Heidi Splete

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

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

It's important to be aware of the possibility of dosing errors in young children who receive oseltamivir in oral suspension, physicians warned in a letter in the New England Journal of Medicine.

The letter describes the case of a 6-year-old diagnosed with pandemic influenza A(H1N1) and given a prescription for oseltamivir (Tamiflu). An oral dosing dispenser that accompanied the drug's package was marked in 30-, 45-, and 60-mg increments, but the label from the pharmacy listed the child's dose in volume — ¾ teaspoon by mouth twice daily.

The child's parents—one a primary care physician, the other one of the letter's authors—were able to determine the correct dose only after solving an equation to determine the milligram equivalent of a ¾-tsp dose (N. Engl. J. Med. 2009 Sept. 23 [doi: 10.1056/c0908840]).

“Most families and caregivers would not be able to identify or perform the cumbersome calculations required to administer Tamiflu safely to children,” wrote Dr. Ruth M. Parker of Emory University in Atlanta, and her colleagues.

This disparity in units of measure could lead to dosing errors, compromised treatment, or toxic effects, they wrote. “In the future, all measuring devices for use in children should be marked with volumetric doses (milliliters or teaspoons),” the authors stated.

The coauthors of the letter were Michael S. Wolf, Ph.D., MPH, of the Feinberg School of Medicine in Chicago; Kara L. Jacobson, MPH, of Emory University, and Dr. Alastair J.J. Wood of Symphony Capital in New York.

Dr. Wolf has received consulting fees from Abbott and Pfizer, and grant support from Ortho-McNeil Pharmaceuticals. Dr. Wood has served as a director of Oxigene Inc., and he has served as a consultant for international reinsurance companies.

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

Approximately 38% of American adults use some type of complementary and alternative medicine, and they spent nearly $34 billion on CAM products and practitioners over the past 12 months, based on data from the 2007 National Health Interview Survey presented in a telebriefing.

Researchers reviewed interviews with 23,393 adults aged 18 years and older who were included in the National Health Interview Survey. The survey is conducted annually by the Centers for Disease Control and Prevention. Lead author Richard L. Nahin, Ph.D., is acting director of the Division of Extramural Research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Overall, approximately 65% ($22 billion) of American adults' spending on CAM went toward self-care, while approximately 35% ($11.9 billion) was spent on visits to CAM practitioners, Dr. Nahin and his colleagues reported.

Of the money spent on self-care, nearly 44% ($14.8 billion) went to nonvitamin, nonmineral products. Another $4.1 billion was spent on classes such as yoga and tai chi, $2.9 billion was spent on homeopathic medicine, and $200 million was spent on relaxation techniques.

The money spent on CAM products was approximately one-third of the $47.6 billion American adults spent on pharmaceutical drugs in 2007, the researchers noted. The money spent on CAM provider visits was approximately one-quarter of the $49.6 billion spent on conventional physician services.

The NHIS data show that U.S. adults make more than 300 million visits (slightly fewer than a decade earlier) to CAM providers, and that “at least 20% of persons visiting practitioners of acupuncture, homeopathy, naturopathy, massage, and hypnosis therapy paid $75 or more per visit,” the researchers wrote.

The results were limited by the reliance on self-reports from the survey respondents, and by estimates of each respondent's annual CAM spending based on the most recent purchase, which may not have been typical of a respondent's CAM use, the researchers said.

Expenditures on CAM, “although a small fraction of total health care spending in the United States, constitute a substantial part of out-of-pocket health care costs and are comparable to out-of-pocket costs for conventional physician services and prescription drug use,” the researchers said.

View the complete report at www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu

WASHINGTON — Species-jumping pathogens such as the 2009 pandemic influenza A(H1N1) virus have caused more than 65% of infectious disease outbreaks in the past 6 decades, according to a report from the Institute of Medicine and the National Research Council.

The report suggests that conditions that can drive the emergence of zoonotic disease, including global travel, are intensifying.

“We don't think business as usual is enough. We need to go beyond that,” said Dr. Gerald Keusch, of Boston University, who is cochair of the committee. “Clinicians around the world really need to be thinking about what's different, what's unusual,: 'Am I seeing the start of something?'” he said.

The report outlines 12 recommendations as part of a plan to establish a comprehensive, global surveillance system to identify zoonotic disease threats as early as possible.

The recommendations fall into three categories: technical, economic, and political.

▸ Technical. Instead of responding to individual diseases as they arise, the report calls for the establishment of a surveillance system that focuses on preventing the conditions that foster the development of zoonotic disease outbreaks, and monitoring signs of such outbreaks worldwide on an ongoing basis.

“Disease surveillance is critical for detecting the emergence of zoonotic pathogens in human populations, preventing their spread between animal populations, and preventing transmission to human populations,” according to the report, which was written by the Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin.

▸ Economic. The report also calls on the U.S. Agency for International Development to identify sustainable sources of funding to maintain a global surveillance system for zoonotic disease. Possible strategies include a tax on internationally traded meat and meat products, and economic incentives from the U.S. government and other donor groups to encourage the reporting of outbreaks at the local and national level.

▸ Political. Another high-priority recommendation calls for the creation of a coordinating body for global zoonotic disease surveillance and response. The the report also recommends that the director general of the World Organisation for Animal Health have the power to declare animal health emergencies and share information about animal disease outbreaks worldwide if national governments don't provide such information promptly.

“Greater transparency could improve control of animal diseases before they decimate livestock or wildlife or make large numbers of people sick,” according to a statement that accompanied the report.

Challenges to the development of a global surveillance system for species-jumping diseases include a lack of funding and coordination at the government level, lack of cooperation between human and animal health experts, and lack of concern for infectious disease issues among political leaders in some countries, according to the report.

Other recommendations include improving the use of information technology to monitor outbreaks and response activities, strengthening laboratory networks to assist in disease surveillance and response, and mitigating threats of zoonotic disease outbreaks from wildlife and trade.

The report was supported by a grant to the U.S. Agency for International Development. The complete report is available online at www.nap.edu