected influences sexual behavior only in the short term, and therefore should focus on interpersonal and relationship factors to influence long-term decisions about sex and abstinence,” Dr. Ott said at the annual meeting of the Midwest Society for Pediatric Research.

This urban study of 378 high-risk women aged 14–18 years indicated that the decision to have sex after a period of abstinence was strongly influenced by the relationship between the woman and the man she was involved with, as well as by sexual interest and mood, Dr. Ott explained, adding that this challenges the popular notion that adolescent sex is largely casual and lacking in personal commitment and caring.

The cohort of young women completed quarterly face-to-face interviews and two 3-month daily diary collections per year, and were followed up for a maximum of 4.5 years.

Periods of abstinence were defined as consecutive days of no vaginal sex as recorded in the daily diary. At the time of the study, 9% of the women had an active STI, either Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis.

Frailty models were used to estimate the effects of intrapersonal and interpersonal factors, as well as the effect of STI diagnosis, on the time to ending a period of abstinence. A frailty model is an adaptation of a proportional hazards model that controls for multiple observations from a single participant.

The study cohort had more than 6,000 periods of abstinence, of which 55% ended in sex. The median length of abstinence was 10 days, and the mean length was 39 days.

“Each year increase in a participant's age increased the hazard of ending an abstinence period with sex by 22%,” Dr. Ott said.

“For interpersonal influences, each unit increase in positive mood increased the hazard by 2%, each unit increase in negative mood decreased the hazard by 1%, and each unit increase in sexual interest raised the hazard by 22%,” she said.

Looking at interpersonal influences, each unit increase in partner support hiked the hazard of having sex by 25%, each unit increase in relationship quality raised the hazard by 5%, while a recent STI decreased the hazard of having sex and stopping a period of abstinence by 17%.

However, although mood and the influence of a previous STI lowered the risk of ending short periods of abstinence, they had little effect on ending longer periods of abstinence.

The longer that young women at high risk for STIs went without having sex, the more likely they were to remain abstinent, Dr. Ott said.

INDIANAPOLIS — Adolescent women at high risk for acquiring sexually transmitted infections may not respond well to counseling and prevention efforts that focus on the fear of becoming infected, according to a study by researchers at Indiana University in Indianapolis.

Instead, programs and physicians may need to tailor their pregnancy and sexually transmitted infection (STI) counseling to recent patterns of sexual behavior, said Dr. Mary A. Ott of the university's section of adolescent medicine.

“Physicians and other counselors should be aware that fear related to being infected influences sexual behavior only in the short term, and therefore should focus on interpersonal and relationship factors to influence long-term decisions about sex and abstinence,” Dr. Ott said at the annual meeting of the Midwest Society for Pediatric Research.

This urban study of 378 high-risk women aged 14–18 years indicated that the decision to have sex after a period of abstinence was strongly influenced by the relationship between the woman and the man she was involved with, as well as by sexual interest and mood, Dr. Ott explained, adding that this challenges the popular notion that adolescent sex is largely casual and lacking in personal commitment and caring.

The cohort of young women completed quarterly face-to-face interviews and two 3-month daily diary collections per year, and were followed up for a maximum of 4.5 years.

Periods of abstinence were defined as consecutive days of no vaginal sex as recorded in the daily diary. At the time of the study, 9% of the women had an active STI, either Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis.

Frailty models were used to estimate the effects of intrapersonal and interpersonal factors, as well as the effect of STI diagnosis, on the time to ending a period of abstinence. A frailty model is an adaptation of a proportional hazards model that controls for multiple observations from a single participant.

The study cohort had more than 6,000 periods of abstinence, of which 55% ended in sex. The median length of abstinence was 10 days, and the mean length was 39 days.

“Each year increase in a participant's age increased the hazard of ending an abstinence period with sex by 22%,” Dr. Ott said.

“For interpersonal influences, each unit increase in positive mood increased the hazard by 2%, each unit increase in negative mood decreased the hazard by 1%, and each unit increase in sexual interest raised the hazard by 22%,” she said.

Looking at interpersonal influences, each unit increase in partner support hiked the hazard of having sex by 25%, each unit increase in relationship quality raised the hazard by 5%, while a recent STI decreased the hazard of having sex and stopping a period of abstinence by 17%.

However, although mood and the influence of a previous STI lowered the risk of ending short periods of abstinence, they had little effect on ending longer periods of abstinence.

The longer that young women at high risk for STIs went without having sex, the more likely they were to remain abstinent, Dr. Ott said.

INDIANAPOLIS — Adolescent women at high risk for acquiring sexually transmitted infections may not respond well to counseling and prevention efforts that focus on the fear of becoming infected, according to a study by researchers at Indiana University in Indianapolis.

Instead, programs and physicians may need to tailor their pregnancy and sexually transmitted infection (STI) counseling to recent patterns of sexual behavior, said Dr. Mary A. Ott of the university's section of adolescent medicine.

“Physicians and other counselors should be aware that fear related to being infected influences sexual behavior only in the short term, and therefore should focus on interpersonal and relationship factors to influence long-term decisions about sex and abstinence,” Dr. Ott said at the annual meeting of the Midwest Society for Pediatric Research.

This urban study of 378 high-risk women aged 14–18 years indicated that the decision to have sex after a period of abstinence was strongly influenced by the relationship between the woman and the man she was involved with, as well as by sexual interest and mood, Dr. Ott explained, adding that this challenges the popular notion that adolescent sex is largely casual and lacking in personal commitment and caring.

The cohort of young women completed quarterly face-to-face interviews and two 3-month daily diary collections per year, and were followed up for a maximum of 4.5 years.

Periods of abstinence were defined as consecutive days of no vaginal sex as recorded in the daily diary. At the time of the study, 9% of the women had an active STI, either Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis.

Frailty models were used to estimate the effects of intrapersonal and interpersonal factors, as well as the effect of STI diagnosis, on the time to ending a period of abstinence. A frailty model is an adaptation of a proportional hazards model that controls for multiple observations from a single participant.

The study cohort had more than 6,000 periods of abstinence, of which 55% ended in sex. The median length of abstinence was 10 days, and the mean length was 39 days.

“Each year increase in a participant's age increased the hazard of ending an abstinence period with sex by 22%,” Dr. Ott said.

“For interpersonal influences, each unit increase in positive mood increased the hazard by 2%, each unit increase in negative mood decreased the hazard by 1%, and each unit increase in sexual interest raised the hazard by 22%,” she said.

Looking at interpersonal influences, each unit increase in partner support hiked the hazard of having sex by 25%, each unit increase in relationship quality raised the hazard by 5%, while a recent STI decreased the hazard of having sex and stopping a period of abstinence by 17%.

However, although mood and the influence of a previous STI lowered the risk of ending short periods of abstinence, they had little effect on ending longer periods of abstinence.

The longer that young women at high risk for STIs went without having sex, the more likely they were to remain abstinent, Dr. Ott said.

INDIANAPOLIS — A group of Chicago pediatricians has developed a cost-effective model for protecting preterm infants in urban settings against respiratory syncytial virus.

“All of the challenges posed by respiratory syncytial virus prophylaxis are addressed by this model,” said Dr. Hari B. Srinivasan of Sinai Children's Hospital in Chicago.

“When the babies are brought in for repeat immunizations and well baby care, we now give them Synagis [palivizumab] in the clinic,” Dr. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research. “That way there's no separate trip and no payment for home health.”

The monoclonal antibody palivizumab is administered to these high-risk babies to protect them against respiratory syncytial virus (RSV). However, in an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence, explained Dr. Srinivasan. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits.

“So we incorporated RSV prophylaxis for these babies as part of the regular health maintenance visits to the high-risk follow-up clinic,” he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. The first injection was given prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 g, and the mean gestational age was 31 weeks. Sixty-four percent of infants got all the recommended doses, and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study, there were two documented RSV infections; one infant was rehospitalized and required oxygen by nasal canula and albuterol nebulization only.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

“The model is ideal for urban, inner-city clinics,” added Dr. Srinivasan.

INDIANAPOLIS — A group of Chicago pediatricians has developed a cost-effective model for protecting preterm infants in urban settings against respiratory syncytial virus.

“All of the challenges posed by respiratory syncytial virus prophylaxis are addressed by this model,” said Dr. Hari B. Srinivasan of Sinai Children's Hospital in Chicago.

“When the babies are brought in for repeat immunizations and well baby care, we now give them Synagis [palivizumab] in the clinic,” Dr. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research. “That way there's no separate trip and no payment for home health.”

The monoclonal antibody palivizumab is administered to these high-risk babies to protect them against respiratory syncytial virus (RSV). However, in an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence, explained Dr. Srinivasan. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits.

“So we incorporated RSV prophylaxis for these babies as part of the regular health maintenance visits to the high-risk follow-up clinic,” he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. The first injection was given prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 g, and the mean gestational age was 31 weeks. Sixty-four percent of infants got all the recommended doses, and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study, there were two documented RSV infections; one infant was rehospitalized and required oxygen by nasal canula and albuterol nebulization only.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

“The model is ideal for urban, inner-city clinics,” added Dr. Srinivasan.

INDIANAPOLIS — A group of Chicago pediatricians has developed a cost-effective model for protecting preterm infants in urban settings against respiratory syncytial virus.

“All of the challenges posed by respiratory syncytial virus prophylaxis are addressed by this model,” said Dr. Hari B. Srinivasan of Sinai Children's Hospital in Chicago.

“When the babies are brought in for repeat immunizations and well baby care, we now give them Synagis [palivizumab] in the clinic,” Dr. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research. “That way there's no separate trip and no payment for home health.”

The monoclonal antibody palivizumab is administered to these high-risk babies to protect them against respiratory syncytial virus (RSV). However, in an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence, explained Dr. Srinivasan. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits.

“So we incorporated RSV prophylaxis for these babies as part of the regular health maintenance visits to the high-risk follow-up clinic,” he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. The first injection was given prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 g, and the mean gestational age was 31 weeks. Sixty-four percent of infants got all the recommended doses, and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study, there were two documented RSV infections; one infant was rehospitalized and required oxygen by nasal canula and albuterol nebulization only.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

“The model is ideal for urban, inner-city clinics,” added Dr. Srinivasan.

SCOTTSDALE, ARIZ. – Misconceptions and other barriers to behavioral therapy limit headache patients' access to potentially beneficial nonpharmacologic treatments, Donald B. Penzien, Ph.D., said at a symposium sponsored by the American Headache Society.

Standard behavioral interventions include relaxation training, biofeedback training, cognitive behavioral therapy, stress management, or some combination of these approaches, said Dr. Penzien, professor of psychiatry and director of the Head Pain Center at the University of Mississippi, Jackson.

Reimbursement and workforce issues limit the use of these nonpharmacologic treatments, but another factor weighs heavily as well: the stigma of seeking care from a behavioral specialist, he said.

“The reality is that patients with migraine or tension headache don't necessarily have emotional illness, yet research shows they can still benefit from behavioral therapy,” he said in an interview.

Even the best pharmacologic agents have their limits because headache is a psychophysiologic disorder, Dr. Penzien explained.

Patients most suitable for behavioral headache treatments include those with poor tolerance of and medical contraindications for drug treatment or inadequate response to medications; those who prefer nondrug interventions; pregnant and nursing women; and those with history of frequent or excessive use of analgesic or other acute medications.

“Over 300 studies have evaluated behavioral therapy for the management of migraine. On average, these interventions have shown 35%–55% improvement pretreatment to post treatment,” Dr. Penzien said.

Furthermore, he added, the effects of behavioral treatments appear enduring; the literature shows efficacy up to 7 years post treatment.

Behavioral treatment typically entails 6–12 clinic sessions with a professional. Cost and time considerations have given rise to the minimal therapist contact (MTC) approach, which requires fewer sessions.

MTC interventions are started at the clinic and then patients are sent home with reading and audio materials that guide their acquisition of new behavioral skills on their own time. “Minimal contact therapies are producing results in the range of what we can do with the more intensive clinic-based therapies. The patients appreciate the convenience and lower cost,” he said.

Dr. Penzien said that he would like to see primary care physicians and neurologists increase their focus on psychological and emotional factors underlying migraines. “Relatively short-term behavioral interventions can be of great importance in assisting your patients to better manage their headaches.”

SCOTTSDALE, ARIZ. – Misconceptions and other barriers to behavioral therapy limit headache patients' access to potentially beneficial nonpharmacologic treatments, Donald B. Penzien, Ph.D., said at a symposium sponsored by the American Headache Society.

Standard behavioral interventions include relaxation training, biofeedback training, cognitive behavioral therapy, stress management, or some combination of these approaches, said Dr. Penzien, professor of psychiatry and director of the Head Pain Center at the University of Mississippi, Jackson.

Reimbursement and workforce issues limit the use of these nonpharmacologic treatments, but another factor weighs heavily as well: the stigma of seeking care from a behavioral specialist, he said.

“The reality is that patients with migraine or tension headache don't necessarily have emotional illness, yet research shows they can still benefit from behavioral therapy,” he said in an interview.

Even the best pharmacologic agents have their limits because headache is a psychophysiologic disorder, Dr. Penzien explained.

Patients most suitable for behavioral headache treatments include those with poor tolerance of and medical contraindications for drug treatment or inadequate response to medications; those who prefer nondrug interventions; pregnant and nursing women; and those with history of frequent or excessive use of analgesic or other acute medications.

“Over 300 studies have evaluated behavioral therapy for the management of migraine. On average, these interventions have shown 35%–55% improvement pretreatment to post treatment,” Dr. Penzien said.

Furthermore, he added, the effects of behavioral treatments appear enduring; the literature shows efficacy up to 7 years post treatment.

Behavioral treatment typically entails 6–12 clinic sessions with a professional. Cost and time considerations have given rise to the minimal therapist contact (MTC) approach, which requires fewer sessions.

MTC interventions are started at the clinic and then patients are sent home with reading and audio materials that guide their acquisition of new behavioral skills on their own time. “Minimal contact therapies are producing results in the range of what we can do with the more intensive clinic-based therapies. The patients appreciate the convenience and lower cost,” he said.

Dr. Penzien said that he would like to see primary care physicians and neurologists increase their focus on psychological and emotional factors underlying migraines. “Relatively short-term behavioral interventions can be of great importance in assisting your patients to better manage their headaches.”

SCOTTSDALE, ARIZ. – Misconceptions and other barriers to behavioral therapy limit headache patients' access to potentially beneficial nonpharmacologic treatments, Donald B. Penzien, Ph.D., said at a symposium sponsored by the American Headache Society.

Standard behavioral interventions include relaxation training, biofeedback training, cognitive behavioral therapy, stress management, or some combination of these approaches, said Dr. Penzien, professor of psychiatry and director of the Head Pain Center at the University of Mississippi, Jackson.

Reimbursement and workforce issues limit the use of these nonpharmacologic treatments, but another factor weighs heavily as well: the stigma of seeking care from a behavioral specialist, he said.

“The reality is that patients with migraine or tension headache don't necessarily have emotional illness, yet research shows they can still benefit from behavioral therapy,” he said in an interview.

Even the best pharmacologic agents have their limits because headache is a psychophysiologic disorder, Dr. Penzien explained.

Patients most suitable for behavioral headache treatments include those with poor tolerance of and medical contraindications for drug treatment or inadequate response to medications; those who prefer nondrug interventions; pregnant and nursing women; and those with history of frequent or excessive use of analgesic or other acute medications.

“Over 300 studies have evaluated behavioral therapy for the management of migraine. On average, these interventions have shown 35%–55% improvement pretreatment to post treatment,” Dr. Penzien said.

Furthermore, he added, the effects of behavioral treatments appear enduring; the literature shows efficacy up to 7 years post treatment.

Behavioral treatment typically entails 6–12 clinic sessions with a professional. Cost and time considerations have given rise to the minimal therapist contact (MTC) approach, which requires fewer sessions.

MTC interventions are started at the clinic and then patients are sent home with reading and audio materials that guide their acquisition of new behavioral skills on their own time. “Minimal contact therapies are producing results in the range of what we can do with the more intensive clinic-based therapies. The patients appreciate the convenience and lower cost,” he said.

Dr. Penzien said that he would like to see primary care physicians and neurologists increase their focus on psychological and emotional factors underlying migraines. “Relatively short-term behavioral interventions can be of great importance in assisting your patients to better manage their headaches.”

CLEVELAND — Surgeons at the Cleveland Clinic have developed an outpatient procedure for creating a continent catheterizable channel to the bladder or neobladder in patients with lower urinary tract dysfunction, Dr. Raymond R. Rackley said at the annual international meeting of the Endourological Society.

“While we've made great advances in helping people with failure-to-store conditions, this is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions,” Dr. Rackley said in an interview.

“That's the real frontier left in lower urinary pelvic reconstruction,” he added.

Surgeons formed this “continent neo-urachus” by making a tube of skin from an in situ abdominal skin flap over an 18F catheter that extends from the umbilicus to the dome of the bladder. The skin tube is placed through an opening between the braiding or crossing of the overlying rectus muscle fibers to form an external compressive continence mechanism, said Dr. Rackley, a professor of surgery at Case Western Reserve University, Cleveland.

“We form a subcutaneous tunnel to the dome of the bladder and make that bladder access dry by surrounding it and compressing it with the muscles of the patient's abdomen,” he said.

The abdominal skin is reapproximated, and the 18F catheter through the neostomal channel is left to heal for about 6 weeks while providing bladder drainage to a leg bag. Once the channel heals, the catheter is removed and the patient begins intermittent catheterization on a regular basis.

The surgery is all subcutaneous, unlike the traditional 8-hour procedure, in which intestines are harvested and reconstruction performed to create a continent mechanism, Dr. Rackley said. The new procedure “takes less than 1 hour under minimal sedation,” he noted.

In addition to being less invasive, the procedure eliminates the need for a foreign body or chronic catheter in the bladder, thereby reducing the risk of infection.

The procedure is a good alternative for those who wish to avoid a catheter in their native urethra or who can't catheterize in the sitting position because of a spinal cord injury or neurologic condition.

“It's also a good choice for patients who have had pelvic reconstruction and are not dry because of leaking channels,” Dr. Rackley said.

The continent neo-urachus, now with 18 months of follow-up, has been successful in more than 20 patients at the Cleveland Clinic and has been performed by urologists worldwide since its recent inception, he said.

The concept of braiding or crossing the rectus muscle for a continence mechanism may be extended to revisions of nondiversion channels that have developed incontinent catheterizable stomas due to outlet resistance pressure that is less than the bladder or neobladder filling pressure, Dr. Rackley said.

'This is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions.' DR. RACKLEY

EMILY BRANNAN, ILLUSRATION

CLEVELAND — Surgeons at the Cleveland Clinic have developed an outpatient procedure for creating a continent catheterizable channel to the bladder or neobladder in patients with lower urinary tract dysfunction, Dr. Raymond R. Rackley said at the annual international meeting of the Endourological Society.

“While we've made great advances in helping people with failure-to-store conditions, this is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions,” Dr. Rackley said in an interview.

“That's the real frontier left in lower urinary pelvic reconstruction,” he added.

Surgeons formed this “continent neo-urachus” by making a tube of skin from an in situ abdominal skin flap over an 18F catheter that extends from the umbilicus to the dome of the bladder. The skin tube is placed through an opening between the braiding or crossing of the overlying rectus muscle fibers to form an external compressive continence mechanism, said Dr. Rackley, a professor of surgery at Case Western Reserve University, Cleveland.

“We form a subcutaneous tunnel to the dome of the bladder and make that bladder access dry by surrounding it and compressing it with the muscles of the patient's abdomen,” he said.

The abdominal skin is reapproximated, and the 18F catheter through the neostomal channel is left to heal for about 6 weeks while providing bladder drainage to a leg bag. Once the channel heals, the catheter is removed and the patient begins intermittent catheterization on a regular basis.

The surgery is all subcutaneous, unlike the traditional 8-hour procedure, in which intestines are harvested and reconstruction performed to create a continent mechanism, Dr. Rackley said. The new procedure “takes less than 1 hour under minimal sedation,” he noted.

In addition to being less invasive, the procedure eliminates the need for a foreign body or chronic catheter in the bladder, thereby reducing the risk of infection.

The procedure is a good alternative for those who wish to avoid a catheter in their native urethra or who can't catheterize in the sitting position because of a spinal cord injury or neurologic condition.

“It's also a good choice for patients who have had pelvic reconstruction and are not dry because of leaking channels,” Dr. Rackley said.

The continent neo-urachus, now with 18 months of follow-up, has been successful in more than 20 patients at the Cleveland Clinic and has been performed by urologists worldwide since its recent inception, he said.

The concept of braiding or crossing the rectus muscle for a continence mechanism may be extended to revisions of nondiversion channels that have developed incontinent catheterizable stomas due to outlet resistance pressure that is less than the bladder or neobladder filling pressure, Dr. Rackley said.

'This is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions.' DR. RACKLEY

EMILY BRANNAN, ILLUSRATION

CLEVELAND — Surgeons at the Cleveland Clinic have developed an outpatient procedure for creating a continent catheterizable channel to the bladder or neobladder in patients with lower urinary tract dysfunction, Dr. Raymond R. Rackley said at the annual international meeting of the Endourological Society.

“While we've made great advances in helping people with failure-to-store conditions, this is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions,” Dr. Rackley said in an interview.

“That's the real frontier left in lower urinary pelvic reconstruction,” he added.

Surgeons formed this “continent neo-urachus” by making a tube of skin from an in situ abdominal skin flap over an 18F catheter that extends from the umbilicus to the dome of the bladder. The skin tube is placed through an opening between the braiding or crossing of the overlying rectus muscle fibers to form an external compressive continence mechanism, said Dr. Rackley, a professor of surgery at Case Western Reserve University, Cleveland.

“We form a subcutaneous tunnel to the dome of the bladder and make that bladder access dry by surrounding it and compressing it with the muscles of the patient's abdomen,” he said.

The abdominal skin is reapproximated, and the 18F catheter through the neostomal channel is left to heal for about 6 weeks while providing bladder drainage to a leg bag. Once the channel heals, the catheter is removed and the patient begins intermittent catheterization on a regular basis.

The surgery is all subcutaneous, unlike the traditional 8-hour procedure, in which intestines are harvested and reconstruction performed to create a continent mechanism, Dr. Rackley said. The new procedure “takes less than 1 hour under minimal sedation,” he noted.

In addition to being less invasive, the procedure eliminates the need for a foreign body or chronic catheter in the bladder, thereby reducing the risk of infection.

The procedure is a good alternative for those who wish to avoid a catheter in their native urethra or who can't catheterize in the sitting position because of a spinal cord injury or neurologic condition.

“It's also a good choice for patients who have had pelvic reconstruction and are not dry because of leaking channels,” Dr. Rackley said.

The continent neo-urachus, now with 18 months of follow-up, has been successful in more than 20 patients at the Cleveland Clinic and has been performed by urologists worldwide since its recent inception, he said.

The concept of braiding or crossing the rectus muscle for a continence mechanism may be extended to revisions of nondiversion channels that have developed incontinent catheterizable stomas due to outlet resistance pressure that is less than the bladder or neobladder filling pressure, Dr. Rackley said.

'This is probably one of the first minimally invasive procedures that helps those with failure-to-empty conditions.' DR. RACKLEY

EMILY BRANNAN, ILLUSRATION

INDIANAPOLIS — Obese children may eat less when offered larger, less frequent meals, Dr. Rinku Mehra reported at the annual meeting of the Midwest Society for Pediatric Research.

“The preliminary results of our study suggest that altering meal frequency affects satiety in obese children, but not in the way we had hypothesized,” Dr. Mehra said.

The researchers' hypothesis was based largely on previous studies of adults in which smaller, more frequent meals increased satiety and cut total caloric consumption. “Obese children may experience greater satiety when offered larger meals without snacks,” said Dr. Mehra of the University of Iowa Hospitals and Clinics in Iowa City.

The results of the 2-day study also suggest that the more restrictions parents place on certain foods, the more of those foods children will eat when unsupervised. In this case, the food in question was ice cream.

During the study, 18 normal weight and 8 obese children were admitted fasting to the General Clinical Research Center.

The normal children's body mass index (BMI) ranged from the 25th to the 85th percentile and produced an average BMI score of 0.31. In the obese cohort, BMIs were all greater than the 95th percentile and the average score was 2.37. The children were aged 6–10 years.

On the first day, subjects were randomly assigned to diet A (three meals and two snacks) or diet B (three meals). The energy distribution was the same in all meals: 14% from protein, 32% from fat, and 54% from carbohydrate per the current National Health and Nutrition Examination Survey guidelines for childhood reference intakes.

On the second day, they got the opposite meal pattern. At the end of each day, all the children were offered eight scoops of ice cream and were told they could eat as much as they wanted. Parents were given child feeding questionnaires (CFQs) to complete, said Dr. Mehra.

“Obese children consumed more ice cream when given frequent small meals than when given less frequent, larger meals. Despite receiving equivalent meals adjusted for energy requirements, obese children ate more ice cream than nonobese children. Also, the parents of heavier children had higher restriction scores on the CFQ than parents of normal weight children—and higher parental restriction scores, regardless of the child's weight, correlated with higher ice cream consumption,” said Dr. Mehra.

“High levels of parental control and increased restriction may influence the development of the child's self-control based on hunger and satiety cues, and less frequent meals and less parental restriction may improve satiety in obese children,” he said.

INDIANAPOLIS — Obese children may eat less when offered larger, less frequent meals, Dr. Rinku Mehra reported at the annual meeting of the Midwest Society for Pediatric Research.

“The preliminary results of our study suggest that altering meal frequency affects satiety in obese children, but not in the way we had hypothesized,” Dr. Mehra said.

The researchers' hypothesis was based largely on previous studies of adults in which smaller, more frequent meals increased satiety and cut total caloric consumption. “Obese children may experience greater satiety when offered larger meals without snacks,” said Dr. Mehra of the University of Iowa Hospitals and Clinics in Iowa City.

The results of the 2-day study also suggest that the more restrictions parents place on certain foods, the more of those foods children will eat when unsupervised. In this case, the food in question was ice cream.

During the study, 18 normal weight and 8 obese children were admitted fasting to the General Clinical Research Center.

The normal children's body mass index (BMI) ranged from the 25th to the 85th percentile and produced an average BMI score of 0.31. In the obese cohort, BMIs were all greater than the 95th percentile and the average score was 2.37. The children were aged 6–10 years.

On the first day, subjects were randomly assigned to diet A (three meals and two snacks) or diet B (three meals). The energy distribution was the same in all meals: 14% from protein, 32% from fat, and 54% from carbohydrate per the current National Health and Nutrition Examination Survey guidelines for childhood reference intakes.

On the second day, they got the opposite meal pattern. At the end of each day, all the children were offered eight scoops of ice cream and were told they could eat as much as they wanted. Parents were given child feeding questionnaires (CFQs) to complete, said Dr. Mehra.

“Obese children consumed more ice cream when given frequent small meals than when given less frequent, larger meals. Despite receiving equivalent meals adjusted for energy requirements, obese children ate more ice cream than nonobese children. Also, the parents of heavier children had higher restriction scores on the CFQ than parents of normal weight children—and higher parental restriction scores, regardless of the child's weight, correlated with higher ice cream consumption,” said Dr. Mehra.

“High levels of parental control and increased restriction may influence the development of the child's self-control based on hunger and satiety cues, and less frequent meals and less parental restriction may improve satiety in obese children,” he said.

INDIANAPOLIS — Obese children may eat less when offered larger, less frequent meals, Dr. Rinku Mehra reported at the annual meeting of the Midwest Society for Pediatric Research.

“The preliminary results of our study suggest that altering meal frequency affects satiety in obese children, but not in the way we had hypothesized,” Dr. Mehra said.

The researchers' hypothesis was based largely on previous studies of adults in which smaller, more frequent meals increased satiety and cut total caloric consumption. “Obese children may experience greater satiety when offered larger meals without snacks,” said Dr. Mehra of the University of Iowa Hospitals and Clinics in Iowa City.

The results of the 2-day study also suggest that the more restrictions parents place on certain foods, the more of those foods children will eat when unsupervised. In this case, the food in question was ice cream.

During the study, 18 normal weight and 8 obese children were admitted fasting to the General Clinical Research Center.

The normal children's body mass index (BMI) ranged from the 25th to the 85th percentile and produced an average BMI score of 0.31. In the obese cohort, BMIs were all greater than the 95th percentile and the average score was 2.37. The children were aged 6–10 years.

On the first day, subjects were randomly assigned to diet A (three meals and two snacks) or diet B (three meals). The energy distribution was the same in all meals: 14% from protein, 32% from fat, and 54% from carbohydrate per the current National Health and Nutrition Examination Survey guidelines for childhood reference intakes.

On the second day, they got the opposite meal pattern. At the end of each day, all the children were offered eight scoops of ice cream and were told they could eat as much as they wanted. Parents were given child feeding questionnaires (CFQs) to complete, said Dr. Mehra.

“Obese children consumed more ice cream when given frequent small meals than when given less frequent, larger meals. Despite receiving equivalent meals adjusted for energy requirements, obese children ate more ice cream than nonobese children. Also, the parents of heavier children had higher restriction scores on the CFQ than parents of normal weight children—and higher parental restriction scores, regardless of the child's weight, correlated with higher ice cream consumption,” said Dr. Mehra.

“High levels of parental control and increased restriction may influence the development of the child's self-control based on hunger and satiety cues, and less frequent meals and less parental restriction may improve satiety in obese children,” he said.

INDIANAPOLIS — Providing the monoclonal antibody, palivizumab, during well baby visits improves the prevention of respiratory syncytial virus in high-risk urban infants, Dr. Hari B. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research.

This approach eliminates having to arrange and pay for a separate home health visit, said Dr. Srinivasan of Sinai Children's Hospital in Chicago. In an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits, he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. Neonates discharged during the RSV season received their first injection prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 grams and the mean gestational age was 31 weeks.

Sixty-four percent of infants got all the recommended doses and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study there were two documented RSV infections and one of the infants was hospitalized.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

Ninety-one percent of infants received greater than 80% of the recommended doses. DR. SRINIVASAN

INDIANAPOLIS — Providing the monoclonal antibody, palivizumab, during well baby visits improves the prevention of respiratory syncytial virus in high-risk urban infants, Dr. Hari B. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research.

This approach eliminates having to arrange and pay for a separate home health visit, said Dr. Srinivasan of Sinai Children's Hospital in Chicago. In an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits, he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. Neonates discharged during the RSV season received their first injection prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 grams and the mean gestational age was 31 weeks.

Sixty-four percent of infants got all the recommended doses and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study there were two documented RSV infections and one of the infants was hospitalized.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

Ninety-one percent of infants received greater than 80% of the recommended doses. DR. SRINIVASAN

INDIANAPOLIS — Providing the monoclonal antibody, palivizumab, during well baby visits improves the prevention of respiratory syncytial virus in high-risk urban infants, Dr. Hari B. Srinivasan said in a poster session at the annual meeting of the Midwest Society for Pediatric Research.

This approach eliminates having to arrange and pay for a separate home health visit, said Dr. Srinivasan of Sinai Children's Hospital in Chicago. In an urban inner-city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence. And in some cases, there is significant delay involved in getting authorization from Medicaid health maintenance organizations to provide home visits, he said.

To prove the efficacy of this approach, the researchers reviewed the number of doses of palivizumab administered and the incidence and number of hospitalizations for RSV-related illness in a cohort of infants during the RSV season from November 2004 to April 2005.

All infants discharged from the neonatal intensive care unit were followed up in a high-risk clinic offering comprehensive medical care, including health maintenance visits.

Palivizumab (15 mg/kg) was given as monthly injections to infants qualifying under the American Academy of Pediatrics guidelines. Neonates discharged during the RSV season received their first injection prior to discharge from the neonatal intensive care unit.

A total of 72 infants qualified for palivizumab administration. The mean birth weight was 1,620 grams and the mean gestational age was 31 weeks.

Sixty-four percent of infants got all the recommended doses and 28% got 80% of the recommended doses, he said, adding that only 8% of the patients received fewer than 80% of the recommended doses.

During the study there were two documented RSV infections and one of the infants was hospitalized.

“This model of administration of palivizumab resulted in 91% of infants receiving greater than 80% of the recommended doses … and is a viable alternate to the home health model to administer palivizumab in an inner city population,” the researchers concluded.

Ninety-one percent of infants received greater than 80% of the recommended doses. DR. SRINIVASAN

LA JOLLA, CALIF. — Hysterectomy and the levonorgestrel-releasing intrauterine system are equally effective for improving sexual functioning in women being treated for menorrhagia, according to Dr. Karoliina Halmesmaki.

“One-third of women suffer from menorrhagia during their reproductive years, and as a result have a lower quality of life,” she said at the annual meeting of the Association of Reproductive Health Professionals.

The most common surgical treatment for this condition is hysterectomy, which has the potential to affect sexual functioning by disrupting the vaginal nerve supply and changing pelvic anatomy, explained Dr. Halmesmaki, a professor in the department of obstetrics and gynecology at the University of Helsinki.

“Previous randomized controlled trials comparing hysterectomy with medical treatment … have produced controversial results. The aim of our study was to compare these two treatments' effects on sexual functioning,” she said.

The study included 236 nondepressed women aged 35–49 years who were referred for menorrhagia to five university hospitals in Finland. Equal numbers of women were matched and randomized to either surgery or a levonorgestrel-releasing intrauterine system (LNG-IUS). Sexual functioning was assessed by a modified McCoy sexual scale, a questionnaire addressing sexual satisfaction, partner satisfaction, and sexual problems.

“Sexual satisfaction increased in both groups at 6 months' follow-up, but more so in the hysterectomy group,” Dr. Halmesmaki said. “However, the two groups did not differ at 12 months and 5 years.”

Sexual problems decreased among women with hysterectomies at 6 and 12 months, but again, there was no group difference at the 5-year follow-up.

“Interestingly, even though the two groups did not differ with regard to sexual satisfaction or sex problems at 5 years, the women using LNG-IUS were less satisfied with their partners at 1 year and beyond; they generally felt their partners were not as good [sexually],” Dr. Halmesmaki said. Inexplicably, smoking on the part of the women also was associated with lower partner satisfaction, she commented.

LA JOLLA, CALIF. — Hysterectomy and the levonorgestrel-releasing intrauterine system are equally effective for improving sexual functioning in women being treated for menorrhagia, according to Dr. Karoliina Halmesmaki.

“One-third of women suffer from menorrhagia during their reproductive years, and as a result have a lower quality of life,” she said at the annual meeting of the Association of Reproductive Health Professionals.

The most common surgical treatment for this condition is hysterectomy, which has the potential to affect sexual functioning by disrupting the vaginal nerve supply and changing pelvic anatomy, explained Dr. Halmesmaki, a professor in the department of obstetrics and gynecology at the University of Helsinki.

“Previous randomized controlled trials comparing hysterectomy with medical treatment … have produced controversial results. The aim of our study was to compare these two treatments' effects on sexual functioning,” she said.

The study included 236 nondepressed women aged 35–49 years who were referred for menorrhagia to five university hospitals in Finland. Equal numbers of women were matched and randomized to either surgery or a levonorgestrel-releasing intrauterine system (LNG-IUS). Sexual functioning was assessed by a modified McCoy sexual scale, a questionnaire addressing sexual satisfaction, partner satisfaction, and sexual problems.

“Sexual satisfaction increased in both groups at 6 months' follow-up, but more so in the hysterectomy group,” Dr. Halmesmaki said. “However, the two groups did not differ at 12 months and 5 years.”

Sexual problems decreased among women with hysterectomies at 6 and 12 months, but again, there was no group difference at the 5-year follow-up.

“Interestingly, even though the two groups did not differ with regard to sexual satisfaction or sex problems at 5 years, the women using LNG-IUS were less satisfied with their partners at 1 year and beyond; they generally felt their partners were not as good [sexually],” Dr. Halmesmaki said. Inexplicably, smoking on the part of the women also was associated with lower partner satisfaction, she commented.

LA JOLLA, CALIF. — Hysterectomy and the levonorgestrel-releasing intrauterine system are equally effective for improving sexual functioning in women being treated for menorrhagia, according to Dr. Karoliina Halmesmaki.

“One-third of women suffer from menorrhagia during their reproductive years, and as a result have a lower quality of life,” she said at the annual meeting of the Association of Reproductive Health Professionals.

The most common surgical treatment for this condition is hysterectomy, which has the potential to affect sexual functioning by disrupting the vaginal nerve supply and changing pelvic anatomy, explained Dr. Halmesmaki, a professor in the department of obstetrics and gynecology at the University of Helsinki.

“Previous randomized controlled trials comparing hysterectomy with medical treatment … have produced controversial results. The aim of our study was to compare these two treatments' effects on sexual functioning,” she said.

The study included 236 nondepressed women aged 35–49 years who were referred for menorrhagia to five university hospitals in Finland. Equal numbers of women were matched and randomized to either surgery or a levonorgestrel-releasing intrauterine system (LNG-IUS). Sexual functioning was assessed by a modified McCoy sexual scale, a questionnaire addressing sexual satisfaction, partner satisfaction, and sexual problems.

“Sexual satisfaction increased in both groups at 6 months' follow-up, but more so in the hysterectomy group,” Dr. Halmesmaki said. “However, the two groups did not differ at 12 months and 5 years.”

Sexual problems decreased among women with hysterectomies at 6 and 12 months, but again, there was no group difference at the 5-year follow-up.

“Interestingly, even though the two groups did not differ with regard to sexual satisfaction or sex problems at 5 years, the women using LNG-IUS were less satisfied with their partners at 1 year and beyond; they generally felt their partners were not as good [sexually],” Dr. Halmesmaki said. Inexplicably, smoking on the part of the women also was associated with lower partner satisfaction, she commented.

INDIANAPOLIS — Myths about the effects of breast-feeding, the promotion and availability of formula, and the absence of maternal role models are combining to thwart breast-feeding among urban African American women, Dr. Hari B. Srinivasan said during a poster presentation at the annual meeting of the Midwest Society for Pediatric Research.

In a study that mined data similar to those from a 2004 national survey by the Centers for Disease Control and Prevention, Dr. Srinivasan found that fewer than half of African American mothers initiate breast-feeding immediately following an in-hospital educational support program.

The study from Chicago's Sinai Children's Hospital revealed that among Hispanic and white mothers, the rate of breast-feeding initiation was 78% and 72%, respectively. The national goal is to have 75% of mothers initiate breast-feeding by 2010.

“This is a cultural issue. Breast-feeding education has to be started early in schools and in communities,” said Dr. Srinivasan, who is an assistant professor of pediatrics and an attending neonatologist at Sinai. He noted that if one generation chooses breast-feeding over formula, the next generation is more likely to follow suit.

“Also, the Women, Infants and Children program makes formula available to anyone who qualifies and who wants it free of cost. Although WIC is a good program, it serves as a disincentive to breast-feeding, especially among poorer populations. And every woman leaving the hospital after delivery gets a small bag from Ross Pharmaceuticals, and in that bag is a can of formula; so hospitals reinforce formula use,” Dr. Srinivasan said.

He pointed out that obstetricians serve as the first line of defense against formula use. “Obstetricians should get involved in educating patients about the benefits of breast-feeding early, during prenatal visits, and in the first 48 hours after delivery,” he said, adding that it's then up to pediatricians to pick up the ball.

In talking with his patients, Dr. Srinivasan discovered that many harbor negative myths, such as the myth that breast-feeding can cause a loss of breast contour and can slow weight loss after delivery.

“In actuality, women who breast-feed tend to return to their prepregnancy weights faster than those who don't,” he noted.

In this study, data on breast-feeding initiation rates for 3,324 infants were prospectively collected for a 1-year period. The overall breast-feeding initiation rate for the population was 68%.

Earlier this year, the Centers for Disease Control and Prevention reported that in 2004, 71.5% of non-Hispanic white children were ever breast-fed, compared with 50% of non-Hispanic black children. Among those who were ever breast-fed, 54% of white and 43% of black children continued breast-feeding until age 6 months (MMWR 2006;55:335–9).

“Strenuous public health efforts are needed to improve breast-feeding behaviors, particularly among black women and socially disadvantaged groups,” Dr. Srinivasan concluded.

'Strenuous public health efforts are needed to improve breast-feeding behaviors.' DR. SRINIVASAN

INDIANAPOLIS — Myths about the effects of breast-feeding, the promotion and availability of formula, and the absence of maternal role models are combining to thwart breast-feeding among urban African American women, Dr. Hari B. Srinivasan said during a poster presentation at the annual meeting of the Midwest Society for Pediatric Research.

In a study that mined data similar to those from a 2004 national survey by the Centers for Disease Control and Prevention, Dr. Srinivasan found that fewer than half of African American mothers initiate breast-feeding immediately following an in-hospital educational support program.

The study from Chicago's Sinai Children's Hospital revealed that among Hispanic and white mothers, the rate of breast-feeding initiation was 78% and 72%, respectively. The national goal is to have 75% of mothers initiate breast-feeding by 2010.

“This is a cultural issue. Breast-feeding education has to be started early in schools and in communities,” said Dr. Srinivasan, who is an assistant professor of pediatrics and an attending neonatologist at Sinai. He noted that if one generation chooses breast-feeding over formula, the next generation is more likely to follow suit.

“Also, the Women, Infants and Children program makes formula available to anyone who qualifies and who wants it free of cost. Although WIC is a good program, it serves as a disincentive to breast-feeding, especially among poorer populations. And every woman leaving the hospital after delivery gets a small bag from Ross Pharmaceuticals, and in that bag is a can of formula; so hospitals reinforce formula use,” Dr. Srinivasan said.

He pointed out that obstetricians serve as the first line of defense against formula use. “Obstetricians should get involved in educating patients about the benefits of breast-feeding early, during prenatal visits, and in the first 48 hours after delivery,” he said, adding that it's then up to pediatricians to pick up the ball.

In talking with his patients, Dr. Srinivasan discovered that many harbor negative myths, such as the myth that breast-feeding can cause a loss of breast contour and can slow weight loss after delivery.

“In actuality, women who breast-feed tend to return to their prepregnancy weights faster than those who don't,” he noted.

In this study, data on breast-feeding initiation rates for 3,324 infants were prospectively collected for a 1-year period. The overall breast-feeding initiation rate for the population was 68%.

Earlier this year, the Centers for Disease Control and Prevention reported that in 2004, 71.5% of non-Hispanic white children were ever breast-fed, compared with 50% of non-Hispanic black children. Among those who were ever breast-fed, 54% of white and 43% of black children continued breast-feeding until age 6 months (MMWR 2006;55:335–9).

“Strenuous public health efforts are needed to improve breast-feeding behaviors, particularly among black women and socially disadvantaged groups,” Dr. Srinivasan concluded.

'Strenuous public health efforts are needed to improve breast-feeding behaviors.' DR. SRINIVASAN

INDIANAPOLIS — Myths about the effects of breast-feeding, the promotion and availability of formula, and the absence of maternal role models are combining to thwart breast-feeding among urban African American women, Dr. Hari B. Srinivasan said during a poster presentation at the annual meeting of the Midwest Society for Pediatric Research.

In a study that mined data similar to those from a 2004 national survey by the Centers for Disease Control and Prevention, Dr. Srinivasan found that fewer than half of African American mothers initiate breast-feeding immediately following an in-hospital educational support program.

The study from Chicago's Sinai Children's Hospital revealed that among Hispanic and white mothers, the rate of breast-feeding initiation was 78% and 72%, respectively. The national goal is to have 75% of mothers initiate breast-feeding by 2010.

“This is a cultural issue. Breast-feeding education has to be started early in schools and in communities,” said Dr. Srinivasan, who is an assistant professor of pediatrics and an attending neonatologist at Sinai. He noted that if one generation chooses breast-feeding over formula, the next generation is more likely to follow suit.

“Also, the Women, Infants and Children program makes formula available to anyone who qualifies and who wants it free of cost. Although WIC is a good program, it serves as a disincentive to breast-feeding, especially among poorer populations. And every woman leaving the hospital after delivery gets a small bag from Ross Pharmaceuticals, and in that bag is a can of formula; so hospitals reinforce formula use,” Dr. Srinivasan said.

He pointed out that obstetricians serve as the first line of defense against formula use. “Obstetricians should get involved in educating patients about the benefits of breast-feeding early, during prenatal visits, and in the first 48 hours after delivery,” he said, adding that it's then up to pediatricians to pick up the ball.

In talking with his patients, Dr. Srinivasan discovered that many harbor negative myths, such as the myth that breast-feeding can cause a loss of breast contour and can slow weight loss after delivery.

“In actuality, women who breast-feed tend to return to their prepregnancy weights faster than those who don't,” he noted.

In this study, data on breast-feeding initiation rates for 3,324 infants were prospectively collected for a 1-year period. The overall breast-feeding initiation rate for the population was 68%.

Earlier this year, the Centers for Disease Control and Prevention reported that in 2004, 71.5% of non-Hispanic white children were ever breast-fed, compared with 50% of non-Hispanic black children. Among those who were ever breast-fed, 54% of white and 43% of black children continued breast-feeding until age 6 months (MMWR 2006;55:335–9).

“Strenuous public health efforts are needed to improve breast-feeding behaviors, particularly among black women and socially disadvantaged groups,” Dr. Srinivasan concluded.

'Strenuous public health efforts are needed to improve breast-feeding behaviors.' DR. SRINIVASAN

How would you like to reduce your practice's patient data research load by 12 hours a week? That's precisely what Dr. Alan Brush did for his multispecialty practice in Cambridge, Mass.

“Using the EpicCare electronic medical record system's SmartPhrases feature, I created what we call 'RxRefill phrases' for all formulary drugs where lookup of essential information is required for a refill,” Dr. Brush said in an interview. “The process of making sure that lab tests, blood values, and mammogram results are current takes about 5 minutes per prescription. I do 100 refills a week in a practice that is about 60% full time.”

Dr. Brush's office is 1 of 14 sites in the Harvard Vanguard group, all of which are served by EpicCare. “In moving from paper to EpicCare's EMR system, I noted little improvement in the efficiency of refilling medications; it was just a shift from paper to electronic medium. When refills required essential data such as creatinine and potassium and last blood pressure values for diuretic refills, someone still had to spend time looking up and communicating the information to the clinician ultimately responsible for that prescription,” he explained.

As the leader of the Harvard Vanguard group's Internal Medicine Design Team, Dr. Brush helps to modify medical records so they're user friendly to clinicians. While on a flight home from a meeting 3 years ago, he decided to do something about the refill problem. “I started working on a catalog of formulary drugs that had relevant tests that you needed, or parameters that you would use at the time of refill. Now, all my assistant has to do is type 'Rx' followed by the name of the drug—for example, 'RxSimvastatin'—and all the data are generated. These phrases contain the request for the drug, as well as data links that automatically bring the required lab tests and clinical information into the refill request,” Dr. Brush explained.

When the test is overdue or the last blood pressure test is beyond the time for a reasonable refill, the medical assistant or nurse requesting the clinician to sign off knows to first arrange the appropriate appointment or tests and to request a refill that lasts just beyond that date, he said.

When the timing is up to date, the request automatically includes the essential data for the clinician to view. This information becomes part of the medical record at the time of the refill, indicating that it has been reviewed, Dr. Brush added.

“Not only does the medical assistant or nurse save time in looking up the essential information, but the clinician sees [only] refill requests that are already adequately researched, much simplifying his or her work,” said Dr. Brush, who has no financial interest in EpiCare.

“When I receive a prescription refill request now, if everything has been done, all the necessary data appear on the screen. To complete the process I hit 'approve,' and 'close encounter,' and the refill process is complete.”

The right electronic health record software can reduce research by 12 hours weekly. DR. BRUSH

How would you like to reduce your practice's patient data research load by 12 hours a week? That's precisely what Dr. Alan Brush did for his multispecialty practice in Cambridge, Mass.

“Using the EpicCare electronic medical record system's SmartPhrases feature, I created what we call 'RxRefill phrases' for all formulary drugs where lookup of essential information is required for a refill,” Dr. Brush said in an interview. “The process of making sure that lab tests, blood values, and mammogram results are current takes about 5 minutes per prescription. I do 100 refills a week in a practice that is about 60% full time.”

Dr. Brush's office is 1 of 14 sites in the Harvard Vanguard group, all of which are served by EpicCare. “In moving from paper to EpicCare's EMR system, I noted little improvement in the efficiency of refilling medications; it was just a shift from paper to electronic medium. When refills required essential data such as creatinine and potassium and last blood pressure values for diuretic refills, someone still had to spend time looking up and communicating the information to the clinician ultimately responsible for that prescription,” he explained.

As the leader of the Harvard Vanguard group's Internal Medicine Design Team, Dr. Brush helps to modify medical records so they're user friendly to clinicians. While on a flight home from a meeting 3 years ago, he decided to do something about the refill problem. “I started working on a catalog of formulary drugs that had relevant tests that you needed, or parameters that you would use at the time of refill. Now, all my assistant has to do is type 'Rx' followed by the name of the drug—for example, 'RxSimvastatin'—and all the data are generated. These phrases contain the request for the drug, as well as data links that automatically bring the required lab tests and clinical information into the refill request,” Dr. Brush explained.

When the test is overdue or the last blood pressure test is beyond the time for a reasonable refill, the medical assistant or nurse requesting the clinician to sign off knows to first arrange the appropriate appointment or tests and to request a refill that lasts just beyond that date, he said.

When the timing is up to date, the request automatically includes the essential data for the clinician to view. This information becomes part of the medical record at the time of the refill, indicating that it has been reviewed, Dr. Brush added.

“Not only does the medical assistant or nurse save time in looking up the essential information, but the clinician sees [only] refill requests that are already adequately researched, much simplifying his or her work,” said Dr. Brush, who has no financial interest in EpiCare.

“When I receive a prescription refill request now, if everything has been done, all the necessary data appear on the screen. To complete the process I hit 'approve,' and 'close encounter,' and the refill process is complete.”

The right electronic health record software can reduce research by 12 hours weekly. DR. BRUSH

How would you like to reduce your practice's patient data research load by 12 hours a week? That's precisely what Dr. Alan Brush did for his multispecialty practice in Cambridge, Mass.

“Using the EpicCare electronic medical record system's SmartPhrases feature, I created what we call 'RxRefill phrases' for all formulary drugs where lookup of essential information is required for a refill,” Dr. Brush said in an interview. “The process of making sure that lab tests, blood values, and mammogram results are current takes about 5 minutes per prescription. I do 100 refills a week in a practice that is about 60% full time.”

Dr. Brush's office is 1 of 14 sites in the Harvard Vanguard group, all of which are served by EpicCare. “In moving from paper to EpicCare's EMR system, I noted little improvement in the efficiency of refilling medications; it was just a shift from paper to electronic medium. When refills required essential data such as creatinine and potassium and last blood pressure values for diuretic refills, someone still had to spend time looking up and communicating the information to the clinician ultimately responsible for that prescription,” he explained.

As the leader of the Harvard Vanguard group's Internal Medicine Design Team, Dr. Brush helps to modify medical records so they're user friendly to clinicians. While on a flight home from a meeting 3 years ago, he decided to do something about the refill problem. “I started working on a catalog of formulary drugs that had relevant tests that you needed, or parameters that you would use at the time of refill. Now, all my assistant has to do is type 'Rx' followed by the name of the drug—for example, 'RxSimvastatin'—and all the data are generated. These phrases contain the request for the drug, as well as data links that automatically bring the required lab tests and clinical information into the refill request,” Dr. Brush explained.

When the test is overdue or the last blood pressure test is beyond the time for a reasonable refill, the medical assistant or nurse requesting the clinician to sign off knows to first arrange the appropriate appointment or tests and to request a refill that lasts just beyond that date, he said.

When the timing is up to date, the request automatically includes the essential data for the clinician to view. This information becomes part of the medical record at the time of the refill, indicating that it has been reviewed, Dr. Brush added.

“Not only does the medical assistant or nurse save time in looking up the essential information, but the clinician sees [only] refill requests that are already adequately researched, much simplifying his or her work,” said Dr. Brush, who has no financial interest in EpiCare.

“When I receive a prescription refill request now, if everything has been done, all the necessary data appear on the screen. To complete the process I hit 'approve,' and 'close encounter,' and the refill process is complete.”

The right electronic health record software can reduce research by 12 hours weekly. DR. BRUSH

If you're frustrated with the expense and delays of Dictaphone transcriptions, Dr. Jonathan Krant's solution may be just what the doctor ordered.

“Until 5 years ago, I utilized a Dictaphone with off-site transcriptions [at a monthly cost of $3,000], a process that resulted in chart and referral consultation notes taking a week or longer to get to the referring physician,” said Dr. Krant, a rheumatologist in Pittsfield, Mass.

Dr. Krant invested $4,000 in an off-the-shelf version of Dragon Systems Medical Suite and a sophisticated Dell computer system. “I customized the voice recognition software with a rheumatology lexicon of about 10,000 words and corrected mistakes in real time on screen,” he said.

“Now, 5 years later, there are no charts on my desk. Follow-up appointments and new patient consultations are dictated at the time of service into either a portable handheld unit or a microphone connected to the computer. I can send either faxed notes or dictated copy with a keystroke [with] over 99.5% accuracy,” explained Dr. Krant, who has no financial interest in the technology.

And his practice has tallied up savings of $180,000 ($3,000 a month for 60 months).

“Several years ago, I spoke with Kim Bruce, then chair of computer science at nearby Williams College, about the advantages and pitfalls of vocal recognition software,” he said. Further investigation revealed that the Modifying the Dragon Systems Medical Suite had a tolerable error rate and could be modified to fit Dr. Krant's rheumatology practice needs.

“It took me about a month to create a database where I would dictate into the computer. A word would come up and I'd change it, then speak the word. For example, 'sedimentation rate' may come out as 'sentient rate'; that could be corrected in real time using the keyboard and [microphone].”

After several thousand entries and corrections, his system became a valuable tool in his practice. “It's fast, accurate, and even recognizes my voice when I have a cold or pharyngitis. Entire phrases and chart notes can be set up using templates that have assigned identifier numbers, so all I have to do is say the number and there's the phrase or chart, lickety-split.”

Dr. Krant receives referral patients from about 200 primary care physicians. He's now able to get his notes to them within 10 minutes of seeing a patient, making evaluation and therapeutic intervention almost simultaneous with the patient visit.

“If I've got a patient with leg swelling and his physician thinks he's got an effusion in the knee because of arthritis, but I'm concerned about a clot in a lower extremity, I have an ultrasound waiting to be performed and an admission pending for deep vein thrombosis lined up within 15 minutes of the patient's examination,” he said.

If you're frustrated with the expense and delays of Dictaphone transcriptions, Dr. Jonathan Krant's solution may be just what the doctor ordered.

“Until 5 years ago, I utilized a Dictaphone with off-site transcriptions [at a monthly cost of $3,000], a process that resulted in chart and referral consultation notes taking a week or longer to get to the referring physician,” said Dr. Krant, a rheumatologist in Pittsfield, Mass.

Dr. Krant invested $4,000 in an off-the-shelf version of Dragon Systems Medical Suite and a sophisticated Dell computer system. “I customized the voice recognition software with a rheumatology lexicon of about 10,000 words and corrected mistakes in real time on screen,” he said.

“Now, 5 years later, there are no charts on my desk. Follow-up appointments and new patient consultations are dictated at the time of service into either a portable handheld unit or a microphone connected to the computer. I can send either faxed notes or dictated copy with a keystroke [with] over 99.5% accuracy,” explained Dr. Krant, who has no financial interest in the technology.

And his practice has tallied up savings of $180,000 ($3,000 a month for 60 months).

“Several years ago, I spoke with Kim Bruce, then chair of computer science at nearby Williams College, about the advantages and pitfalls of vocal recognition software,” he said. Further investigation revealed that the Modifying the Dragon Systems Medical Suite had a tolerable error rate and could be modified to fit Dr. Krant's rheumatology practice needs.

“It took me about a month to create a database where I would dictate into the computer. A word would come up and I'd change it, then speak the word. For example, 'sedimentation rate' may come out as 'sentient rate'; that could be corrected in real time using the keyboard and [microphone].”

After several thousand entries and corrections, his system became a valuable tool in his practice. “It's fast, accurate, and even recognizes my voice when I have a cold or pharyngitis. Entire phrases and chart notes can be set up using templates that have assigned identifier numbers, so all I have to do is say the number and there's the phrase or chart, lickety-split.”

Dr. Krant receives referral patients from about 200 primary care physicians. He's now able to get his notes to them within 10 minutes of seeing a patient, making evaluation and therapeutic intervention almost simultaneous with the patient visit.

“If I've got a patient with leg swelling and his physician thinks he's got an effusion in the knee because of arthritis, but I'm concerned about a clot in a lower extremity, I have an ultrasound waiting to be performed and an admission pending for deep vein thrombosis lined up within 15 minutes of the patient's examination,” he said.

If you're frustrated with the expense and delays of Dictaphone transcriptions, Dr. Jonathan Krant's solution may be just what the doctor ordered.

“Until 5 years ago, I utilized a Dictaphone with off-site transcriptions [at a monthly cost of $3,000], a process that resulted in chart and referral consultation notes taking a week or longer to get to the referring physician,” said Dr. Krant, a rheumatologist in Pittsfield, Mass.

Dr. Krant invested $4,000 in an off-the-shelf version of Dragon Systems Medical Suite and a sophisticated Dell computer system. “I customized the voice recognition software with a rheumatology lexicon of about 10,000 words and corrected mistakes in real time on screen,” he said.

“Now, 5 years later, there are no charts on my desk. Follow-up appointments and new patient consultations are dictated at the time of service into either a portable handheld unit or a microphone connected to the computer. I can send either faxed notes or dictated copy with a keystroke [with] over 99.5% accuracy,” explained Dr. Krant, who has no financial interest in the technology.

And his practice has tallied up savings of $180,000 ($3,000 a month for 60 months).

“Several years ago, I spoke with Kim Bruce, then chair of computer science at nearby Williams College, about the advantages and pitfalls of vocal recognition software,” he said. Further investigation revealed that the Modifying the Dragon Systems Medical Suite had a tolerable error rate and could be modified to fit Dr. Krant's rheumatology practice needs.

“It took me about a month to create a database where I would dictate into the computer. A word would come up and I'd change it, then speak the word. For example, 'sedimentation rate' may come out as 'sentient rate'; that could be corrected in real time using the keyboard and [microphone].”

After several thousand entries and corrections, his system became a valuable tool in his practice. “It's fast, accurate, and even recognizes my voice when I have a cold or pharyngitis. Entire phrases and chart notes can be set up using templates that have assigned identifier numbers, so all I have to do is say the number and there's the phrase or chart, lickety-split.”

Dr. Krant receives referral patients from about 200 primary care physicians. He's now able to get his notes to them within 10 minutes of seeing a patient, making evaluation and therapeutic intervention almost simultaneous with the patient visit.

“If I've got a patient with leg swelling and his physician thinks he's got an effusion in the knee because of arthritis, but I'm concerned about a clot in a lower extremity, I have an ultrasound waiting to be performed and an admission pending for deep vein thrombosis lined up within 15 minutes of the patient's examination,” he said.