Naseem S. Miller

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage where all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR study, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date.

It also comes just days after four leading cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States.

Heart Teams, a national registry, and careful evaluation and selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs while stressing measures that would ensure quality of care. “This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment,” said STS President Dr. Jeffrey B. Rich, in a statement.

“We are especially please to that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve,” said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage determination analysis in September, before Sapien was even approved, in response to a request from the the two organizations to establish the criteria for national Medicare coverage of the minimally invasive valve procedure.

The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The CMS coverage proposal is open for comment until March 3. The agency is expected to make a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage where all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR study, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date.

It also comes just days after four leading cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States.

Heart Teams, a national registry, and careful evaluation and selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs while stressing measures that would ensure quality of care. “This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment,” said STS President Dr. Jeffrey B. Rich, in a statement.

“We are especially please to that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve,” said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage determination analysis in September, before Sapien was even approved, in response to a request from the the two organizations to establish the criteria for national Medicare coverage of the minimally invasive valve procedure.

The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The CMS coverage proposal is open for comment until March 3. The agency is expected to make a final decision by May of this year.

Medicare officials have released a coverage proposal for transcatheter aortic valve replacement 3 months after the procedure was approved in the United States.

The Centers for Medicare and Medicaid Services’ proposal restricts the procedure’s coverage where all of the following five criteria are met:

• The procedure meets Food and Drug Administration–approved criteria, and an FDA-approved device is used.

• Two cardiac surgeons evaluate the patient’s suitability for open valve replacement surgery.

• The procedure is performed in a facility that meets a certain level of experience. The document breaks down the criteria by centers with or without previous transcatheter aortic valve replacement (TAVR) clinical trial experience. All centers are required to participate in a prospective national TAVR study, and be committed to the Heart Team concept.

• The cardiac surgeon and interventionalist meet certain qualifications and levels of experience.

• The patient is enrolled in the prospective national registry for TAVR. The treating physician team also needs to be participating in the national registry.

The memo arrived ahead of its March 28 due date.

It also comes just days after four leading cardiovascular societies issued a document providing detailed guidance on TAVR implementation in centers across the United States.

Heart Teams, a national registry, and careful evaluation and selection of patients are also among the societies’ consensus document highlights.

In the United States, the first valve to be used for TAVR (the Edwards Lifesciences Sapien valve) was approved in November 2011. The valve is currently approved for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials.

In a joint statement, the Society of Thoracic Surgeons and the American College of Cardiology said they were pleased with CMS’s comprehensive approach to the coverage of TAVR, balancing the patients’ needs while stressing measures that would ensure quality of care. “This coverage analysis achieves these goals through the use of specialized centers with multidisciplinary heart teams and registry enrollment,” said STS President Dr. Jeffrey B. Rich, in a statement.

“We are especially please to that CMS has proposed to provide a smooth path to Medicare coverage as the technology continues to evolve and improve,” said ACC President Dr. David R. Holmes, in a statement.

CMS opened the national coverage determination analysis in September, before Sapien was even approved, in response to a request from the the two organizations to establish the criteria for national Medicare coverage of the minimally invasive valve procedure.

The CMS proposal is a step in the national coverage analysis process, in which the agency decides whether an item or service is covered by Medicare.

The CMS coverage proposal is open for comment until March 3. The agency is expected to make a final decision by May of this year.

Diabetes Care Barriers Explored

Lack of time with patients, inadequate reimbursement, and lack of patient adherence are the three main barriers to diabetes care, according to a white paper released by the Diabetes Working Group. To overcome the barriers, issues including payment reform, physician and health care provider supply, and changes in care management – such as incorporating health IT tools and increasing use of shared decision-making – must be addressed. “With the increasing cost and occurrence of diabetes and its complications, treatment is more important than ever, and successful treatment of people suffering from diabetes requires active participation from the patient and the health care delivery team to achieve desired outcomes,” the group wrote in its report.

Medicare Covers Thyroid Gene Test

Afirma Gene Expression Classifier, a genomic test for use in thyroid nodule diagnosis, is now covered by Medicare. The test, developed by Veracyte Inc., helps resolve inconclusive results on thyroid nodule fine needle aspiration samples with a high degree of accuracy, according to a company statement. Two independent, multicenter, prospective clinical trials have shown the gene expression test's role in reclassifying patients. In addition, “a more consistent and transparent approach to reimbursement will help to further drive innovation in the rapidly growing molecular diagnostics field,” Dr. Elaine Jeter, medical director of Palmetto GBA, a national contractor administering Medicare benefits, said in a statement.

Grant to Foster Diabetes Research

There is much emphasis on prevention and treatment of diabetes, but there are still unanswered questions about its causes. The Karolinska Institutet in Stockholm, a medical university, has received a 1.6 million–Euro grant to study the fundamental causes of diabetes. “Diabetes is a global problem, and this means that it is vital that we understand the causes of the disease, in order to be able to offer more effective treatment,” Robert af Jochnick, one of the founders of the Jochnick Foundation, which provided the grant, said in a statement. With the grant, researchers plan to use microscope technology to observe “in detail and for long periods, how various signals control the release of insulin in living animals,” according to a statement from the institute. The research will also enable scientists to identify new targets for more effective and specific diabetes drugs.

Gardasil, Autoimmunity Not Linked

The human papillomavirus vaccine Gardasil does not trigger autoimmune conditions such as lupus, rheumatoid arthritis, type 1 diabetes, or multiple sclerosis in young women, according to a study from Kaiser Permanente. The study, reported in the Journal of Internal Medicine, looked at electronic health records of 189,629 females aged 9–26 years who were followed for 6 months after receiving each of three Gardasil doses. Researchers did not find increases in 16 autoimmune conditions among the vaccinated population when compared with a matched group of unvaccinated girls and women. The study was funded by Merck, which manufactures Gardasil.

School Lunch Standards Unveiled

The U.S. Department of Agriculture has unveiled new school lunch standards that should lead to more fruits, vegetables, and whole grains on children's lunch trays. The standards call for schools to serve only low-fat or fat-free milk; limit calories in age-appropriate portion sizes; and attempt to decrease sodium, trans fats, and saturated fats in cafeteria foods. The new rules will encourage schools to replace items such as hot dogs on white buns with selections such as low-fat turkey breast on a whole wheat submarine roll, according to the USDA. However, tomato paste and starchy vegetables including white potatoes still count as vegetables under the new standards. Last year's USDA appropriations bill included language to that effect, thereby protecting pizza and french fries in the school lunch program. The new rules will be phased in beginning in the next school year.

Diabetes Care Barriers Explored

Lack of time with patients, inadequate reimbursement, and lack of patient adherence are the three main barriers to diabetes care, according to a white paper released by the Diabetes Working Group. To overcome the barriers, issues including payment reform, physician and health care provider supply, and changes in care management – such as incorporating health IT tools and increasing use of shared decision-making – must be addressed. “With the increasing cost and occurrence of diabetes and its complications, treatment is more important than ever, and successful treatment of people suffering from diabetes requires active participation from the patient and the health care delivery team to achieve desired outcomes,” the group wrote in its report.

Medicare Covers Thyroid Gene Test

Afirma Gene Expression Classifier, a genomic test for use in thyroid nodule diagnosis, is now covered by Medicare. The test, developed by Veracyte Inc., helps resolve inconclusive results on thyroid nodule fine needle aspiration samples with a high degree of accuracy, according to a company statement. Two independent, multicenter, prospective clinical trials have shown the gene expression test's role in reclassifying patients. In addition, “a more consistent and transparent approach to reimbursement will help to further drive innovation in the rapidly growing molecular diagnostics field,” Dr. Elaine Jeter, medical director of Palmetto GBA, a national contractor administering Medicare benefits, said in a statement.

Grant to Foster Diabetes Research

There is much emphasis on prevention and treatment of diabetes, but there are still unanswered questions about its causes. The Karolinska Institutet in Stockholm, a medical university, has received a 1.6 million–Euro grant to study the fundamental causes of diabetes. “Diabetes is a global problem, and this means that it is vital that we understand the causes of the disease, in order to be able to offer more effective treatment,” Robert af Jochnick, one of the founders of the Jochnick Foundation, which provided the grant, said in a statement. With the grant, researchers plan to use microscope technology to observe “in detail and for long periods, how various signals control the release of insulin in living animals,” according to a statement from the institute. The research will also enable scientists to identify new targets for more effective and specific diabetes drugs.

Gardasil, Autoimmunity Not Linked

The human papillomavirus vaccine Gardasil does not trigger autoimmune conditions such as lupus, rheumatoid arthritis, type 1 diabetes, or multiple sclerosis in young women, according to a study from Kaiser Permanente. The study, reported in the Journal of Internal Medicine, looked at electronic health records of 189,629 females aged 9–26 years who were followed for 6 months after receiving each of three Gardasil doses. Researchers did not find increases in 16 autoimmune conditions among the vaccinated population when compared with a matched group of unvaccinated girls and women. The study was funded by Merck, which manufactures Gardasil.

School Lunch Standards Unveiled

The U.S. Department of Agriculture has unveiled new school lunch standards that should lead to more fruits, vegetables, and whole grains on children's lunch trays. The standards call for schools to serve only low-fat or fat-free milk; limit calories in age-appropriate portion sizes; and attempt to decrease sodium, trans fats, and saturated fats in cafeteria foods. The new rules will encourage schools to replace items such as hot dogs on white buns with selections such as low-fat turkey breast on a whole wheat submarine roll, according to the USDA. However, tomato paste and starchy vegetables including white potatoes still count as vegetables under the new standards. Last year's USDA appropriations bill included language to that effect, thereby protecting pizza and french fries in the school lunch program. The new rules will be phased in beginning in the next school year.

Diabetes Care Barriers Explored

Lack of time with patients, inadequate reimbursement, and lack of patient adherence are the three main barriers to diabetes care, according to a white paper released by the Diabetes Working Group. To overcome the barriers, issues including payment reform, physician and health care provider supply, and changes in care management – such as incorporating health IT tools and increasing use of shared decision-making – must be addressed. “With the increasing cost and occurrence of diabetes and its complications, treatment is more important than ever, and successful treatment of people suffering from diabetes requires active participation from the patient and the health care delivery team to achieve desired outcomes,” the group wrote in its report.

Medicare Covers Thyroid Gene Test

Afirma Gene Expression Classifier, a genomic test for use in thyroid nodule diagnosis, is now covered by Medicare. The test, developed by Veracyte Inc., helps resolve inconclusive results on thyroid nodule fine needle aspiration samples with a high degree of accuracy, according to a company statement. Two independent, multicenter, prospective clinical trials have shown the gene expression test's role in reclassifying patients. In addition, “a more consistent and transparent approach to reimbursement will help to further drive innovation in the rapidly growing molecular diagnostics field,” Dr. Elaine Jeter, medical director of Palmetto GBA, a national contractor administering Medicare benefits, said in a statement.

Grant to Foster Diabetes Research

There is much emphasis on prevention and treatment of diabetes, but there are still unanswered questions about its causes. The Karolinska Institutet in Stockholm, a medical university, has received a 1.6 million–Euro grant to study the fundamental causes of diabetes. “Diabetes is a global problem, and this means that it is vital that we understand the causes of the disease, in order to be able to offer more effective treatment,” Robert af Jochnick, one of the founders of the Jochnick Foundation, which provided the grant, said in a statement. With the grant, researchers plan to use microscope technology to observe “in detail and for long periods, how various signals control the release of insulin in living animals,” according to a statement from the institute. The research will also enable scientists to identify new targets for more effective and specific diabetes drugs.

Gardasil, Autoimmunity Not Linked

The human papillomavirus vaccine Gardasil does not trigger autoimmune conditions such as lupus, rheumatoid arthritis, type 1 diabetes, or multiple sclerosis in young women, according to a study from Kaiser Permanente. The study, reported in the Journal of Internal Medicine, looked at electronic health records of 189,629 females aged 9–26 years who were followed for 6 months after receiving each of three Gardasil doses. Researchers did not find increases in 16 autoimmune conditions among the vaccinated population when compared with a matched group of unvaccinated girls and women. The study was funded by Merck, which manufactures Gardasil.

School Lunch Standards Unveiled

The U.S. Department of Agriculture has unveiled new school lunch standards that should lead to more fruits, vegetables, and whole grains on children's lunch trays. The standards call for schools to serve only low-fat or fat-free milk; limit calories in age-appropriate portion sizes; and attempt to decrease sodium, trans fats, and saturated fats in cafeteria foods. The new rules will encourage schools to replace items such as hot dogs on white buns with selections such as low-fat turkey breast on a whole wheat submarine roll, according to the USDA. However, tomato paste and starchy vegetables including white potatoes still count as vegetables under the new standards. Last year's USDA appropriations bill included language to that effect, thereby protecting pizza and french fries in the school lunch program. The new rules will be phased in beginning in the next school year.

To ensure appropriate implementation and use of transcatheter aortic valve replacement in medical centers across the United States, four leading cardiovascular organizations have pooled their knowledge and issued a consensus document.

The document comes 2 months after the Food and Drug Administration approved the first minimally invasive transcatheter aortic valve replacement (TAVR) system (J. Am. Coll. Cardiol. 2012 Jan. 31; doi:10.1016/j.jacc.2012.001).

The document reviews in detail several aspects of the procedure, including the current state of evidence, patient selection, management of complications and steps to integrating TAVR into practice.

Courtesy UH Case Medical Center

"Our goal in crafting this expert consensus document is to provide a clear road map for the use of TAVR as it reaches patients across the United States," Dr. Michael J. Mack, medical director of cardiovascular surgery at Baylor Health Care System, Heart Hospital Baylor Plano (Tex.), president of the Society of Thoracic Surgeons, and vice chair of the writing committee, said in a statement.

The report also recommends establishment of a national registry by cardiovascular organizations and not the industry, to create standard definitions and data specifications and to avoid the potential for conflict of interest.

In the expert consensus, the organizations also stress that the procedure’s rollout is a "key issue" in the United States. "The rollout is influenced by the societal beliefs in a free market, convenient and timely access to medical care, patient and physician expectations, as well as return on investment by companies and institutions alike," according to the report.

What complicates the rollout, they added, is the proliferation of advanced cardiovascular facilities.

Take, for instance, Los Angeles County, which has 33 cardiovascular surgical and primary ST-elevation myocardial infarction centers. If all these centers were to offer TAVR, the result would be "the dilution of concentrated experience," the report stated.

So, establishment of specialized centers of excellence should be a top priority, the report advised.

"As this technology is introduced into practice, detailed and agreed upon protocols are needed to ensure we achieve optimal clinical results," Dr. David R. Holmes, professor of medicine at Mayo Clinic in Rochester, Minn., president of the American College of Cardiology, and chair of the writing committee, said in a statement.

Nearly 45,000 patients have received TAVR around the world, but the experience with the procedure in the United States lags far behind that in Europe. Five different valves are currently in widespread use across Europe. In the United States, the first valve, Edwards Sapien, was approved in 2011 for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials. The report lists several next-generation devices under investigation.

"TAVR innovation is a major advance in treating aortic stenosis and sick, elderly patients should have access to this new treatment so they can resume normal, active lives," Dr. Mack said in a statement. "These guidelines are a coordinated effort from the cardiovascular community to help ensure the appropriate use of TAVR therapy for optimum patient safety."

The American College of Cardiology Foundation, the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons were the main authors of the consensus document. Eight other medical and consumer groups were involved in the writing and endorsement of the document.

Dr. Mack and Dr. Holmes reported no relevant disclosures.

To ensure appropriate implementation and use of transcatheter aortic valve replacement in medical centers across the United States, four leading cardiovascular organizations have pooled their knowledge and issued a consensus document.

The document comes 2 months after the Food and Drug Administration approved the first minimally invasive transcatheter aortic valve replacement (TAVR) system (J. Am. Coll. Cardiol. 2012 Jan. 31; doi:10.1016/j.jacc.2012.001).

The document reviews in detail several aspects of the procedure, including the current state of evidence, patient selection, management of complications and steps to integrating TAVR into practice.

Courtesy UH Case Medical Center

"Our goal in crafting this expert consensus document is to provide a clear road map for the use of TAVR as it reaches patients across the United States," Dr. Michael J. Mack, medical director of cardiovascular surgery at Baylor Health Care System, Heart Hospital Baylor Plano (Tex.), president of the Society of Thoracic Surgeons, and vice chair of the writing committee, said in a statement.

The report also recommends establishment of a national registry by cardiovascular organizations and not the industry, to create standard definitions and data specifications and to avoid the potential for conflict of interest.

In the expert consensus, the organizations also stress that the procedure’s rollout is a "key issue" in the United States. "The rollout is influenced by the societal beliefs in a free market, convenient and timely access to medical care, patient and physician expectations, as well as return on investment by companies and institutions alike," according to the report.

What complicates the rollout, they added, is the proliferation of advanced cardiovascular facilities.

Take, for instance, Los Angeles County, which has 33 cardiovascular surgical and primary ST-elevation myocardial infarction centers. If all these centers were to offer TAVR, the result would be "the dilution of concentrated experience," the report stated.

So, establishment of specialized centers of excellence should be a top priority, the report advised.

"As this technology is introduced into practice, detailed and agreed upon protocols are needed to ensure we achieve optimal clinical results," Dr. David R. Holmes, professor of medicine at Mayo Clinic in Rochester, Minn., president of the American College of Cardiology, and chair of the writing committee, said in a statement.

Nearly 45,000 patients have received TAVR around the world, but the experience with the procedure in the United States lags far behind that in Europe. Five different valves are currently in widespread use across Europe. In the United States, the first valve, Edwards Sapien, was approved in 2011 for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials. The report lists several next-generation devices under investigation.

"TAVR innovation is a major advance in treating aortic stenosis and sick, elderly patients should have access to this new treatment so they can resume normal, active lives," Dr. Mack said in a statement. "These guidelines are a coordinated effort from the cardiovascular community to help ensure the appropriate use of TAVR therapy for optimum patient safety."

The American College of Cardiology Foundation, the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons were the main authors of the consensus document. Eight other medical and consumer groups were involved in the writing and endorsement of the document.

Dr. Mack and Dr. Holmes reported no relevant disclosures.

To ensure appropriate implementation and use of transcatheter aortic valve replacement in medical centers across the United States, four leading cardiovascular organizations have pooled their knowledge and issued a consensus document.

The document comes 2 months after the Food and Drug Administration approved the first minimally invasive transcatheter aortic valve replacement (TAVR) system (J. Am. Coll. Cardiol. 2012 Jan. 31; doi:10.1016/j.jacc.2012.001).

The document reviews in detail several aspects of the procedure, including the current state of evidence, patient selection, management of complications and steps to integrating TAVR into practice.

Courtesy UH Case Medical Center

"Our goal in crafting this expert consensus document is to provide a clear road map for the use of TAVR as it reaches patients across the United States," Dr. Michael J. Mack, medical director of cardiovascular surgery at Baylor Health Care System, Heart Hospital Baylor Plano (Tex.), president of the Society of Thoracic Surgeons, and vice chair of the writing committee, said in a statement.

The report also recommends establishment of a national registry by cardiovascular organizations and not the industry, to create standard definitions and data specifications and to avoid the potential for conflict of interest.

In the expert consensus, the organizations also stress that the procedure’s rollout is a "key issue" in the United States. "The rollout is influenced by the societal beliefs in a free market, convenient and timely access to medical care, patient and physician expectations, as well as return on investment by companies and institutions alike," according to the report.

What complicates the rollout, they added, is the proliferation of advanced cardiovascular facilities.

Take, for instance, Los Angeles County, which has 33 cardiovascular surgical and primary ST-elevation myocardial infarction centers. If all these centers were to offer TAVR, the result would be "the dilution of concentrated experience," the report stated.

So, establishment of specialized centers of excellence should be a top priority, the report advised.

"As this technology is introduced into practice, detailed and agreed upon protocols are needed to ensure we achieve optimal clinical results," Dr. David R. Holmes, professor of medicine at Mayo Clinic in Rochester, Minn., president of the American College of Cardiology, and chair of the writing committee, said in a statement.

Nearly 45,000 patients have received TAVR around the world, but the experience with the procedure in the United States lags far behind that in Europe. Five different valves are currently in widespread use across Europe. In the United States, the first valve, Edwards Sapien, was approved in 2011 for use in inoperable patients with severe aortic stenosis. Other use of the Sapien valve is limited to clinical trials. Medtronic’s CoreValve is also in being studied in large U.S. trials. The report lists several next-generation devices under investigation.

"TAVR innovation is a major advance in treating aortic stenosis and sick, elderly patients should have access to this new treatment so they can resume normal, active lives," Dr. Mack said in a statement. "These guidelines are a coordinated effort from the cardiovascular community to help ensure the appropriate use of TAVR therapy for optimum patient safety."

The American College of Cardiology Foundation, the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons were the main authors of the consensus document. Eight other medical and consumer groups were involved in the writing and endorsement of the document.

Dr. Mack and Dr. Holmes reported no relevant disclosures.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to matches the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to matches the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

New federal regulations aim to accelerate the use of electronic payments to health care providers while reducing administrative costs and saving resources.

The interim final regulations – part of a series of regulations coming from the Department of Health and Human Services – standardize the format and content of the transmissions that health plans send to banks when paying claims via electronic funds transfer (EFT) and will require plans to use a trace number to matches the EFT with the remittance advice sent to providers. Currently the EFT and the remittance documents are sent to providers separately, and matching them is difficult.

The new standards took effect on Jan. 1; full compliance will be required by Jan. 1, 2014, according to the agency.

Under the new rules, "health care professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients," HHS Secretary Kathleen Sebelius said in a statement.

Further, the rules will cost physicians, hospitals, and other providers little or nothing, since "providers are the receivers of the standardized transactions and not the senders," according to HHS.

The agency also estimated that widespread use of EFT should save physician practices and hospitals between $3 billion and $4.5 billion over the next 10 years. The most common savings from implementation of electronic fund transfers are in paper, printing, and postage, as well as staff time for processing paper payments and depositing checks.

The cost to implement the new standards across all commercial health plans is estimated at between $18 million and $28 million. Implementation in Medicaid, the Children’s Health Insurance Plan, and the Indian Health Service is estimated at $400,000-$600,000. Meanwhile, the savings for commercial health plans could be as much as $40 million over 10 years, and $31 million for Medicaid, CHIP, and IHS, according to an HHS fact sheet.

Use of EFT, while widespread in many industries – has been slow in health care, partly due to lack of standardization of transactions, HHS officials said.

The new standards are required by the Affordable Care Act, and fall under the Health Insurance Portability and Accountability Act (HIPAA). They are second in a series of regulations that aim to streamline health care administrative transactions within the next 5 years. Future efforts are slated to include a standard unique identifier for health plans and standardized claim attachments.

ORLANDO – Although higher systolic blood pressure and LDL cholesterol are traditional risk factors for cardiovascular disease, each may have a different effect on the cerebrovascular and coronary systems.

Pooled analysis of three landmark studies done on the cholesterol-lowering agent atorvastatin in high-risk patients showed that higher baseline systolic blood pressure is predictive of a significantly higher risk of stroke. Meanwhile, higher baseline LDL cholesterol is predictive of a significantly higher risk of coronary events, the analysis showed.

The findings have implications on both research design and clinical practice, Dr. Prakash C. Deedwania, the study's lead author, said at the meeting.

Patients who might be at risk of both stroke and coronary events should be treated aggressively to reduce systolic blood pressure and LDL cholesterol, he said. (See video for more comments from Dr. Deedwania.)

Dr. Deedwania and his colleagues pooled data on 21,727 patients from three trials: Treating to New Targets (TNT), which compared 10 mg with 80 mg atorvastatin in patients with stable coronary heart disease and LDL levels below 130 mg/dL (N. Engl. J. Med. 2005;352:1425-35), Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL), which compared high-dose (80 mg) atorvastatin with normal-dose (20-40 mg) simvastatin in post-MI patients (JAMA 2005;294:2437-45), and the Collaborative Atorvastatin Diabetes Study (CARDS), which compared 20 mg atorvastatin with placebo in patients with type 2 diabetes and without established coronary heart disease (Lancet 2004;364:685-96).

Results showed that with each 10-mm Hg increase in baseline systolic blood pressure, the risk of a fatal or nonfatal stroke increased by 16%. Meanwhile, each 10-mg/dL increase in baseline LDL cholesterol increased the risk of coronary events by 5%.

Both differences were significantly different.

Dr. Deedwania said that the reduction in LDL cholesterol has been associated with a decrease in the risk of stroke, “but perhaps by a different mechanism.”

The investigators also looked at a subgroup of patients with type 2 diabetes (5,408 patients from the three trials), and found results consistent with the larger cohort.

Although systolic blood pressure is known to be a powerful predictor of stroke, many clinicians may not be aware that LDL cholesterol is not associated with an increased risk of stroke, said Dr. Deedwania. “What predicts baseline risk is different than what happens in treatment, so there are yet many lessons to be learned from these trials.”

Dr. Deedwania has received research grants from Pfizer. He has been a consultant to and on the advisory boards of Pfizer and Novartis.

In a video interview, Dr. Deedwania discusses the way different factors affect stroke and coronary event risks. Scan the QR code (right) or go to

Source Naseem S. Miller/Elsevier Global Medical Newswww.clinicalendocrinologynews.com

ORLANDO – Although higher systolic blood pressure and LDL cholesterol are traditional risk factors for cardiovascular disease, each may have a different effect on the cerebrovascular and coronary systems.

Pooled analysis of three landmark studies done on the cholesterol-lowering agent atorvastatin in high-risk patients showed that higher baseline systolic blood pressure is predictive of a significantly higher risk of stroke. Meanwhile, higher baseline LDL cholesterol is predictive of a significantly higher risk of coronary events, the analysis showed.

The findings have implications on both research design and clinical practice, Dr. Prakash C. Deedwania, the study's lead author, said at the meeting.

Patients who might be at risk of both stroke and coronary events should be treated aggressively to reduce systolic blood pressure and LDL cholesterol, he said. (See video for more comments from Dr. Deedwania.)

Dr. Deedwania and his colleagues pooled data on 21,727 patients from three trials: Treating to New Targets (TNT), which compared 10 mg with 80 mg atorvastatin in patients with stable coronary heart disease and LDL levels below 130 mg/dL (N. Engl. J. Med. 2005;352:1425-35), Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL), which compared high-dose (80 mg) atorvastatin with normal-dose (20-40 mg) simvastatin in post-MI patients (JAMA 2005;294:2437-45), and the Collaborative Atorvastatin Diabetes Study (CARDS), which compared 20 mg atorvastatin with placebo in patients with type 2 diabetes and without established coronary heart disease (Lancet 2004;364:685-96).

Results showed that with each 10-mm Hg increase in baseline systolic blood pressure, the risk of a fatal or nonfatal stroke increased by 16%. Meanwhile, each 10-mg/dL increase in baseline LDL cholesterol increased the risk of coronary events by 5%.

Both differences were significantly different.

Dr. Deedwania said that the reduction in LDL cholesterol has been associated with a decrease in the risk of stroke, “but perhaps by a different mechanism.”

The investigators also looked at a subgroup of patients with type 2 diabetes (5,408 patients from the three trials), and found results consistent with the larger cohort.

Although systolic blood pressure is known to be a powerful predictor of stroke, many clinicians may not be aware that LDL cholesterol is not associated with an increased risk of stroke, said Dr. Deedwania. “What predicts baseline risk is different than what happens in treatment, so there are yet many lessons to be learned from these trials.”

Dr. Deedwania has received research grants from Pfizer. He has been a consultant to and on the advisory boards of Pfizer and Novartis.

In a video interview, Dr. Deedwania discusses the way different factors affect stroke and coronary event risks. Scan the QR code (right) or go to

Source Naseem S. Miller/Elsevier Global Medical Newswww.clinicalendocrinologynews.com

ORLANDO – Although higher systolic blood pressure and LDL cholesterol are traditional risk factors for cardiovascular disease, each may have a different effect on the cerebrovascular and coronary systems.

Pooled analysis of three landmark studies done on the cholesterol-lowering agent atorvastatin in high-risk patients showed that higher baseline systolic blood pressure is predictive of a significantly higher risk of stroke. Meanwhile, higher baseline LDL cholesterol is predictive of a significantly higher risk of coronary events, the analysis showed.

The findings have implications on both research design and clinical practice, Dr. Prakash C. Deedwania, the study's lead author, said at the meeting.

Patients who might be at risk of both stroke and coronary events should be treated aggressively to reduce systolic blood pressure and LDL cholesterol, he said. (See video for more comments from Dr. Deedwania.)

Dr. Deedwania and his colleagues pooled data on 21,727 patients from three trials: Treating to New Targets (TNT), which compared 10 mg with 80 mg atorvastatin in patients with stable coronary heart disease and LDL levels below 130 mg/dL (N. Engl. J. Med. 2005;352:1425-35), Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL), which compared high-dose (80 mg) atorvastatin with normal-dose (20-40 mg) simvastatin in post-MI patients (JAMA 2005;294:2437-45), and the Collaborative Atorvastatin Diabetes Study (CARDS), which compared 20 mg atorvastatin with placebo in patients with type 2 diabetes and without established coronary heart disease (Lancet 2004;364:685-96).

Results showed that with each 10-mm Hg increase in baseline systolic blood pressure, the risk of a fatal or nonfatal stroke increased by 16%. Meanwhile, each 10-mg/dL increase in baseline LDL cholesterol increased the risk of coronary events by 5%.

Both differences were significantly different.

Dr. Deedwania said that the reduction in LDL cholesterol has been associated with a decrease in the risk of stroke, “but perhaps by a different mechanism.”

The investigators also looked at a subgroup of patients with type 2 diabetes (5,408 patients from the three trials), and found results consistent with the larger cohort.

Although systolic blood pressure is known to be a powerful predictor of stroke, many clinicians may not be aware that LDL cholesterol is not associated with an increased risk of stroke, said Dr. Deedwania. “What predicts baseline risk is different than what happens in treatment, so there are yet many lessons to be learned from these trials.”

Dr. Deedwania has received research grants from Pfizer. He has been a consultant to and on the advisory boards of Pfizer and Novartis.

In a video interview, Dr. Deedwania discusses the way different factors affect stroke and coronary event risks. Scan the QR code (right) or go to

Source Naseem S. Miller/Elsevier Global Medical Newswww.clinicalendocrinologynews.com

 A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees' feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to “capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging,” and reach underserved groups, according to one of the agency's recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency's texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

“The overwhelming response was that the program brought information into their hands,” said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself “a bit of a devil's advocate,” and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County's text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of “medical warning signs that they did not know,” and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

“The messages support the messages ob.gyns provide to their patients,” said Dr. LaCoursiere. “I tell my patients it's the text version of a [maternity book].”

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also “picked up some tips” from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the “pregnancy” or “new baby' protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

“Pregnant women are hungry for knowledge,” said Dr. LaCoursiere. “They want to learn how to be a good mom. So you have a population who's very interested in learning.”

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program's organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

'The [text4baby] messages support the messages ob.gyns. provide to their patients.'

Source DR. LaCOURSIERE

A sample of text4baby messages is shown on a cellphone screen.

Source Naseem S. Miller/Elsevier Global Medical News

 A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees' feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to “capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging,” and reach underserved groups, according to one of the agency's recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency's texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

“The overwhelming response was that the program brought information into their hands,” said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself “a bit of a devil's advocate,” and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County's text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of “medical warning signs that they did not know,” and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

“The messages support the messages ob.gyns provide to their patients,” said Dr. LaCoursiere. “I tell my patients it's the text version of a [maternity book].”

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also “picked up some tips” from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the “pregnancy” or “new baby' protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

“Pregnant women are hungry for knowledge,” said Dr. LaCoursiere. “They want to learn how to be a good mom. So you have a population who's very interested in learning.”

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program's organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

'The [text4baby] messages support the messages ob.gyns. provide to their patients.'

Source DR. LaCOURSIERE

A sample of text4baby messages is shown on a cellphone screen.

Source Naseem S. Miller/Elsevier Global Medical News

 A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees' feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to “capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging,” and reach underserved groups, according to one of the agency's recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency's texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

“The overwhelming response was that the program brought information into their hands,” said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself “a bit of a devil's advocate,” and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County's text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of “medical warning signs that they did not know,” and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

“The messages support the messages ob.gyns provide to their patients,” said Dr. LaCoursiere. “I tell my patients it's the text version of a [maternity book].”

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also “picked up some tips” from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the “pregnancy” or “new baby' protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

“Pregnant women are hungry for knowledge,” said Dr. LaCoursiere. “They want to learn how to be a good mom. So you have a population who's very interested in learning.”

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program's organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

'The [text4baby] messages support the messages ob.gyns. provide to their patients.'

Source DR. LaCOURSIERE

A sample of text4baby messages is shown on a cellphone screen.

Source Naseem S. Miller/Elsevier Global Medical News

A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees’ feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

© Poulsons Photography - Fotolia.com

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to "capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging," and reach underserved groups, according to one of the agency’s recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency’s texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

"The overwhelming response was that the program brought information into their hands," said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself "a bit of a devil’s advocate," and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County’s text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of "medical warning signs that they did not know," and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

"The messages support the messages ob.gyns provide to their patients," said Dr. LaCoursiere. "I tell my patients it’s the text version of a [maternity book.]"

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also "picked up some tips" from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the "pregnancy" or "new baby" protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

"Pregnant women are hungry for knowledge," said Dr. LaCoursiere. "They want to learn how to be a good mom. So you have a population who’s very interested in learning."

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program’s organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees’ feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

© Poulsons Photography - Fotolia.com

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to "capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging," and reach underserved groups, according to one of the agency’s recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency’s texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

"The overwhelming response was that the program brought information into their hands," said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself "a bit of a devil’s advocate," and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County’s text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of "medical warning signs that they did not know," and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

"The messages support the messages ob.gyns provide to their patients," said Dr. LaCoursiere. "I tell my patients it’s the text version of a [maternity book.]"

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also "picked up some tips" from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the "pregnancy" or "new baby" protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

"Pregnant women are hungry for knowledge," said Dr. LaCoursiere. "They want to learn how to be a good mom. So you have a population who’s very interested in learning."

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program’s organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

A nationwide texting program for new moms continues to grow in its second year, and an initial evaluation of the enrollees’ feedback is showing promising results.

The public-private partnership called text4baby sends free educational text messages to expecting and new moms. The program now has over 260,000 enrollees, up from more than 150,000 in April.

With the advancement of technology and the widespread access to mobile phones, national agencies are trying to use tools such as texting to promote healthy behaviors.

© Poulsons Photography - Fotolia.com

The U.S. Department of Health and Human Services created a Text4Health Task Force in 2010, trying to "capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging," and reach underserved groups, according to one of the agency’s recent announcements.

Maternal and child health, domestic violence and sexual abuse prevention, tobacco control, emergency preparedness, and diabetes and asthma education are among the agency’s texting projects.

Although it is too soon to tell whether such texting initiatives will improve health outcomes, positive feedback from women and physicians who use text4baby has turned some skeptics into believers.

"The overwhelming response was that the program brought information into their hands," said Dr. Yvette LaCoursiere, an assistant clinical professor in the reproductive medicine department at University of California, San Diego. She was involved in the multiagency partnership that conducted a small-scale evaluation of text4baby enrollees in San Diego.

Dr. LaCoursiere calls herself "a bit of a devil’s advocate," and before conducting the survey she had some concerns. For one, she wondered whether the program was well received and whether it would create more work for physicians.

But she found out otherwise, she said.

With the goal of reaching women, especially those who are uninsured or underinsured, text4baby sends three free text messages daily to enrollees, many of which are relevant to their due date (nationally, around 46% of women signed up during their first trimester). It sends out phone numbers of relevant resources, and it alerts women of an outbreak or recall.

In the telephone survey of 122 text4baby users (roughly 10% of San Diego County’s text4baby enrollees), 63% of the respondents said that the service helped them remember appointments or immunizations for themselves or their child, 75% said the messages informed them of "medical warning signs that they did not know," and 71% said the messages promoted a conversation with their physician.

More than half of underinsured respondents (53%) said they called a phone number that was sent in a text4baby message.

"The messages support the messages ob.gyns provide to their patients," said Dr. LaCoursiere. "I tell my patients it’s the text version of a [maternity book.]"

Dr. LaCoursiere said that some of her physician colleagues who have signed up for the service have also "picked up some tips" from the messages.

To become more attractive to users and gather their insights, the messaging program is now trying to become interactive.

One of its first interactive projects was a flu module, which asked enrollees whether or not they were planning to get a flu shot this season.

Of the 31% of over 100,000 active text4baby users currently in the "pregnancy" or "new baby" protocol who responded, 40% said they had already gotten the shot, 29% said they were planning to, and 31% said they were not. More than half of those who said they were planning to get the flu shot requested a reminder provided by the module.

Such interactivity can help engage the users and also reinforce key health concepts, according to Dr. Carolyn B. Bridges, associate director of adult immunization at the Centers for Disease Control and Prevention, who spoke about the module at a recent briefing.

Text4baby, which is a program of the National Healthy Mothers, Healthy Babies Coalition, is planning to reach 1 million women by the end of 2012. The program was developed as a free tool to reach mothers across the nation and help reduce the risk of negative birth outcomes, according to the organization. With more than 28,000 infant deaths each year, the United States has one of the highest infant mortality rates among the industrialized nations.

While there are various texting projects underway, maternal and child health might have one of the more eager audiences.

"Pregnant women are hungry for knowledge," said Dr. LaCoursiere. "They want to learn how to be a good mom. So you have a population who’s very interested in learning."

Text4baby is planning to release radio and television Public Service Announcements and increase its presence on social media in 2012, according to the program’s organizers.

Several national evaluations are underway, and the results could be available within the next 2 years.

State Sees Some Obesity Progress

California is making some headway on childhood obesity, with the percentage of overweight and obese children in the state dropping 1.1% from 2005 to 2010, according to a report from the University of California, Los Angeles Center for Health Policy Research and the California Center for Public Health Advocacy. The report credited the slight decrease to local policies and programs to improve access to playgrounds and other open spaces, to increase the availability of healthy foods, and to educate the public on the dangers of childhood obesity. Still, 31 of California's 58 counties experienced an increase in their childhood overweight and obesity rates during the 6-year study period. Statewide, 38% of public school students in the fifth, seventh, and ninth grades were overweight or obese in 2010, the report said.

New Tools for Health Advice

To help physicians discuss healthy lifestyles and physical activity with their adult patients, the American Medical Association has released continuing medical education materials including videos and patient handouts. “By using these tools, physicians will gain a better understanding of why patients make unhealthy decisions and will learn how to initiate conversations about healthy eating and physical activity,” said AMA President Dr. Peter W. Carmel in a statement. Study and use of the materials have been certified for AMA PRA Category 1 Credit. They are available at

www.ama-assn.org/go/obesity

AMA Says Tone Down the Energy

Caffeinated, sugary, “energy” drinks such as Red Bull, Rockstar, Monster, and Full Throttle need closer scrutiny, said the AMA House of Delegates at its interim meeting last month. The association's Michigan delegation introduced the successful resolution. The state is one of several that have banned “Four Loko,” a drink that is similar but includes alcohol. The energy drinks can be dangerous when combined with alcohol, according to the resolution. It also urged the FDA to regulate the drinks and to seek federal legislation to mandate warning labels listing potential side effects, “particularly when combined with alcohol.”

More Docs Using E-Rx

Just over half of all office-based physicians are sending prescriptions electronically, according to statistics from the e-prescription network Surescripts. That percentage is up from 36% at the end of 2010 and just 10% in 2008. “This represents one of the most significant milestones achieved to date in the nationwide effort to adopt and achieve meaningful use of health information technology,” according to Harry Totonis, president and CEO of Surescripts. E-prescribing is one of the requirements for physicians to qualify for Medicare and Medicaid health IT incentive payments, in order to meet meaningful use standards for electronic medical records. States with the highest rates of e-prescribing were Massachusetts, Delaware, Michigan, Connecticut, and Rhode Island, according to Surescripts.

Medical Homes a Challenge

Nearly half of physician practices do not meet national standards to qualify as patient-centered medical homes, according to a study from the University of Michigan Health System. Nearly three-quarters of multispecialty groups would meet criteria of the National Committee on Quality Assurance, but only half of solo and partnership practices meet those standards, the researchers reported. About 40% of primary care practices would not qualify as a medical home under the current standards. Market forces pushing patients toward medical homes might force practices to close that don't have the infrastructure to qualify, said Dr. John Hollingsworth, the study's lead author. This could disproportionately affect patients in rural areas, and policy makers should address the challenges facing small and rural practices, the researchers said in their report.

Insurance Competition Low

Four out of five U.S. metropolitan areas lack a competitive health insurance market, according to an analysis from the AMA. In addition, in about half of all metropolitan markets, one health insurer controls 50% or more of the market. In half the states, competition is limited to two health insurers who together control about 70% of the market. According to the study, Alabama, Alaska, Delaware, Michigan, Hawaii, the District of Columbia, Nebraska, North Carolina, Indiana, and Maine have the least competitive health insurance markets in the country.

State Sees Some Obesity Progress

California is making some headway on childhood obesity, with the percentage of overweight and obese children in the state dropping 1.1% from 2005 to 2010, according to a report from the University of California, Los Angeles Center for Health Policy Research and the California Center for Public Health Advocacy. The report credited the slight decrease to local policies and programs to improve access to playgrounds and other open spaces, to increase the availability of healthy foods, and to educate the public on the dangers of childhood obesity. Still, 31 of California's 58 counties experienced an increase in their childhood overweight and obesity rates during the 6-year study period. Statewide, 38% of public school students in the fifth, seventh, and ninth grades were overweight or obese in 2010, the report said.

New Tools for Health Advice

To help physicians discuss healthy lifestyles and physical activity with their adult patients, the American Medical Association has released continuing medical education materials including videos and patient handouts. “By using these tools, physicians will gain a better understanding of why patients make unhealthy decisions and will learn how to initiate conversations about healthy eating and physical activity,” said AMA President Dr. Peter W. Carmel in a statement. Study and use of the materials have been certified for AMA PRA Category 1 Credit. They are available at

www.ama-assn.org/go/obesity

AMA Says Tone Down the Energy

Caffeinated, sugary, “energy” drinks such as Red Bull, Rockstar, Monster, and Full Throttle need closer scrutiny, said the AMA House of Delegates at its interim meeting last month. The association's Michigan delegation introduced the successful resolution. The state is one of several that have banned “Four Loko,” a drink that is similar but includes alcohol. The energy drinks can be dangerous when combined with alcohol, according to the resolution. It also urged the FDA to regulate the drinks and to seek federal legislation to mandate warning labels listing potential side effects, “particularly when combined with alcohol.”

More Docs Using E-Rx

Just over half of all office-based physicians are sending prescriptions electronically, according to statistics from the e-prescription network Surescripts. That percentage is up from 36% at the end of 2010 and just 10% in 2008. “This represents one of the most significant milestones achieved to date in the nationwide effort to adopt and achieve meaningful use of health information technology,” according to Harry Totonis, president and CEO of Surescripts. E-prescribing is one of the requirements for physicians to qualify for Medicare and Medicaid health IT incentive payments, in order to meet meaningful use standards for electronic medical records. States with the highest rates of e-prescribing were Massachusetts, Delaware, Michigan, Connecticut, and Rhode Island, according to Surescripts.

Medical Homes a Challenge

Nearly half of physician practices do not meet national standards to qualify as patient-centered medical homes, according to a study from the University of Michigan Health System. Nearly three-quarters of multispecialty groups would meet criteria of the National Committee on Quality Assurance, but only half of solo and partnership practices meet those standards, the researchers reported. About 40% of primary care practices would not qualify as a medical home under the current standards. Market forces pushing patients toward medical homes might force practices to close that don't have the infrastructure to qualify, said Dr. John Hollingsworth, the study's lead author. This could disproportionately affect patients in rural areas, and policy makers should address the challenges facing small and rural practices, the researchers said in their report.

Insurance Competition Low

Four out of five U.S. metropolitan areas lack a competitive health insurance market, according to an analysis from the AMA. In addition, in about half of all metropolitan markets, one health insurer controls 50% or more of the market. In half the states, competition is limited to two health insurers who together control about 70% of the market. According to the study, Alabama, Alaska, Delaware, Michigan, Hawaii, the District of Columbia, Nebraska, North Carolina, Indiana, and Maine have the least competitive health insurance markets in the country.

State Sees Some Obesity Progress

California is making some headway on childhood obesity, with the percentage of overweight and obese children in the state dropping 1.1% from 2005 to 2010, according to a report from the University of California, Los Angeles Center for Health Policy Research and the California Center for Public Health Advocacy. The report credited the slight decrease to local policies and programs to improve access to playgrounds and other open spaces, to increase the availability of healthy foods, and to educate the public on the dangers of childhood obesity. Still, 31 of California's 58 counties experienced an increase in their childhood overweight and obesity rates during the 6-year study period. Statewide, 38% of public school students in the fifth, seventh, and ninth grades were overweight or obese in 2010, the report said.

New Tools for Health Advice

To help physicians discuss healthy lifestyles and physical activity with their adult patients, the American Medical Association has released continuing medical education materials including videos and patient handouts. “By using these tools, physicians will gain a better understanding of why patients make unhealthy decisions and will learn how to initiate conversations about healthy eating and physical activity,” said AMA President Dr. Peter W. Carmel in a statement. Study and use of the materials have been certified for AMA PRA Category 1 Credit. They are available at

www.ama-assn.org/go/obesity

AMA Says Tone Down the Energy

Caffeinated, sugary, “energy” drinks such as Red Bull, Rockstar, Monster, and Full Throttle need closer scrutiny, said the AMA House of Delegates at its interim meeting last month. The association's Michigan delegation introduced the successful resolution. The state is one of several that have banned “Four Loko,” a drink that is similar but includes alcohol. The energy drinks can be dangerous when combined with alcohol, according to the resolution. It also urged the FDA to regulate the drinks and to seek federal legislation to mandate warning labels listing potential side effects, “particularly when combined with alcohol.”

More Docs Using E-Rx

Just over half of all office-based physicians are sending prescriptions electronically, according to statistics from the e-prescription network Surescripts. That percentage is up from 36% at the end of 2010 and just 10% in 2008. “This represents one of the most significant milestones achieved to date in the nationwide effort to adopt and achieve meaningful use of health information technology,” according to Harry Totonis, president and CEO of Surescripts. E-prescribing is one of the requirements for physicians to qualify for Medicare and Medicaid health IT incentive payments, in order to meet meaningful use standards for electronic medical records. States with the highest rates of e-prescribing were Massachusetts, Delaware, Michigan, Connecticut, and Rhode Island, according to Surescripts.

Medical Homes a Challenge

Nearly half of physician practices do not meet national standards to qualify as patient-centered medical homes, according to a study from the University of Michigan Health System. Nearly three-quarters of multispecialty groups would meet criteria of the National Committee on Quality Assurance, but only half of solo and partnership practices meet those standards, the researchers reported. About 40% of primary care practices would not qualify as a medical home under the current standards. Market forces pushing patients toward medical homes might force practices to close that don't have the infrastructure to qualify, said Dr. John Hollingsworth, the study's lead author. This could disproportionately affect patients in rural areas, and policy makers should address the challenges facing small and rural practices, the researchers said in their report.

Insurance Competition Low

Four out of five U.S. metropolitan areas lack a competitive health insurance market, according to an analysis from the AMA. In addition, in about half of all metropolitan markets, one health insurer controls 50% or more of the market. In half the states, competition is limited to two health insurers who together control about 70% of the market. According to the study, Alabama, Alaska, Delaware, Michigan, Hawaii, the District of Columbia, Nebraska, North Carolina, Indiana, and Maine have the least competitive health insurance markets in the country.