Denise Napoli

Lupus Registry Is Online

The Lupus Foundation of America has established an online site where a patient can register to be considered for clinical trials in his or her geographic area. People with drug-induced, antiphospholipid, cutaneous, hematologic, or any systemic subtype of lupus may register their e-mail addresses at the Web site,

www.lupus.org/clinicaltrials/registry.htm

Pain Treatment Targeted

The Food and Drug Administration has formed a partnership with the University of Rochester (N.Y.) to help “streamline the discovery and development process” for new analgesics, according to an FDA announcement. With a $1 million grant from the FDA, the medical center will spearhead the Analgesic Clinical Trial Innovations, Opportunities, and Networks (ACTION) initiative to find alternatives to existing pain drugs. Current opioids and nonsteroidal anti-inflammatory agents “have serious, potentially life-threatening toxicities, even when used properly,” according to the FDA. The university will work with the International Association for the Study of Pain and Outcome Measures in Rheumatology, the American Pain Society, and other specialty and pharmaceutical groups to promote research on new pain medications. “One of the issues with pain is that it cuts across so many specialties – anesthesiologists, rheumatologists, emergency department physicians, and others,” said Dr. Denham Ward of the university. “This initiative is crucial because it is bringing together all the key players in pain research and treatment.”

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes after the discovery that patients who received treatment from at least six California hospitals received up to eight times the normal dose of radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Additionally, beginning in 2013, medical imaging facilities need to report to the state any medical injury resulting from CT radiation and any instance in which certain doses have been exceeded.

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine).

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

Lupus Registry Is Online

The Lupus Foundation of America has established an online site where a patient can register to be considered for clinical trials in his or her geographic area. People with drug-induced, antiphospholipid, cutaneous, hematologic, or any systemic subtype of lupus may register their e-mail addresses at the Web site,

www.lupus.org/clinicaltrials/registry.htm

Pain Treatment Targeted

The Food and Drug Administration has formed a partnership with the University of Rochester (N.Y.) to help “streamline the discovery and development process” for new analgesics, according to an FDA announcement. With a $1 million grant from the FDA, the medical center will spearhead the Analgesic Clinical Trial Innovations, Opportunities, and Networks (ACTION) initiative to find alternatives to existing pain drugs. Current opioids and nonsteroidal anti-inflammatory agents “have serious, potentially life-threatening toxicities, even when used properly,” according to the FDA. The university will work with the International Association for the Study of Pain and Outcome Measures in Rheumatology, the American Pain Society, and other specialty and pharmaceutical groups to promote research on new pain medications. “One of the issues with pain is that it cuts across so many specialties – anesthesiologists, rheumatologists, emergency department physicians, and others,” said Dr. Denham Ward of the university. “This initiative is crucial because it is bringing together all the key players in pain research and treatment.”

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes after the discovery that patients who received treatment from at least six California hospitals received up to eight times the normal dose of radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Additionally, beginning in 2013, medical imaging facilities need to report to the state any medical injury resulting from CT radiation and any instance in which certain doses have been exceeded.

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine).

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

Lupus Registry Is Online

The Lupus Foundation of America has established an online site where a patient can register to be considered for clinical trials in his or her geographic area. People with drug-induced, antiphospholipid, cutaneous, hematologic, or any systemic subtype of lupus may register their e-mail addresses at the Web site,

www.lupus.org/clinicaltrials/registry.htm

Pain Treatment Targeted

The Food and Drug Administration has formed a partnership with the University of Rochester (N.Y.) to help “streamline the discovery and development process” for new analgesics, according to an FDA announcement. With a $1 million grant from the FDA, the medical center will spearhead the Analgesic Clinical Trial Innovations, Opportunities, and Networks (ACTION) initiative to find alternatives to existing pain drugs. Current opioids and nonsteroidal anti-inflammatory agents “have serious, potentially life-threatening toxicities, even when used properly,” according to the FDA. The university will work with the International Association for the Study of Pain and Outcome Measures in Rheumatology, the American Pain Society, and other specialty and pharmaceutical groups to promote research on new pain medications. “One of the issues with pain is that it cuts across so many specialties – anesthesiologists, rheumatologists, emergency department physicians, and others,” said Dr. Denham Ward of the university. “This initiative is crucial because it is bringing together all the key players in pain research and treatment.”

California Limits CT Radiation

California Gov. Arnold Schwarzenegger (R) has signed a bill that limits the radiation dose provided in computed tomography scans. The new law comes after the discovery that patients who received treatment from at least six California hospitals received up to eight times the normal dose of radiation from their CT scans. Beginning in 2012, technicians must record the radiation dose from every scan, and radiology reports must include that information. Each year, a medical physicist will be required to confirm each CT machine's readings. Additionally, beginning in 2013, medical imaging facilities need to report to the state any medical injury resulting from CT radiation and any instance in which certain doses have been exceeded.

Productivity, Ownership Linked

Billable work per patient appears to be increasing only at physician groups under the “private practice model,” but expenses have also grown, according to a Medical Group Management Association study. Over the past 5 years, relative value units per patient rose by 13% at private medical practices but declined nearly 18% at practices owned by hospitals or integrated delivery systems, analysts found. Meanwhile, operating costs for private practices increased by nearly 2% last year, in contrast to a slight decline for practices owned by the larger entities. MGMA attributed part of the increase in expenses for private practices to the cost of implementing electronic health record systems.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine).

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

Major Finding: Treatment with adalimumab lowered the disease activity score among a group of rheumatoid arthritis patients, but did not affect serum vitamin D levels.

Data Source: A prospective study of 170 consecutive patients with rheumatoid arthritis seen at an outpatient facility in Amsterdam.

Disclosures: The authors stated that they had no competing interests. The study was supported by the European League Against Rheumatism and the Jan van Breemen Institute, in Amsterdam.

Four months of treatment with the anti–tumor necrosis factor drug adalimumab did not affect serum vitamin D levels in rheumatoid arthritis patients, though it did ease symptoms.

The finding refutes the theory that systemic inflammation may negatively affect circulating serum 25-hydroxyvitamin D (25[OH]D) levels, wrote Dr. Paul Welsh and his colleagues.

Moreover, the data confirm a high prevalence of vitamin D insufficiency and frank deficiency among RA patients, they added.

According to Dr. Welsh of the British Heart Foundation Glasgow Cardiovascular Research Center at the University of Glasgow and his associates, there are several reasons why treatment with a potent anti-inflammatory medication, such as the tumor necrosis factor–alpha blocker adalimumab, might be hypothesized to increase vitamin D levels.

Data from a 2006 study showed an inverse relationship between serum vitamin D and DAS-28 scores (Clin. Exp. Rheumatol. 2006;24:702–4). “Furthermore, data for an apparent beneficial effect of statins on circulating 25[OH]D concentrations have been speculated to be attributable to statin 'pleiotropic' anti-inflammatory effects,” the researchers said. They also noted that serum vitamin D levels are known to drop in the acute phase following surgery, when inflammation is likely to be elevated.

To test the hypothesis that lowering inflammation would result in an increase of vitamin D, the researchers looked at 170 consecutive patients with RA seen at an outpatient clinic in Amsterdam (Ann. Rheum. Dis. 2010 [doi:10.1136/ard.2010.137265]).

Patients were treated either with adalimumab alone, at a dose of 40 mg administered every 2 weeks, or with adalimumab plus other disease-modifying antirheumatic drugs (DMARDs).

At baseline, 66 patients (39%) were vitamin D deficient, with a serum concentration of less than 15 ng/mL. Sixty-three patients (39%) had vitamin D insufficiency, with levels between 15 and 25 ng/mL. The remaining patients had adequate vitamin D levels.

After 16 weeks of treatment with adalimumab, patients' mean disease activity score-28 (DAS-28) had dropped significantly, from 5.1 to 3.2 (P less than .001). However, median circulating levels of vitamin D were not significantly altered, moving from 18.5 ng/mL at baseline to 19.0 ng/mL at the study's completion (P = .67). Nor did the prevalence of patients with vitamin D deficiency and insufficiency change after treatment, wrote the authors.

“Whether longer-term biological therapy has any beneficial effect on circulating 25[OH]D concentrations requires further study, although any such effect may be attributable to increased sunlight exposure rather than decreasing inflammation,” concluded the authors.

“Our observations also weaken the possibility that TNF-alpha blockers, which improve bone mineral density and potentially lower cardiovascular risk, do so via changes in 25[OH]D levels.”

They added: “Further research is needed to address determinants of poor 25[OH]D status in RA.”

Major Finding: Treatment with adalimumab lowered the disease activity score among a group of rheumatoid arthritis patients, but did not affect serum vitamin D levels.

Data Source: A prospective study of 170 consecutive patients with rheumatoid arthritis seen at an outpatient facility in Amsterdam.

Disclosures: The authors stated that they had no competing interests. The study was supported by the European League Against Rheumatism and the Jan van Breemen Institute, in Amsterdam.

Four months of treatment with the anti–tumor necrosis factor drug adalimumab did not affect serum vitamin D levels in rheumatoid arthritis patients, though it did ease symptoms.

The finding refutes the theory that systemic inflammation may negatively affect circulating serum 25-hydroxyvitamin D (25[OH]D) levels, wrote Dr. Paul Welsh and his colleagues.

Moreover, the data confirm a high prevalence of vitamin D insufficiency and frank deficiency among RA patients, they added.

According to Dr. Welsh of the British Heart Foundation Glasgow Cardiovascular Research Center at the University of Glasgow and his associates, there are several reasons why treatment with a potent anti-inflammatory medication, such as the tumor necrosis factor–alpha blocker adalimumab, might be hypothesized to increase vitamin D levels.

Data from a 2006 study showed an inverse relationship between serum vitamin D and DAS-28 scores (Clin. Exp. Rheumatol. 2006;24:702–4). “Furthermore, data for an apparent beneficial effect of statins on circulating 25[OH]D concentrations have been speculated to be attributable to statin 'pleiotropic' anti-inflammatory effects,” the researchers said. They also noted that serum vitamin D levels are known to drop in the acute phase following surgery, when inflammation is likely to be elevated.

To test the hypothesis that lowering inflammation would result in an increase of vitamin D, the researchers looked at 170 consecutive patients with RA seen at an outpatient clinic in Amsterdam (Ann. Rheum. Dis. 2010 [doi:10.1136/ard.2010.137265]).

Patients were treated either with adalimumab alone, at a dose of 40 mg administered every 2 weeks, or with adalimumab plus other disease-modifying antirheumatic drugs (DMARDs).

At baseline, 66 patients (39%) were vitamin D deficient, with a serum concentration of less than 15 ng/mL. Sixty-three patients (39%) had vitamin D insufficiency, with levels between 15 and 25 ng/mL. The remaining patients had adequate vitamin D levels.

After 16 weeks of treatment with adalimumab, patients' mean disease activity score-28 (DAS-28) had dropped significantly, from 5.1 to 3.2 (P less than .001). However, median circulating levels of vitamin D were not significantly altered, moving from 18.5 ng/mL at baseline to 19.0 ng/mL at the study's completion (P = .67). Nor did the prevalence of patients with vitamin D deficiency and insufficiency change after treatment, wrote the authors.

“Whether longer-term biological therapy has any beneficial effect on circulating 25[OH]D concentrations requires further study, although any such effect may be attributable to increased sunlight exposure rather than decreasing inflammation,” concluded the authors.

“Our observations also weaken the possibility that TNF-alpha blockers, which improve bone mineral density and potentially lower cardiovascular risk, do so via changes in 25[OH]D levels.”

They added: “Further research is needed to address determinants of poor 25[OH]D status in RA.”

Major Finding: Treatment with adalimumab lowered the disease activity score among a group of rheumatoid arthritis patients, but did not affect serum vitamin D levels.

Data Source: A prospective study of 170 consecutive patients with rheumatoid arthritis seen at an outpatient facility in Amsterdam.

Disclosures: The authors stated that they had no competing interests. The study was supported by the European League Against Rheumatism and the Jan van Breemen Institute, in Amsterdam.

Four months of treatment with the anti–tumor necrosis factor drug adalimumab did not affect serum vitamin D levels in rheumatoid arthritis patients, though it did ease symptoms.

The finding refutes the theory that systemic inflammation may negatively affect circulating serum 25-hydroxyvitamin D (25[OH]D) levels, wrote Dr. Paul Welsh and his colleagues.

Moreover, the data confirm a high prevalence of vitamin D insufficiency and frank deficiency among RA patients, they added.

According to Dr. Welsh of the British Heart Foundation Glasgow Cardiovascular Research Center at the University of Glasgow and his associates, there are several reasons why treatment with a potent anti-inflammatory medication, such as the tumor necrosis factor–alpha blocker adalimumab, might be hypothesized to increase vitamin D levels.

Data from a 2006 study showed an inverse relationship between serum vitamin D and DAS-28 scores (Clin. Exp. Rheumatol. 2006;24:702–4). “Furthermore, data for an apparent beneficial effect of statins on circulating 25[OH]D concentrations have been speculated to be attributable to statin 'pleiotropic' anti-inflammatory effects,” the researchers said. They also noted that serum vitamin D levels are known to drop in the acute phase following surgery, when inflammation is likely to be elevated.

To test the hypothesis that lowering inflammation would result in an increase of vitamin D, the researchers looked at 170 consecutive patients with RA seen at an outpatient clinic in Amsterdam (Ann. Rheum. Dis. 2010 [doi:10.1136/ard.2010.137265]).

Patients were treated either with adalimumab alone, at a dose of 40 mg administered every 2 weeks, or with adalimumab plus other disease-modifying antirheumatic drugs (DMARDs).

At baseline, 66 patients (39%) were vitamin D deficient, with a serum concentration of less than 15 ng/mL. Sixty-three patients (39%) had vitamin D insufficiency, with levels between 15 and 25 ng/mL. The remaining patients had adequate vitamin D levels.

After 16 weeks of treatment with adalimumab, patients' mean disease activity score-28 (DAS-28) had dropped significantly, from 5.1 to 3.2 (P less than .001). However, median circulating levels of vitamin D were not significantly altered, moving from 18.5 ng/mL at baseline to 19.0 ng/mL at the study's completion (P = .67). Nor did the prevalence of patients with vitamin D deficiency and insufficiency change after treatment, wrote the authors.

“Whether longer-term biological therapy has any beneficial effect on circulating 25[OH]D concentrations requires further study, although any such effect may be attributable to increased sunlight exposure rather than decreasing inflammation,” concluded the authors.

“Our observations also weaken the possibility that TNF-alpha blockers, which improve bone mineral density and potentially lower cardiovascular risk, do so via changes in 25[OH]D levels.”

They added: “Further research is needed to address determinants of poor 25[OH]D status in RA.”

Since the launch of the new “blue button” on the Medicare and Veterans Affairs patient Web sites this summer, tens of thousands of patients have downloaded their personal health records to computers, flash drives, and disks – including claims data, test results, and more.

Now, physicians' groups and patients are calling for this practice to be commonplace for all.

“If the patient has access to his or her [personal health] information, they become part of the decision-making process, they are more engaged in their care, and they're empowered to make better decisions,” said Dr. Steven Waldren, director of the American Academy of Family Physicians' Center for Health Information Technology.

The blue button, developed jointly by the Department of Veterans Affairs, the Centers for Medicare and Medicaid Services, and the Department of Defense, is a “a Web-based feature through which patients may easily download their health information and share it with health care providers, caregivers, and others they trust,” according to Todd Park, chief technology officer at the Health and Human Services department, writing in a post on the White House's Office of Science and Technology blog.

The blue button went live in August on www.mymedicare.govwww.myhealth.va.gov

“This new option will help veterans and Medicare beneficiaries save their information on individual computers and portable storage devices or print that information in hard copy,” Mr. Park wrote. “Having ready access to personal health information from Medicare claims can help beneficiaries understand their medical history and partner more effectively with providers.”

Now, many physicians and physician groups want to see the concept of downloadable personal health records extended to all of their patients.

A policy paper on the topic published by the nonprofit Markle Foundation aims to promote the use of the blue button by calling on “organizations that display personal health information electronically to individuals in Web browsers to include an option for individuals to download the information.”

Additionally, the paper recommended making the download capability a “core procurement requirement for federal- and state-sponsored health [information technology] grants and projects” that come about as a result of the American Recovery and Reinvestment Act of 2009, which allocated billions of dollars for the development of health care technology.

Dr. Waldren was a member of the work group that reviewed the foundation's paper; he and more than a dozen physicians and other stakeholders endorsed it, including Dr. Jack Lewin, CEO of the American College of Cardiology, Dr. Brian F. Keaton, past president of the American College of Emergency Physicians, and Dr. Allan Korn, chief medical officer for the Blue Cross and Blue Shield Association.

Patients, too, seem to embrace the concept of downloadable personal health records. In an online survey commissioned by Markle, 70% of almost 1,600 adult respondents agreed that they should be able to download and keep copies of their personal health information.

The real benefit, however, lies in the potential of Internet- and mobile phone–based “apps,” or applications, which can access the data and increase its usefulness for patients and physicians alike.

For example, said Dr. Waldren, imagine a tool that parses through all of a patient's downloaded health data, highlighting all potential and actual medical problems, making lists of all prescribed medications and doses, assessing them for drug-drug interactions, and communicating that information to the physician at every visit.

He went on to say that such a smart app also could scan resource Web sites to find new scientific data and government findings that affect patient care. “Those are the things that can start to happen,” with blue button technology, Dr. Waldren said.

Despite the myriad possible benefits of downloadable records, however, privacy remains a concern, for patients and physicians alike.

According to the Markle Foundation paper, “Any online download capability for personal health information must be provided via secure access. That means the identity of each individual given credentials to access their own data must be proofed to an acceptable level of accuracy, and the individual must present those credentials or some acceptable token of those credentials upon login in order to get access to the data for download.”

Dr. Waldren agreed. “There's no question that privacy and security are real issues,” he said. And that means not only keeping the site secure, but educating patients, too.

“Every time the patient clicks on that blue button, they need to be reminded, 'You're doing something that puts your information at risk,'” he said. But he added that privacy concerns should not be something that keeps technology like the blue button moving forward.

The Markle Foundation's paper, “The Download Capability,” is available at www.markle.org/downloadable_assets/20100831_dlcapability.pdf

Patients who can access their records “are more engaged in their care.”

Source ©Crystal Kirk/Fotolia.com

Since the launch of the new “blue button” on the Medicare and Veterans Affairs patient Web sites this summer, tens of thousands of patients have downloaded their personal health records to computers, flash drives, and disks – including claims data, test results, and more.

Now, physicians' groups and patients are calling for this practice to be commonplace for all.

“If the patient has access to his or her [personal health] information, they become part of the decision-making process, they are more engaged in their care, and they're empowered to make better decisions,” said Dr. Steven Waldren, director of the American Academy of Family Physicians' Center for Health Information Technology.

The blue button, developed jointly by the Department of Veterans Affairs, the Centers for Medicare and Medicaid Services, and the Department of Defense, is a “a Web-based feature through which patients may easily download their health information and share it with health care providers, caregivers, and others they trust,” according to Todd Park, chief technology officer at the Health and Human Services department, writing in a post on the White House's Office of Science and Technology blog.

The blue button went live in August on www.mymedicare.govwww.myhealth.va.gov

“This new option will help veterans and Medicare beneficiaries save their information on individual computers and portable storage devices or print that information in hard copy,” Mr. Park wrote. “Having ready access to personal health information from Medicare claims can help beneficiaries understand their medical history and partner more effectively with providers.”

Now, many physicians and physician groups want to see the concept of downloadable personal health records extended to all of their patients.

A policy paper on the topic published by the nonprofit Markle Foundation aims to promote the use of the blue button by calling on “organizations that display personal health information electronically to individuals in Web browsers to include an option for individuals to download the information.”

Additionally, the paper recommended making the download capability a “core procurement requirement for federal- and state-sponsored health [information technology] grants and projects” that come about as a result of the American Recovery and Reinvestment Act of 2009, which allocated billions of dollars for the development of health care technology.

Dr. Waldren was a member of the work group that reviewed the foundation's paper; he and more than a dozen physicians and other stakeholders endorsed it, including Dr. Jack Lewin, CEO of the American College of Cardiology, Dr. Brian F. Keaton, past president of the American College of Emergency Physicians, and Dr. Allan Korn, chief medical officer for the Blue Cross and Blue Shield Association.

Patients, too, seem to embrace the concept of downloadable personal health records. In an online survey commissioned by Markle, 70% of almost 1,600 adult respondents agreed that they should be able to download and keep copies of their personal health information.

The real benefit, however, lies in the potential of Internet- and mobile phone–based “apps,” or applications, which can access the data and increase its usefulness for patients and physicians alike.

For example, said Dr. Waldren, imagine a tool that parses through all of a patient's downloaded health data, highlighting all potential and actual medical problems, making lists of all prescribed medications and doses, assessing them for drug-drug interactions, and communicating that information to the physician at every visit.

He went on to say that such a smart app also could scan resource Web sites to find new scientific data and government findings that affect patient care. “Those are the things that can start to happen,” with blue button technology, Dr. Waldren said.

Despite the myriad possible benefits of downloadable records, however, privacy remains a concern, for patients and physicians alike.

According to the Markle Foundation paper, “Any online download capability for personal health information must be provided via secure access. That means the identity of each individual given credentials to access their own data must be proofed to an acceptable level of accuracy, and the individual must present those credentials or some acceptable token of those credentials upon login in order to get access to the data for download.”

Dr. Waldren agreed. “There's no question that privacy and security are real issues,” he said. And that means not only keeping the site secure, but educating patients, too.

“Every time the patient clicks on that blue button, they need to be reminded, 'You're doing something that puts your information at risk,'” he said. But he added that privacy concerns should not be something that keeps technology like the blue button moving forward.

The Markle Foundation's paper, “The Download Capability,” is available at www.markle.org/downloadable_assets/20100831_dlcapability.pdf

Patients who can access their records “are more engaged in their care.”

Source ©Crystal Kirk/Fotolia.com

Since the launch of the new “blue button” on the Medicare and Veterans Affairs patient Web sites this summer, tens of thousands of patients have downloaded their personal health records to computers, flash drives, and disks – including claims data, test results, and more.

Now, physicians' groups and patients are calling for this practice to be commonplace for all.

“If the patient has access to his or her [personal health] information, they become part of the decision-making process, they are more engaged in their care, and they're empowered to make better decisions,” said Dr. Steven Waldren, director of the American Academy of Family Physicians' Center for Health Information Technology.

The blue button, developed jointly by the Department of Veterans Affairs, the Centers for Medicare and Medicaid Services, and the Department of Defense, is a “a Web-based feature through which patients may easily download their health information and share it with health care providers, caregivers, and others they trust,” according to Todd Park, chief technology officer at the Health and Human Services department, writing in a post on the White House's Office of Science and Technology blog.

The blue button went live in August on www.mymedicare.govwww.myhealth.va.gov

“This new option will help veterans and Medicare beneficiaries save their information on individual computers and portable storage devices or print that information in hard copy,” Mr. Park wrote. “Having ready access to personal health information from Medicare claims can help beneficiaries understand their medical history and partner more effectively with providers.”

Now, many physicians and physician groups want to see the concept of downloadable personal health records extended to all of their patients.

A policy paper on the topic published by the nonprofit Markle Foundation aims to promote the use of the blue button by calling on “organizations that display personal health information electronically to individuals in Web browsers to include an option for individuals to download the information.”

Additionally, the paper recommended making the download capability a “core procurement requirement for federal- and state-sponsored health [information technology] grants and projects” that come about as a result of the American Recovery and Reinvestment Act of 2009, which allocated billions of dollars for the development of health care technology.

Dr. Waldren was a member of the work group that reviewed the foundation's paper; he and more than a dozen physicians and other stakeholders endorsed it, including Dr. Jack Lewin, CEO of the American College of Cardiology, Dr. Brian F. Keaton, past president of the American College of Emergency Physicians, and Dr. Allan Korn, chief medical officer for the Blue Cross and Blue Shield Association.

Patients, too, seem to embrace the concept of downloadable personal health records. In an online survey commissioned by Markle, 70% of almost 1,600 adult respondents agreed that they should be able to download and keep copies of their personal health information.

The real benefit, however, lies in the potential of Internet- and mobile phone–based “apps,” or applications, which can access the data and increase its usefulness for patients and physicians alike.

For example, said Dr. Waldren, imagine a tool that parses through all of a patient's downloaded health data, highlighting all potential and actual medical problems, making lists of all prescribed medications and doses, assessing them for drug-drug interactions, and communicating that information to the physician at every visit.

He went on to say that such a smart app also could scan resource Web sites to find new scientific data and government findings that affect patient care. “Those are the things that can start to happen,” with blue button technology, Dr. Waldren said.

Despite the myriad possible benefits of downloadable records, however, privacy remains a concern, for patients and physicians alike.

According to the Markle Foundation paper, “Any online download capability for personal health information must be provided via secure access. That means the identity of each individual given credentials to access their own data must be proofed to an acceptable level of accuracy, and the individual must present those credentials or some acceptable token of those credentials upon login in order to get access to the data for download.”

Dr. Waldren agreed. “There's no question that privacy and security are real issues,” he said. And that means not only keeping the site secure, but educating patients, too.

“Every time the patient clicks on that blue button, they need to be reminded, 'You're doing something that puts your information at risk,'” he said. But he added that privacy concerns should not be something that keeps technology like the blue button moving forward.

The Markle Foundation's paper, “The Download Capability,” is available at www.markle.org/downloadable_assets/20100831_dlcapability.pdf

Patients who can access their records “are more engaged in their care.”

Source ©Crystal Kirk/Fotolia.com

Linaclotide was associated with significant improvement in symptoms of irritable bowel syndrome with constipation, including abdominal pain, within 1 week of therapy, Dr. Jeffrey M. Johnston and colleagues reported in Gastroenterology.

Diarrhea was a common side effect, leading to study withdrawal by more than a dozen patients.

Linaclotide is a novel, 14–amino acid peptide that binds to guanylate cyclase-C receptors on intestinal enterocytes, wrote Dr. Johnston, an employee of the drug's maker, Ironwood Pharmaceuticals Inc. In animal models, it has been shown to increase fluid secretion and transit, he added.

In the current study, Dr. Johnston and colleagues randomized 420 patients in a double-blind, placebo-controlled, phase IIB study. Patients were aged 18 years or older and met the Rome II criteria for irritable bowel syndrome (IBS). The mean patient age was 44 years, and 92% were female (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.041]).

All participants also reported having fewer than three spontaneous bowel movements per week, and at least one of the following symptoms occurring with 25% or more of their bowel movements: straining, lumpy or hard stools, or a sensation of incomplete evacuation.

Patients were randomized into five groups. One received a daily placebo; the rest received once-daily linaclotide in doses of 75 mcg, 150 mcg, 300 mcg, or 600 mcg, taken orally before the first meal of the day.

According to daily assessments completed by phone via an interactive voice-response system, all patients receiving active treatment who completed the study met the primary end point, which was an increase in complete spontaneous bowel movements (CSBMs), measured at 12 weeks, compared with baseline.

At week 12, those receiving 75 mcg had an increase of 2.90 CSBMs per week; the 150-mcg had an increase of 2.49 CSBMs per week; the 300-mcg group an increase of 3.61 per week; and the 600-mcg group an increase of 2.68 per week over their baseline (P less than or equal to .01 for all doses). The placebo group had a mean increase of 1.01 CSBMs per week.

There were also significant decreases in abdominal pain – which was measured on a 5-point scale, with 1 signifying no pain and 5 being very severe pain – among patients taking linaclotide.

Compared with baseline, by 12 weeks the 75-mcg treatment group reported a mean reduction in the pain scale of 0.71 points, as did the 150-mcg group. The 300-mcg group had a reduction of 0.90 points, and the 600-mcg dosing group had a mean decrease of 0.86 points, compared with 0.49 points for placebo patients (P less than or equal to .05 for all doses).

Moreover, linaclotide's effects “occurred within the first week of therapy and were sustained for the entire 3-month duration of this study,” wrote the investigators.

The most frequent side effect was diarrhea. The researchers noted that the diarrhea was dose dependent, reported by 11.4%, 12.2%, 16.5%, and 18.0% of patients in the 75-, 150-, 300-, and 600-mcg dose groups, respectively, compared with 1.2% in the placebo group.

“No dehydration, electrolyte changes, or other adverse clinical sequelae from diarrhea were reported,” the authors wrote.

“Linaclotide resulted in sustained effects in the treatment of a common condition for which few therapies are currently available,” concluded Dr. Johnston and associates.

The results of this placebo-controlled, dose-range–finding, phase IIB study “support further development of linaclotide for treatment of adults with [IBS constipation]”.

Several of Dr. Johnston's coinvestigators are also employees of linaclotide's manufacturer, Ironwood Pharmaceuticals Inc., which also funded the study.

Linaclotide was associated with significant improvement in symptoms of irritable bowel syndrome with constipation, including abdominal pain, within 1 week of therapy, Dr. Jeffrey M. Johnston and colleagues reported in Gastroenterology.

Diarrhea was a common side effect, leading to study withdrawal by more than a dozen patients.

Linaclotide is a novel, 14–amino acid peptide that binds to guanylate cyclase-C receptors on intestinal enterocytes, wrote Dr. Johnston, an employee of the drug's maker, Ironwood Pharmaceuticals Inc. In animal models, it has been shown to increase fluid secretion and transit, he added.

In the current study, Dr. Johnston and colleagues randomized 420 patients in a double-blind, placebo-controlled, phase IIB study. Patients were aged 18 years or older and met the Rome II criteria for irritable bowel syndrome (IBS). The mean patient age was 44 years, and 92% were female (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.041]).

All participants also reported having fewer than three spontaneous bowel movements per week, and at least one of the following symptoms occurring with 25% or more of their bowel movements: straining, lumpy or hard stools, or a sensation of incomplete evacuation.

Patients were randomized into five groups. One received a daily placebo; the rest received once-daily linaclotide in doses of 75 mcg, 150 mcg, 300 mcg, or 600 mcg, taken orally before the first meal of the day.

According to daily assessments completed by phone via an interactive voice-response system, all patients receiving active treatment who completed the study met the primary end point, which was an increase in complete spontaneous bowel movements (CSBMs), measured at 12 weeks, compared with baseline.

At week 12, those receiving 75 mcg had an increase of 2.90 CSBMs per week; the 150-mcg had an increase of 2.49 CSBMs per week; the 300-mcg group an increase of 3.61 per week; and the 600-mcg group an increase of 2.68 per week over their baseline (P less than or equal to .01 for all doses). The placebo group had a mean increase of 1.01 CSBMs per week.

There were also significant decreases in abdominal pain – which was measured on a 5-point scale, with 1 signifying no pain and 5 being very severe pain – among patients taking linaclotide.

Compared with baseline, by 12 weeks the 75-mcg treatment group reported a mean reduction in the pain scale of 0.71 points, as did the 150-mcg group. The 300-mcg group had a reduction of 0.90 points, and the 600-mcg dosing group had a mean decrease of 0.86 points, compared with 0.49 points for placebo patients (P less than or equal to .05 for all doses).

Moreover, linaclotide's effects “occurred within the first week of therapy and were sustained for the entire 3-month duration of this study,” wrote the investigators.

The most frequent side effect was diarrhea. The researchers noted that the diarrhea was dose dependent, reported by 11.4%, 12.2%, 16.5%, and 18.0% of patients in the 75-, 150-, 300-, and 600-mcg dose groups, respectively, compared with 1.2% in the placebo group.

“No dehydration, electrolyte changes, or other adverse clinical sequelae from diarrhea were reported,” the authors wrote.

“Linaclotide resulted in sustained effects in the treatment of a common condition for which few therapies are currently available,” concluded Dr. Johnston and associates.

The results of this placebo-controlled, dose-range–finding, phase IIB study “support further development of linaclotide for treatment of adults with [IBS constipation]”.

Several of Dr. Johnston's coinvestigators are also employees of linaclotide's manufacturer, Ironwood Pharmaceuticals Inc., which also funded the study.

Linaclotide was associated with significant improvement in symptoms of irritable bowel syndrome with constipation, including abdominal pain, within 1 week of therapy, Dr. Jeffrey M. Johnston and colleagues reported in Gastroenterology.

Diarrhea was a common side effect, leading to study withdrawal by more than a dozen patients.

Linaclotide is a novel, 14–amino acid peptide that binds to guanylate cyclase-C receptors on intestinal enterocytes, wrote Dr. Johnston, an employee of the drug's maker, Ironwood Pharmaceuticals Inc. In animal models, it has been shown to increase fluid secretion and transit, he added.

In the current study, Dr. Johnston and colleagues randomized 420 patients in a double-blind, placebo-controlled, phase IIB study. Patients were aged 18 years or older and met the Rome II criteria for irritable bowel syndrome (IBS). The mean patient age was 44 years, and 92% were female (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.041]).

All participants also reported having fewer than three spontaneous bowel movements per week, and at least one of the following symptoms occurring with 25% or more of their bowel movements: straining, lumpy or hard stools, or a sensation of incomplete evacuation.

Patients were randomized into five groups. One received a daily placebo; the rest received once-daily linaclotide in doses of 75 mcg, 150 mcg, 300 mcg, or 600 mcg, taken orally before the first meal of the day.

According to daily assessments completed by phone via an interactive voice-response system, all patients receiving active treatment who completed the study met the primary end point, which was an increase in complete spontaneous bowel movements (CSBMs), measured at 12 weeks, compared with baseline.

At week 12, those receiving 75 mcg had an increase of 2.90 CSBMs per week; the 150-mcg had an increase of 2.49 CSBMs per week; the 300-mcg group an increase of 3.61 per week; and the 600-mcg group an increase of 2.68 per week over their baseline (P less than or equal to .01 for all doses). The placebo group had a mean increase of 1.01 CSBMs per week.

There were also significant decreases in abdominal pain – which was measured on a 5-point scale, with 1 signifying no pain and 5 being very severe pain – among patients taking linaclotide.

Compared with baseline, by 12 weeks the 75-mcg treatment group reported a mean reduction in the pain scale of 0.71 points, as did the 150-mcg group. The 300-mcg group had a reduction of 0.90 points, and the 600-mcg dosing group had a mean decrease of 0.86 points, compared with 0.49 points for placebo patients (P less than or equal to .05 for all doses).

Moreover, linaclotide's effects “occurred within the first week of therapy and were sustained for the entire 3-month duration of this study,” wrote the investigators.

The most frequent side effect was diarrhea. The researchers noted that the diarrhea was dose dependent, reported by 11.4%, 12.2%, 16.5%, and 18.0% of patients in the 75-, 150-, 300-, and 600-mcg dose groups, respectively, compared with 1.2% in the placebo group.

“No dehydration, electrolyte changes, or other adverse clinical sequelae from diarrhea were reported,” the authors wrote.

“Linaclotide resulted in sustained effects in the treatment of a common condition for which few therapies are currently available,” concluded Dr. Johnston and associates.

The results of this placebo-controlled, dose-range–finding, phase IIB study “support further development of linaclotide for treatment of adults with [IBS constipation]”.

Several of Dr. Johnston's coinvestigators are also employees of linaclotide's manufacturer, Ironwood Pharmaceuticals Inc., which also funded the study.

Major Finding: Based on histology reports, patients with chronic active gastritis were extremely likely to have H. pylori infection (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and half as likely to have Barrett's metaplasia (OR, 0.48).

Data Source: A retrospective database analysis from a national sample of gastric biopsy samples from 78,985 unique patients.

Disclosures: Lead author Dr. Sonnenberg disclosed being supported by a grant from Takeda Pharmaceutical Co. Two other investigators are employees of Caris Life Sciences.

Helicobacter pylori infection, chronic active gastritis, and intestinal metaplasia share similar epidemiologic patterns, and are significantly associated with each other, Dr. Amnon Sonnenberg and colleagues reported.

Moreover, all three diagnoses are inversely associated with the presence of Barrett's metaplasia, they found.

Dr. Sonnenberg of the Portland (Ore.) VA Medical Center and Oregon Health and Science University, Portland, and colleagues looked at histology reports from 78,985 patients who had gastric and esophageal biopsies between April 2007 and March 2008. Patients were treated by approximately 1,500 gastroenterologists distributed throughout the United States (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.018]).

All samples were processed by Caris Life Sciences Inc., a gastrointestinal laboratory that works with private outpatient endoscopy centers, at facilities in Phoenix, Boston, and Irving, Tex.

The researchers found that patients who were positive for H. pylori infection had a startlingly high odds ratio for chronic active gastritis: 456. They were also twice as likely to have intestinal metaplasia (OR, 2.00).

However, having H. pylori was apparently protective against a diagnosis of Barrett's metaplasia, in the esophagus: The OR for having the latter among H. pylori-positive patients was 0.42.

Similarly, patients who were histologically positive for chronic active gastritis were extremely likely to have H. pylori (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and roughly half as likely to have Barrett's metaplasia (OR, 0.48). Analyses linking intestinal metaplasia to these conditions revealed an OR of 2.07 for H. pylori, 2.15 for chronic active gastritis, and 0.61 for Barrett's esophagus.

Dr. Sonnenberg and colleagues also found that all three diagnoses were more common among men than women, and that “compared with other insurance types, Medicaid was more common in patients with all three diagnoses.”

Additionally, there was a higher concentration of all three diagnoses in Puerto Rico, New York, South Carolina, and New Mexico, compared with the rest of the country, possibly because of “an underlying variation in the socio-economic well-being among populations from different states,” Dr. Sonnenberg and associates noted.

According to the authors, although an inverse relationship between H. pylori–induced gastritis and Barrett's esophagus has already been suggested in multiple studies, many of those analyses “were based on small population samples, clinical observations, or indirect evidence of opposing epidemiologic trends among H. pylori or peptic ulcer versus gastroesophageal reflux disease.”

In contrast, the current study offers a “direct and inverse relationship between the histologic findings of Barrett's mucosa and H. pylori–induced gastritis,” they wrote.

“Using histological findings to assess the underlying epidemiology represents a new way to study epidemiologic patterns,” the investigators added.

However, the researchers conceded that the study was not without limitations. For one, it “lacks any data to assess the influence of H. pylori–induced gastritis on hyposecretion of acid,” they wrote.

Major Finding: Based on histology reports, patients with chronic active gastritis were extremely likely to have H. pylori infection (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and half as likely to have Barrett's metaplasia (OR, 0.48).

Data Source: A retrospective database analysis from a national sample of gastric biopsy samples from 78,985 unique patients.

Disclosures: Lead author Dr. Sonnenberg disclosed being supported by a grant from Takeda Pharmaceutical Co. Two other investigators are employees of Caris Life Sciences.

Helicobacter pylori infection, chronic active gastritis, and intestinal metaplasia share similar epidemiologic patterns, and are significantly associated with each other, Dr. Amnon Sonnenberg and colleagues reported.

Moreover, all three diagnoses are inversely associated with the presence of Barrett's metaplasia, they found.

Dr. Sonnenberg of the Portland (Ore.) VA Medical Center and Oregon Health and Science University, Portland, and colleagues looked at histology reports from 78,985 patients who had gastric and esophageal biopsies between April 2007 and March 2008. Patients were treated by approximately 1,500 gastroenterologists distributed throughout the United States (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.018]).

All samples were processed by Caris Life Sciences Inc., a gastrointestinal laboratory that works with private outpatient endoscopy centers, at facilities in Phoenix, Boston, and Irving, Tex.

The researchers found that patients who were positive for H. pylori infection had a startlingly high odds ratio for chronic active gastritis: 456. They were also twice as likely to have intestinal metaplasia (OR, 2.00).

However, having H. pylori was apparently protective against a diagnosis of Barrett's metaplasia, in the esophagus: The OR for having the latter among H. pylori-positive patients was 0.42.

Similarly, patients who were histologically positive for chronic active gastritis were extremely likely to have H. pylori (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and roughly half as likely to have Barrett's metaplasia (OR, 0.48). Analyses linking intestinal metaplasia to these conditions revealed an OR of 2.07 for H. pylori, 2.15 for chronic active gastritis, and 0.61 for Barrett's esophagus.

Dr. Sonnenberg and colleagues also found that all three diagnoses were more common among men than women, and that “compared with other insurance types, Medicaid was more common in patients with all three diagnoses.”

Additionally, there was a higher concentration of all three diagnoses in Puerto Rico, New York, South Carolina, and New Mexico, compared with the rest of the country, possibly because of “an underlying variation in the socio-economic well-being among populations from different states,” Dr. Sonnenberg and associates noted.

According to the authors, although an inverse relationship between H. pylori–induced gastritis and Barrett's esophagus has already been suggested in multiple studies, many of those analyses “were based on small population samples, clinical observations, or indirect evidence of opposing epidemiologic trends among H. pylori or peptic ulcer versus gastroesophageal reflux disease.”

In contrast, the current study offers a “direct and inverse relationship between the histologic findings of Barrett's mucosa and H. pylori–induced gastritis,” they wrote.

“Using histological findings to assess the underlying epidemiology represents a new way to study epidemiologic patterns,” the investigators added.

However, the researchers conceded that the study was not without limitations. For one, it “lacks any data to assess the influence of H. pylori–induced gastritis on hyposecretion of acid,” they wrote.

Major Finding: Based on histology reports, patients with chronic active gastritis were extremely likely to have H. pylori infection (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and half as likely to have Barrett's metaplasia (OR, 0.48).

Data Source: A retrospective database analysis from a national sample of gastric biopsy samples from 78,985 unique patients.

Disclosures: Lead author Dr. Sonnenberg disclosed being supported by a grant from Takeda Pharmaceutical Co. Two other investigators are employees of Caris Life Sciences.

Helicobacter pylori infection, chronic active gastritis, and intestinal metaplasia share similar epidemiologic patterns, and are significantly associated with each other, Dr. Amnon Sonnenberg and colleagues reported.

Moreover, all three diagnoses are inversely associated with the presence of Barrett's metaplasia, they found.

Dr. Sonnenberg of the Portland (Ore.) VA Medical Center and Oregon Health and Science University, Portland, and colleagues looked at histology reports from 78,985 patients who had gastric and esophageal biopsies between April 2007 and March 2008. Patients were treated by approximately 1,500 gastroenterologists distributed throughout the United States (Gastroenterology 2010 December [doi:10.1053/j.gastro.2010.08.018]).

All samples were processed by Caris Life Sciences Inc., a gastrointestinal laboratory that works with private outpatient endoscopy centers, at facilities in Phoenix, Boston, and Irving, Tex.

The researchers found that patients who were positive for H. pylori infection had a startlingly high odds ratio for chronic active gastritis: 456. They were also twice as likely to have intestinal metaplasia (OR, 2.00).

However, having H. pylori was apparently protective against a diagnosis of Barrett's metaplasia, in the esophagus: The OR for having the latter among H. pylori-positive patients was 0.42.

Similarly, patients who were histologically positive for chronic active gastritis were extremely likely to have H. pylori (OR, 457), more than twice as likely to have intestinal metaplasia (OR, 2.10), and roughly half as likely to have Barrett's metaplasia (OR, 0.48). Analyses linking intestinal metaplasia to these conditions revealed an OR of 2.07 for H. pylori, 2.15 for chronic active gastritis, and 0.61 for Barrett's esophagus.

Dr. Sonnenberg and colleagues also found that all three diagnoses were more common among men than women, and that “compared with other insurance types, Medicaid was more common in patients with all three diagnoses.”

Additionally, there was a higher concentration of all three diagnoses in Puerto Rico, New York, South Carolina, and New Mexico, compared with the rest of the country, possibly because of “an underlying variation in the socio-economic well-being among populations from different states,” Dr. Sonnenberg and associates noted.

According to the authors, although an inverse relationship between H. pylori–induced gastritis and Barrett's esophagus has already been suggested in multiple studies, many of those analyses “were based on small population samples, clinical observations, or indirect evidence of opposing epidemiologic trends among H. pylori or peptic ulcer versus gastroesophageal reflux disease.”

In contrast, the current study offers a “direct and inverse relationship between the histologic findings of Barrett's mucosa and H. pylori–induced gastritis,” they wrote.

“Using histological findings to assess the underlying epidemiology represents a new way to study epidemiologic patterns,” the investigators added.

However, the researchers conceded that the study was not without limitations. For one, it “lacks any data to assess the influence of H. pylori–induced gastritis on hyposecretion of acid,” they wrote.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

When a parent in the military is deployed, children have an 11% increased risk for requiring mental and behavioral health doctor visits, compared with when the parent is home.

Pediatric behavioral and stress disorders increased 18% and 19%, respectively, when a parent was deployed, according to study findings.

The results "reinforce the importance of providing additional support to children of parents who are frequently deployed and the parent or caregiver who remains at home to care for them," Dr. Gregory H. Gorman and his associates wrote in an article published online in Pediatrics (doi:10.1542/peds.2009-2856).

Using the Defense Enrollment Eligibility Reporting System, Dr. Gorman, a pediatrician at the Uniformed Services University of the Health Sciences, Bethesda, Md., and his associates looked at all military beneficiaries aged 3-8 years who were enrolled in the military health system at the end of fiscal year 2006-2007. Children of parents in the National Guard or in the military reserves were excluded.

All deployment dates and demographic information about the military parents was garnered from the Defense Manpower Data Center, and each subject’s outpatient visits were merged with the parental deployment record.

Overall, the researchers tallied 642,397 children linked to 442,722 active-duty parents. The mean age of the children was 5 years. Half were male; 68% were white and 22% were black.

Among the parents, 90% were male, and 90.5% were married. Thirty-two percent were deployed during the 2-year study period for a mean of 196 days.

According to an unadjusted analysis, the incidence rate ratio (IRR) of all outpatient doctor visits during a parent’s deployment, compared with when a parent was home, was 0.89. However, the IRR for mental health visits was 1.11 while a parent was deployed, compared with when the parent was home, Dr. Gorman and his associates reported.

These deployment-time mental health appointments included 26.7 excess visits per 1,000 person-years for anxiety disorders, compared with when the parent was at home, 6.5 excess visits for behavioral disorders, and 22.3 excess visits for stress disorders.

When Dr. Gorman and his associates adjusted for the child’s age and gender as well as the parental age, gender, marital status, and military rank, they found that older children experienced significantly greater rates of mental health visits while the military parent was deployed, compared with younger children. For example, among 8-year-old children with married parents and deployed fathers, the IRR was 14.2.

Having a father deployed, vs. a mother, also carried a greater IRR of mental health visits – 1.19 vs. 0.70, respectively.

The results are limited by several factors. For one, diagnoses such as autism, developmental delay, and speech disorders are categorized as mental health or behavioral disorders in the database used for this study.

Additionally, the researchers lacked data about the parents’ mental health history and current status. That’s important, because according to the "depression-distortion hypothesis," depressed mothers perceive their children’s mental health problems more frequently than did nondepressed mothers, and this may have altered the findings as well, they said.

Nevertheless, Dr. Gorman and his associates concluded, these findings are important, especially for nonmilitary pediatricians "who provide almost two-thirds of outpatient care for the children of military parents." Indeed, "Providers and policy makers should continue their focus on supporting military families before, during, and after deployments."

"Future analyses will be needed to determine if the effects of deployment on parent-child separation persist into adulthood," they said.

Dr. Gorman and his associates stated that they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

A state-funded initiative to offer free mental health consultations to pediatric primary care physicians increased the proportion of pediatricians who said they were able to meet the needs of their psychiatric patients from 8% to 63% in 3.5 years.

Indeed, the program’s success means it could offer a model for how to at least temporarily increase access to psychiatric care among children and adolescents, according to a study published online Nov. 8 in Pediatrics (doi:10.1542/peds.2009-1340).

The initiative, known as the Massachusetts Child Psychiatry Access Project (MCPAP), began in July 2005 with the goal of increasing access to mental health services among pediatric patients.

According to Dr. Barry Sarvet, medical director of the Baystate Medical Center MCPAP site in Springfield as well as the lead author of the current study, the program divided the state of Massachusetts into six regions. Each region was serviced by one team of at least one child psychiatrist, one child and family psychotherapist, and one care coordinator.

Each team was tasked with providing "immediate informal telephonic consultation" to the primary care clinicians (PCCs) in its region; timely, as-needed formal outpatient consultations; assistance in coordinating community mental health services; and also "continuing professional education regarding children’s mental health designed specifically for PCCs."

At enrollment, PCCs were asked to complete a survey asking about their satisfaction with current mental health resources and access to mental health care for their patients; 514 providers filled this out. Of these, 385 completed a similar follow-up survey in 2008 or 2009.

"By the end of 2008, 353 practices including 1,341 PCCs were oriented and voluntarily enrolled to participate in the program," wrote Dr. Sarvet, who is also chief of child and adolescent psychiatry at Baystate Medical Center and associate clinical professor of psychiatry at Tufts University, Boston, and his associates. The participating practices serviced an estimated 1.36 million children and adolescents, which represented 95% of the child/adolescent population of Massachusetts.

Regarding the first duty of the teams – to provide telephone consultation to PCCs in their region – by Dec. 31, 2008, the six teams had logged 14,174 phone calls, mostly for diagnostic assistance (34%), information about resources in the community (27%), and medication questions (27%), according to Dr. Sarvet and his associates.

Many of these initial phone calls led to an outpatient consultation for the patient with the MCPAP team’s psychiatrist or an advanced practice registered nurse (combined, 28%) or psychotherapist (15%). However, based on these calls, many patients (24%) also simply continued receiving care through their PCC. The remaining cases resulted in a variety of outcomes, including referral to a community psychiatric crisis center or referral to a psychiatrist in the community.

The MCPAP teams also logged 702 "educational encounters" during the study period, including discussions on child psychiatry with PCCs either at their practices or over the phone, and conducted several day-long and half-day conferences on pediatric mental health topics.

According to the 2008 and 2009 surveys, more than 90% of PCCs either agreed or strongly agreed that their consultations with the MCPAP teams had been useful, Dr. Sarvet and his associates said.

Moreover, the percentage of PCCs who agreed or strongly agreed that their patients had adequate access to a child psychiatrist increased from 5% to 33%, while the percentage of PCCs who said that they themselves could meet the psychiatric needs of their patients increased from 8% to 63%.

Finally, the percentage of PCCs who stated that they were able to obtain a child psychiatry consultation in a timely manner increased from 8% to 80%.

"The MCPAP model provides the opportunity to dramatically expand the capacity of the clinical workforce for these children and to make mental health services more accessible for those families who experience barriers to assessment and treatment within the traditional mental health system," Dr. Sarvet and his associates wrote.

And while "the approximate cost of $0.16 per member per month for the operation of the program is by no means insignificant. ... reduction in the utilization of acute psychiatric treatment for previously untreated mental health problems may justify this cost," they added. As this program and others like it proliferate, "it will be important for comparison studies to be undertaken to examine the influence of program design and features on performance."

One of the investigators serves as a consultant to AstraZeneca, is a member of the speakers bureau for Ortho-McNeil Pharmaceutical, and has received a speaker’s honorarium from Shire. Another investigator serves as a consultant to Forest Laboratories and GlaxoSmithKline. The other authors indicated they have no financial relationships relevant to this article.

Hormone therapy stabilized bone loss over a 2-year period in rheumatoid arthritis patients, as measured on digital x-ray radiogrammetry, according to a study published in Annals of the Rheumatic Diseases.

The study is important not only for finding that hormone therapy (HT) was effective, but because it depended on readings that detected losses of as little as 0.36%.

In contrast, plain radiographs, "the standard method for detection and quantification of joint destruction in RA," cannot detect bone loss of less than 30%, wrote Dr. Helena Forsblad-d’Elia and Dr. Hans Carlsten (Ann. Rheum. Dis. 2010 Nov. 3 [doi: 10.1136/ard.2010.137133]).

Dr. Forsblad-d’Elia and Dr. Carlsten, both of the center for bone and arthritis research at the University of Gothenburg (Sweden), looked at 88 postmenopausal women with radiographic joint destruction due to rheumatoid arthritis. Findings from earlier research by Dr. Forsblad-d’Elia has shown that RA is strongly associated with generalized osteoporosis (Ann. Rheum. Dis. 2003;62:617–23).

Patients were randomized to one of two groups. The first received HRT, which consisted of estradiol and norethisterone acetate, plus a daily dose of 500 mg calcium and 400 IU vitamin D. Controls received only the calcium and vitamin D.

Patients had digital x-ray radiogrammetry–bone mineral density (DXR-BMD) readings at baseline and at 2 years. A total of 13 women had ineligible DXR-BMD readings at baseline because of prostheses, osteosynthetic materials, the position of the hands or insufficient x-ray, wrote the authors. Another 25 patients did not complete the second DXR-BMD 2 years later.

That left a total of 50 women (23 HRT patients, 27 controls) to be included in the study analysis. The mean age of both groups was roughly 58 years, and both groups had a mean disease duration of greater than 10 years.

According to the researchers, at baseline, HT patients and controls had an identical mean DXR-BMD reading of 0.45 g/cm²; HRT patients had a standard deviation of 0.096, vs. 0.081 in the control group.

Two years later, HT patients’ mean reading was identical except for a tiny increase in the standard deviation, to 0.097, whereas control patients’ mean DXR-BMD was 0.44, with a standard deviation of 0.084.

The minute difference was insignificant for the HT group (–0.0015 ± 0.0078), but significant for controls, both in terms of change from baseline and difference from the HT group (–0.18 ± 0.038, P less than .05 for both comparisons).

Put another way, the decrease among HT patients from baseline was 0.36%, while the decrease from baseline for controls was 3.74% – more than 10 times greater.

"DXR-BMD has been proposed to be an outcome measure in monitoring treatments in early RA, and can predict future radiographic joint damage," concluded the authors. "So far, there is limited knowledge of DXR-BMD used as an outcome measure in randomized controlled trials in long-term RA."

Based on the current data, however, "we suggest that DXR-BMD could serve as an outcome measure in [randomized controlled trials] in long-standing RA," they wrote.

"Further studies on disease-modifying drugs are needed to assess its usability."

Dr. Forsblad-d’Elia and Dr. Carlsten said that this study was supported by several grants from rheumatology and other foundations; they added that they had no competing interests to disclose.

Hormone therapy stabilized bone loss over a 2-year period in rheumatoid arthritis patients, as measured on digital x-ray radiogrammetry, according to a study published in Annals of the Rheumatic Diseases.

The study is important not only for finding that hormone therapy (HT) was effective, but because it depended on readings that detected losses of as little as 0.36%.

In contrast, plain radiographs, "the standard method for detection and quantification of joint destruction in RA," cannot detect bone loss of less than 30%, wrote Dr. Helena Forsblad-d’Elia and Dr. Hans Carlsten (Ann. Rheum. Dis. 2010 Nov. 3 [doi: 10.1136/ard.2010.137133]).

Dr. Forsblad-d’Elia and Dr. Carlsten, both of the center for bone and arthritis research at the University of Gothenburg (Sweden), looked at 88 postmenopausal women with radiographic joint destruction due to rheumatoid arthritis. Findings from earlier research by Dr. Forsblad-d’Elia has shown that RA is strongly associated with generalized osteoporosis (Ann. Rheum. Dis. 2003;62:617–23).

Patients were randomized to one of two groups. The first received HRT, which consisted of estradiol and norethisterone acetate, plus a daily dose of 500 mg calcium and 400 IU vitamin D. Controls received only the calcium and vitamin D.

Patients had digital x-ray radiogrammetry–bone mineral density (DXR-BMD) readings at baseline and at 2 years. A total of 13 women had ineligible DXR-BMD readings at baseline because of prostheses, osteosynthetic materials, the position of the hands or insufficient x-ray, wrote the authors. Another 25 patients did not complete the second DXR-BMD 2 years later.

That left a total of 50 women (23 HRT patients, 27 controls) to be included in the study analysis. The mean age of both groups was roughly 58 years, and both groups had a mean disease duration of greater than 10 years.

According to the researchers, at baseline, HT patients and controls had an identical mean DXR-BMD reading of 0.45 g/cm²; HRT patients had a standard deviation of 0.096, vs. 0.081 in the control group.

Two years later, HT patients’ mean reading was identical except for a tiny increase in the standard deviation, to 0.097, whereas control patients’ mean DXR-BMD was 0.44, with a standard deviation of 0.084.

The minute difference was insignificant for the HT group (–0.0015 ± 0.0078), but significant for controls, both in terms of change from baseline and difference from the HT group (–0.18 ± 0.038, P less than .05 for both comparisons).

Put another way, the decrease among HT patients from baseline was 0.36%, while the decrease from baseline for controls was 3.74% – more than 10 times greater.

"DXR-BMD has been proposed to be an outcome measure in monitoring treatments in early RA, and can predict future radiographic joint damage," concluded the authors. "So far, there is limited knowledge of DXR-BMD used as an outcome measure in randomized controlled trials in long-term RA."

Based on the current data, however, "we suggest that DXR-BMD could serve as an outcome measure in [randomized controlled trials] in long-standing RA," they wrote.

"Further studies on disease-modifying drugs are needed to assess its usability."

Dr. Forsblad-d’Elia and Dr. Carlsten said that this study was supported by several grants from rheumatology and other foundations; they added that they had no competing interests to disclose.

Hormone therapy stabilized bone loss over a 2-year period in rheumatoid arthritis patients, as measured on digital x-ray radiogrammetry, according to a study published in Annals of the Rheumatic Diseases.

The study is important not only for finding that hormone therapy (HT) was effective, but because it depended on readings that detected losses of as little as 0.36%.

In contrast, plain radiographs, "the standard method for detection and quantification of joint destruction in RA," cannot detect bone loss of less than 30%, wrote Dr. Helena Forsblad-d’Elia and Dr. Hans Carlsten (Ann. Rheum. Dis. 2010 Nov. 3 [doi: 10.1136/ard.2010.137133]).

Dr. Forsblad-d’Elia and Dr. Carlsten, both of the center for bone and arthritis research at the University of Gothenburg (Sweden), looked at 88 postmenopausal women with radiographic joint destruction due to rheumatoid arthritis. Findings from earlier research by Dr. Forsblad-d’Elia has shown that RA is strongly associated with generalized osteoporosis (Ann. Rheum. Dis. 2003;62:617–23).

Patients were randomized to one of two groups. The first received HRT, which consisted of estradiol and norethisterone acetate, plus a daily dose of 500 mg calcium and 400 IU vitamin D. Controls received only the calcium and vitamin D.

Patients had digital x-ray radiogrammetry–bone mineral density (DXR-BMD) readings at baseline and at 2 years. A total of 13 women had ineligible DXR-BMD readings at baseline because of prostheses, osteosynthetic materials, the position of the hands or insufficient x-ray, wrote the authors. Another 25 patients did not complete the second DXR-BMD 2 years later.

That left a total of 50 women (23 HRT patients, 27 controls) to be included in the study analysis. The mean age of both groups was roughly 58 years, and both groups had a mean disease duration of greater than 10 years.

According to the researchers, at baseline, HT patients and controls had an identical mean DXR-BMD reading of 0.45 g/cm²; HRT patients had a standard deviation of 0.096, vs. 0.081 in the control group.

Two years later, HT patients’ mean reading was identical except for a tiny increase in the standard deviation, to 0.097, whereas control patients’ mean DXR-BMD was 0.44, with a standard deviation of 0.084.

The minute difference was insignificant for the HT group (–0.0015 ± 0.0078), but significant for controls, both in terms of change from baseline and difference from the HT group (–0.18 ± 0.038, P less than .05 for both comparisons).

Put another way, the decrease among HT patients from baseline was 0.36%, while the decrease from baseline for controls was 3.74% – more than 10 times greater.

"DXR-BMD has been proposed to be an outcome measure in monitoring treatments in early RA, and can predict future radiographic joint damage," concluded the authors. "So far, there is limited knowledge of DXR-BMD used as an outcome measure in randomized controlled trials in long-term RA."

Based on the current data, however, "we suggest that DXR-BMD could serve as an outcome measure in [randomized controlled trials] in long-standing RA," they wrote.

"Further studies on disease-modifying drugs are needed to assess its usability."

Dr. Forsblad-d’Elia and Dr. Carlsten said that this study was supported by several grants from rheumatology and other foundations; they added that they had no competing interests to disclose.