Heidi Splete

Patients who receive thiopurines for inflammatory bowel disease are at increased risk for lymphoproliferative disorders, but the overall incidence is low and the benefits of treatment for IBD still outweigh the risks, according to data from more than 19,000 adults.

“We have shown that risk of lymphoproliferative disorders was five times higher in patients exposed to thio-purines than in those never exposed to the drugs,” wrote Dr. Laurent Beaugerie of Saint Antoine Hospital, Paris, and colleagues in their report of the prospective, observational cohort study.

But the results also indicate absolute cumulative risks of lymphoproliferative disorders among patients who continue to take thiopurines at less than 1% in patients younger than 50 years, less than 3% in patients aged 50-65 years, and less than 6% in patients older than 65, the researchers said.

The team reviewed data from the CESAME (Cancers et Surrisque Associe aux Maladies Inflammatories Intestinales en France) study, which was designed to assess various risks of taking thiopurines for IBD. The study included 11,759 adults with Crohn's disease and 7,727 adults with ulcerative colitis or unclassified IBD (Lancet 2009 Oct. 18 [Epub doi:10.1016/S0140-6736(09)61302-7]).

At baseline, 5,867 patients were receiving thiopurines, 2,809 patients had discontinued thiopurines, and 10,810 patients had never received thiopurines. Patients were recruited into the study between May 2004 and June 2005, and the researchers followed them until Dec. 31, 2007, an average of 35 months.

During the study period, 114 (2%) of patients who were receiving thio-purines at baseline developed cancer, compared with 41 (1%) of patients who had discontinued the drugs and 134 (1%) of patients who had never taken them. A total of 22 patients were diagnosed with non-Hodgkin's lymphoma, and 1 patient was diagnosed with Hodgkin's lymphoma during 49,713 patient-years of follow-up.

Old age, being male, and longer disease duration were associated with an increased risk of lymphoproliferative disorders.

“Our hypothesis of a constant risk of lymphoproliferative disorder during thiopurine therapy is supported by three considerations,” they said. First, the consistent dose of immunosuppressants in a post-transplant setting keeps the risk for lymphoma constant. Second, the same number of lymphomas was seen during the first and third years of the study. Finally, “the duration of previous thiopurine exposure was evenly distributed among the 23 patients who developed lymphoma.”

Patients who discontinued therapy had more clinically active IBD but a lower risk of lymphoproliferative disorders compared with those receiving thio-purines. Dr. Beaugerie has received funding from UCB Pharma, Sanofi-Aventis, Abbott, and Ferring Pharmaceuticals.

Patients who receive thiopurines for inflammatory bowel disease are at increased risk for lymphoproliferative disorders, but the overall incidence is low and the benefits of treatment for IBD still outweigh the risks, according to data from more than 19,000 adults.

“We have shown that risk of lymphoproliferative disorders was five times higher in patients exposed to thio-purines than in those never exposed to the drugs,” wrote Dr. Laurent Beaugerie of Saint Antoine Hospital, Paris, and colleagues in their report of the prospective, observational cohort study.

But the results also indicate absolute cumulative risks of lymphoproliferative disorders among patients who continue to take thiopurines at less than 1% in patients younger than 50 years, less than 3% in patients aged 50-65 years, and less than 6% in patients older than 65, the researchers said.

The team reviewed data from the CESAME (Cancers et Surrisque Associe aux Maladies Inflammatories Intestinales en France) study, which was designed to assess various risks of taking thiopurines for IBD. The study included 11,759 adults with Crohn's disease and 7,727 adults with ulcerative colitis or unclassified IBD (Lancet 2009 Oct. 18 [Epub doi:10.1016/S0140-6736(09)61302-7]).

At baseline, 5,867 patients were receiving thiopurines, 2,809 patients had discontinued thiopurines, and 10,810 patients had never received thiopurines. Patients were recruited into the study between May 2004 and June 2005, and the researchers followed them until Dec. 31, 2007, an average of 35 months.

During the study period, 114 (2%) of patients who were receiving thio-purines at baseline developed cancer, compared with 41 (1%) of patients who had discontinued the drugs and 134 (1%) of patients who had never taken them. A total of 22 patients were diagnosed with non-Hodgkin's lymphoma, and 1 patient was diagnosed with Hodgkin's lymphoma during 49,713 patient-years of follow-up.

Old age, being male, and longer disease duration were associated with an increased risk of lymphoproliferative disorders.

“Our hypothesis of a constant risk of lymphoproliferative disorder during thiopurine therapy is supported by three considerations,” they said. First, the consistent dose of immunosuppressants in a post-transplant setting keeps the risk for lymphoma constant. Second, the same number of lymphomas was seen during the first and third years of the study. Finally, “the duration of previous thiopurine exposure was evenly distributed among the 23 patients who developed lymphoma.”

Patients who discontinued therapy had more clinically active IBD but a lower risk of lymphoproliferative disorders compared with those receiving thio-purines. Dr. Beaugerie has received funding from UCB Pharma, Sanofi-Aventis, Abbott, and Ferring Pharmaceuticals.

Patients who receive thiopurines for inflammatory bowel disease are at increased risk for lymphoproliferative disorders, but the overall incidence is low and the benefits of treatment for IBD still outweigh the risks, according to data from more than 19,000 adults.

“We have shown that risk of lymphoproliferative disorders was five times higher in patients exposed to thio-purines than in those never exposed to the drugs,” wrote Dr. Laurent Beaugerie of Saint Antoine Hospital, Paris, and colleagues in their report of the prospective, observational cohort study.

But the results also indicate absolute cumulative risks of lymphoproliferative disorders among patients who continue to take thiopurines at less than 1% in patients younger than 50 years, less than 3% in patients aged 50-65 years, and less than 6% in patients older than 65, the researchers said.

The team reviewed data from the CESAME (Cancers et Surrisque Associe aux Maladies Inflammatories Intestinales en France) study, which was designed to assess various risks of taking thiopurines for IBD. The study included 11,759 adults with Crohn's disease and 7,727 adults with ulcerative colitis or unclassified IBD (Lancet 2009 Oct. 18 [Epub doi:10.1016/S0140-6736(09)61302-7]).

At baseline, 5,867 patients were receiving thiopurines, 2,809 patients had discontinued thiopurines, and 10,810 patients had never received thiopurines. Patients were recruited into the study between May 2004 and June 2005, and the researchers followed them until Dec. 31, 2007, an average of 35 months.

During the study period, 114 (2%) of patients who were receiving thio-purines at baseline developed cancer, compared with 41 (1%) of patients who had discontinued the drugs and 134 (1%) of patients who had never taken them. A total of 22 patients were diagnosed with non-Hodgkin's lymphoma, and 1 patient was diagnosed with Hodgkin's lymphoma during 49,713 patient-years of follow-up.

Old age, being male, and longer disease duration were associated with an increased risk of lymphoproliferative disorders.

“Our hypothesis of a constant risk of lymphoproliferative disorder during thiopurine therapy is supported by three considerations,” they said. First, the consistent dose of immunosuppressants in a post-transplant setting keeps the risk for lymphoma constant. Second, the same number of lymphomas was seen during the first and third years of the study. Finally, “the duration of previous thiopurine exposure was evenly distributed among the 23 patients who developed lymphoma.”

Patients who discontinued therapy had more clinically active IBD but a lower risk of lymphoproliferative disorders compared with those receiving thio-purines. Dr. Beaugerie has received funding from UCB Pharma, Sanofi-Aventis, Abbott, and Ferring Pharmaceuticals.

The Food and Drug Administration has approved the Gardasil vaccine for boys and men aged 9-26 years to prevent genital warts associated with the human papillomavirus, according to a statement from the vaccine's manufacturer, Merck & Co. An FDA press officer confirmed the approval.

The human papillomavirus (HPV) vaccine offers protection against four strains of the virus (types 6, 11, 16, and 18) that have been associated with the most disease, including cervical cancer in women (types 16 and 18) and genital warts in both women and men (types 6 and 11), according to the statement.

In an Oct. 21 vote, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) declined to recommend routine use of Gardasil in males aged 9-26 years, letting physicians decide whether to use the vaccine. The vaccine was approved in 2006 for young women and girls aged 9-26 years, and it is part of the CDC's adolescent vaccination schedule.

Gardasil is not recommended for pregnant women or for individuals with hypersensitivity to yeast, according to the vaccine's safety information.

The Food and Drug Administration has approved the Gardasil vaccine for boys and men aged 9-26 years to prevent genital warts associated with the human papillomavirus, according to a statement from the vaccine's manufacturer, Merck & Co. An FDA press officer confirmed the approval.

The human papillomavirus (HPV) vaccine offers protection against four strains of the virus (types 6, 11, 16, and 18) that have been associated with the most disease, including cervical cancer in women (types 16 and 18) and genital warts in both women and men (types 6 and 11), according to the statement.

In an Oct. 21 vote, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) declined to recommend routine use of Gardasil in males aged 9-26 years, letting physicians decide whether to use the vaccine. The vaccine was approved in 2006 for young women and girls aged 9-26 years, and it is part of the CDC's adolescent vaccination schedule.

Gardasil is not recommended for pregnant women or for individuals with hypersensitivity to yeast, according to the vaccine's safety information.

The Food and Drug Administration has approved the Gardasil vaccine for boys and men aged 9-26 years to prevent genital warts associated with the human papillomavirus, according to a statement from the vaccine's manufacturer, Merck & Co. An FDA press officer confirmed the approval.

The human papillomavirus (HPV) vaccine offers protection against four strains of the virus (types 6, 11, 16, and 18) that have been associated with the most disease, including cervical cancer in women (types 16 and 18) and genital warts in both women and men (types 6 and 11), according to the statement.

In an Oct. 21 vote, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) declined to recommend routine use of Gardasil in males aged 9-26 years, letting physicians decide whether to use the vaccine. The vaccine was approved in 2006 for young women and girls aged 9-26 years, and it is part of the CDC's adolescent vaccination schedule.

Gardasil is not recommended for pregnant women or for individuals with hypersensitivity to yeast, according to the vaccine's safety information.

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

Disparities exist in the use and timing of reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians. “Recent national efforts have focused on the regionalization of STEMI care to reduce time to reperfusion,” he noted.

The impact of regionalization on STEMI care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, said Dr. Glickman of the University of North Carolina, Chapel Hill.

In the study, Dr. Glickman and colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007.

The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years.

Overall, median door-to-ECG times before and after RACE dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

There was a slight increase in the use of prehospital ECG as part of the RACE initiative, he added.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 minutes to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, Dr. Glickman noted, which suggests the need for additional study and intervention focused on older patients.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

To watch a video interview with Dr. Glickman, go to www.youtube.com/user/FamilyPracticeNews#p/a/u/0/oZ_aXx-8kqU

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

Disparities exist in the use and timing of reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians. “Recent national efforts have focused on the regionalization of STEMI care to reduce time to reperfusion,” he noted.

The impact of regionalization on STEMI care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, said Dr. Glickman of the University of North Carolina, Chapel Hill.

In the study, Dr. Glickman and colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007.

The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years.

Overall, median door-to-ECG times before and after RACE dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

There was a slight increase in the use of prehospital ECG as part of the RACE initiative, he added.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 minutes to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, Dr. Glickman noted, which suggests the need for additional study and intervention focused on older patients.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

To watch a video interview with Dr. Glickman, go to www.youtube.com/user/FamilyPracticeNews#p/a/u/0/oZ_aXx-8kqU

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

Disparities exist in the use and timing of reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians. “Recent national efforts have focused on the regionalization of STEMI care to reduce time to reperfusion,” he noted.

The impact of regionalization on STEMI care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, said Dr. Glickman of the University of North Carolina, Chapel Hill.

In the study, Dr. Glickman and colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007.

The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years.

Overall, median door-to-ECG times before and after RACE dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

There was a slight increase in the use of prehospital ECG as part of the RACE initiative, he added.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 minutes to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, Dr. Glickman noted, which suggests the need for additional study and intervention focused on older patients.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

To watch a video interview with Dr. Glickman, go to www.youtube.com/user/FamilyPracticeNews#p/a/u/0/oZ_aXx-8kqU

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

The impact of regionalization on ST-segment elevation myocardial infarction (STEMI) care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians.

Dr. Glickman of the University of North Carolina, Chapel Hill and his colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007. The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after implementation of RACE.

After implementation of the program, median door-to-ECG times dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and the times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The study results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, he noted.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

The impact of regionalization on ST-segment elevation myocardial infarction (STEMI) care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians.

Dr. Glickman of the University of North Carolina, Chapel Hill and his colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007. The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after implementation of RACE.

After implementation of the program, median door-to-ECG times dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and the times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The study results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, he noted.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

BOSTON — A statewide program to get patients with severe heart attacks to hospitals faster significantly reduced disparities in reperfusion treatment times for women and elderly patients, based on a study of more than 900 patients in North Carolina.

The impact of regionalization on ST-segment elevation myocardial infarction (STEMI) care for hospitals that don't provide percutaneous coronary intervention (PCI) is unknown, but studies have shown that middle-aged white patients are more likely to benefit than other demographic groups, Dr. Seth Glickman said at the annual meeting of the American College of Emergency Physicians.

Dr. Glickman of the University of North Carolina, Chapel Hill and his colleagues reviewed data from 923 patients treated at 55 hospitals without PCI services during the Reperfusion of Acute Myocardial Infarction of North Carolina Emergency Departments (RACE) initiative from 2005 to 2007. The RACE program divided the state of North Carolina into five regions, with at least one PCI-capable hospital in each region. The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after implementation of RACE.

After implementation of the program, median door-to-ECG times dropped from 10 minutes to 8 minutes in men, and from 15 minutes to 8 minutes in women.

The median door in/door out times for men dropped from 85 minutes to 55 minutes, and times for women dropped from 124 minutes to 65 minutes. Median door-to-needle times decreased from 33 minutes to 29 minutes in men, and from 42 minutes to 30 minutes for women. Before the intervention, women's times were significantly longer than men's. After the intervention, however, the times for both genders were nearly identical, Dr. Glickman noted.

The median door-to-ECG time for patients younger than 70 years dropped from 10 minutes to 7 minutes before and after RACE, and the time for patients 70 and older dropped from 18 to 9 minutes.

Median door in/door out times for patients younger than 70 years dropped from 81 minutes to 48 minutes, and the times for patients 70 years and older dropped from 117 minutes to 76 minutes. Median door-to-needle times for patients younger than 70 years dropped from 32 minutes to 28 minutes, and from 48 minutes to 36 minutes for patients aged 70 years and older.

The study results were limited by a lack of regional comparators during the study period, but the findings showed a reduction in baseline care disparities between men and women, Dr. Glickman said. Disparities persist in the elderly, despite improvements after the RACE initiative, he noted.

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina. For more details on RACE, visit www.nccacc.org/race.html

WASHINGTON — Primary care physicians who have struggled to get a cardiovascular disease patient to adhere to a drug regimen may find practical advice in an online educational program aimed at improving physician/patient communication.

What doctors see as patient noncompliance may actually be the doctor's inability to effectively communicate, especially across cultural barriers, said Dr. Richard H. Carmona, chair of the advisory board for the Time to Talk CARDIO program. He was U.S. Surgeon General in 2002–2006 and is now president of the Canyon Ranch Institute in Tucson, Ariz.

On the program's Web site, physicians answer questions about communication with their most vexing patient. Based on their replies, the program identifies six communication skills that the individual physician needs to work on, along with a selection of video vignettes that demonstrate best practices for each specific skill.

The program is being tested at several sites across the United States, and a national rollout is planned for February 2010, according to a written statement.

The Web site provides a worksheet for patients and providers to set goals, which has motivated patients to become more involved in improving their heart health, said Dr. Jason Dees, a family physician in New Albany, Miss. “This is not a big, time-consuming training tool,” Dr. Dees added.

To learn more about the Time to Talk CARDIO program, go to www.timetotalkcardio.com

Time to Talk CARDIO is supported in part by Merck/Schering-Plough Pharmaceuticals, and it was developed in partnership with the American Academy of Family Physicians, Canyon Ranch Institute, and RIASWorks, a company that supports the development of medical communication tools.

Go to www.youtube.com/InternalMedicineNews

WASHINGTON — Primary care physicians who have struggled to get a cardiovascular disease patient to adhere to a drug regimen may find practical advice in an online educational program aimed at improving physician/patient communication.

What doctors see as patient noncompliance may actually be the doctor's inability to effectively communicate, especially across cultural barriers, said Dr. Richard H. Carmona, chair of the advisory board for the Time to Talk CARDIO program. He was U.S. Surgeon General in 2002–2006 and is now president of the Canyon Ranch Institute in Tucson, Ariz.

On the program's Web site, physicians answer questions about communication with their most vexing patient. Based on their replies, the program identifies six communication skills that the individual physician needs to work on, along with a selection of video vignettes that demonstrate best practices for each specific skill.

The program is being tested at several sites across the United States, and a national rollout is planned for February 2010, according to a written statement.

The Web site provides a worksheet for patients and providers to set goals, which has motivated patients to become more involved in improving their heart health, said Dr. Jason Dees, a family physician in New Albany, Miss. “This is not a big, time-consuming training tool,” Dr. Dees added.

To learn more about the Time to Talk CARDIO program, go to www.timetotalkcardio.com

Time to Talk CARDIO is supported in part by Merck/Schering-Plough Pharmaceuticals, and it was developed in partnership with the American Academy of Family Physicians, Canyon Ranch Institute, and RIASWorks, a company that supports the development of medical communication tools.

Go to www.youtube.com/InternalMedicineNews

WASHINGTON — Primary care physicians who have struggled to get a cardiovascular disease patient to adhere to a drug regimen may find practical advice in an online educational program aimed at improving physician/patient communication.

What doctors see as patient noncompliance may actually be the doctor's inability to effectively communicate, especially across cultural barriers, said Dr. Richard H. Carmona, chair of the advisory board for the Time to Talk CARDIO program. He was U.S. Surgeon General in 2002–2006 and is now president of the Canyon Ranch Institute in Tucson, Ariz.

On the program's Web site, physicians answer questions about communication with their most vexing patient. Based on their replies, the program identifies six communication skills that the individual physician needs to work on, along with a selection of video vignettes that demonstrate best practices for each specific skill.

The program is being tested at several sites across the United States, and a national rollout is planned for February 2010, according to a written statement.

The Web site provides a worksheet for patients and providers to set goals, which has motivated patients to become more involved in improving their heart health, said Dr. Jason Dees, a family physician in New Albany, Miss. “This is not a big, time-consuming training tool,” Dr. Dees added.

To learn more about the Time to Talk CARDIO program, go to www.timetotalkcardio.com

Time to Talk CARDIO is supported in part by Merck/Schering-Plough Pharmaceuticals, and it was developed in partnership with the American Academy of Family Physicians, Canyon Ranch Institute, and RIASWorks, a company that supports the development of medical communication tools.

Go to www.youtube.com/InternalMedicineNews

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement from the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians across the United States begin to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the two codes are:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately.

Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, according to the AMA statement.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said. The codes were created in a joint effort between the AMA CPT editorial panel and the Department of Health and Human Services.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement from the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians across the United States begin to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the two codes are:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately.

Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, according to the AMA statement.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said. The codes were created in a joint effort between the AMA CPT editorial panel and the Department of Health and Human Services.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement from the association.

The new and revised CPT codes will help streamline vaccination reporting and reimbursement as physicians across the United States begin to administer nearly 200 million doses of the new H1N1 vaccine this fall, the AMA said in the statement.

The details of the two codes are:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately.

Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product, according to the statement.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, according to the AMA statement.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge. Providers will be paid for vaccine administration, the AMA said. The codes were created in a joint effort between the AMA CPT editorial panel and the Department of Health and Human Services.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement.

The new and revised CPT codes are expected to help streamline vaccination reporting and reimbursement as physicians across the United States administer nearly 200 million doses of the new H1N1 vaccine this fall.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement.

The new and revised CPT codes are expected to help streamline vaccination reporting and reimbursement as physicians across the United States administer nearly 200 million doses of the new H1N1 vaccine this fall.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge.

The American Medical Association has created a new Current Procedural Terminology code (90470) and revised an existing code (90663) for use with H1N1 vaccinations, according to a statement.

The new and revised CPT codes are expected to help streamline vaccination reporting and reimbursement as physicians across the United States administer nearly 200 million doses of the new H1N1 vaccine this fall.

The details of the codes are as follows:

▸ 90470: H1N1 immunization, both intramuscular and intranasal, including counseling

▸ 90663: Influenza virus vaccine (pandemic H1N1 formulation)

Both the new Category I CPT Code 90470 and the revised code 90663 are effective immediately. Code 90470 was created for use when reporting H1N1 vaccination and counseling, while code 90663 was revised to include the specific H1N1 vaccine product.

To be paid for H1N1 vaccine administration, providers should bill 90663 in conjunction with 90470, the AMA said.

The 90663 code should be billed at zero dollars, because the vaccine itself is being provided by the federal government at no charge.

Bacterial coinfections played a role in almost one-third of fatal cases of pandemic influenza A(H1N1) in the United States, based on data from 77 patients.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” researchers wrote (MMWR 2009;58:1-4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of pandemic H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Strept. pyogenes, 7 were Staphylococcus aureus, 2 were Strep. mitis, and 1 was Haemophilus influenzae.

Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote.

Bacterial coinfections played a role in almost one-third of fatal cases of pandemic influenza A(H1N1) in the United States, based on data from 77 patients.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” researchers wrote (MMWR 2009;58:1-4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of pandemic H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Strept. pyogenes, 7 were Staphylococcus aureus, 2 were Strep. mitis, and 1 was Haemophilus influenzae.

Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote.

Bacterial coinfections played a role in almost one-third of fatal cases of pandemic influenza A(H1N1) in the United States, based on data from 77 patients.

“These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza,” researchers wrote (MMWR 2009;58:1-4).

The investigators found evidence of concurrent bacterial infection in lung specimens from 22 of 77 patients (29%) with fatal cases of pandemic H1N1 infection. The specimens were submitted to the CDC by medical examiners and local health departments between May 1 and Aug. 20, 2009.

A total of 10 fatal cases were coinfections with Streptococcus pneumoniae, 6 were Strept. pyogenes, 7 were Staphylococcus aureus, 2 were Strep. mitis, and 1 was Haemophilus influenzae.

Four of the fatal cases involved multiple pathogens. The age of the patients ranged from 2 months to 56 years, with an average age of 31 years. The 22 patients were divided evenly by sex. The average duration of illness was 6 days, based on data from 17 of the 22 coinfection cases for whom this information was available.

Medical history was available for 21 of the coinfection patients, and 16 of these had underlying medical conditions “that were known to increase the risk for influenza-related complications,” the investigators wrote.

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

The Centers for Disease Control and Prevention is pilot testing a system to deliver information about pandemic influenza A(H1N1) and other health information directly to mobile phones, according to a statement on the CDC's Web site.

The 3-month pilot test began in September, and the CDC is soliciting feedback from users. To subscribe to the service, potential users should text HEALTH to the number 87000.

The CDC does not charge subscribers a fee to participate in the pilot testing, but standard text messaging rates may apply based on an individual's different wireless service contract.

Upon initial signup, users will receive several introductory messages and questions, according to the Web site.

The program then sends three health tips per week. To unsubscribe from the service, users should send a reply with HEALTH QUIT in the body of the message.

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov

Most patients with uncomplicated cases of influenzalike illness, including suspected pandemic influenza A(H1N1), do not need diagnostic testing as part of their clinical management, according to updated interim guidelines for influenza diagnostic testing released by the Centers for Disease Control and Prevention.

“These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations,” the CDC states. The recommendations were developed to aid clinicians during the 2009-2010 season.

The patients for whom the CDC recommends influenza diagnostic testing include:

▸ High-risk patients for whom a diagnosis will affect ongoing care, such as pregnant women or immunocompromised persons.

▸ Hospitalized patients with suspected flu should be tested as soon as possible, but neither antiviral therapy nor infection control practices should be delayed while waiting for test results.

▸ Patients who have died from suspected or confirmed influenza.

For patients who are not severely ill or at high risk for complications, clinicians are advised to weigh whether diagnostic testing is needed to determine clinical care, infection control, or management of close contacts.

Tests available to detect flu viruses include rapid influenza diagnostic tests (RIDTs), direct immunofluorescence assays (DFAs), and real-time reverse transcriptase polymerase chain reaction tests (rRT-PCRs). When interpreting test results, consider the sensitivity of the test, the patient's stage of illness, and local virus surveillance information (www.cdc.gov/flu/weekly

When influenza viruses are circulating in a community, the positive predictive value of the RDIT and DFA tests are high, but they may not specifically identify the H1N1 subtype. And not all rRT-PCR assays can identify the pandemic H1N1 virus, according to the CDC statement.

If specific diagnosis of the pandemic H1N1 influenza virus is required, the CDC recommends testing with either an rRT-PCR assay specific for pandemic H1N1 influenza or testing with a viral culture.

The recommendations also include guidance for clinicians about proper collection and storage of respiratory specimens.

Find the complete pandemic influenza A(H1N1) recommendations online at the CDC Web site, cdc.gov