Naseem S. Miller

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It's a simple idea, but it could help save millions of lives: a website helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grassroots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the website (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The website follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the website that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It's a simple idea, but it could help save millions of lives: a website helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grassroots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the website (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The website follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the website that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It's a simple idea, but it could help save millions of lives: a website helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grassroots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the website (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The website follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the website that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

It’s a simple idea, but it could help save millions of lives: a Web site called ORReady is helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

The grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea – a global effort to improve surgical outcomes – would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That’s six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it’s a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project and is run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We’re looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It’s very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it’s going to be."

He hopes to see his project make an impact within the next few years.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

In obese patients with knee osteoarthritis, significant weight loss after bariatric surgery reduced pain and stiffness, decreased low-grade inflammation, and changed cartilage turnover, according to a study published in the January issue of Annals of Rheumatic Diseases.

In addition to the well-known relationship between obesity and onset of knee osteoarthritis (OA), several studies have now shown that the association goes beyond the increase in mechanical load on the tibiofemoral cartilage. "Adipose tissue may act as an endocrine organ, releasing several proinflammatory mediators and adipokines in blood that may participate in cartilage alteration in obese patients," according to Dr. Pascal Richette of Hôpital Lariboisière and coauthors. The authors added, "Trials that have assessed the efficacy of surgically induced massive weight loss on knee OA symptoms are scarce and have not specifically included patients with well-defined radiographic evidence of knee OA, as in our study." (Ann. Rheum. Dis. 2011;70:139-44).

The authors studied 44 obese patients (36 women) with a baseline body mass index of 50.7 before surgery and moderate to severe knee OA. The patients underwent laparoscopic Roux-en-Y gastric bypass surgery or laparoscopic adjustable gastric banding. Patient data was collected before and 6 months after the surgery.

At 6 months, patients had a 20% drop from baseline BMIs. Their VAS (visual acuity scores) decreased from 50 mm to 24.5 mm and their scores on the WOMAC (Western Ontario MacMaster) Questionnaire improved. Significant decreases were seen in average serum levels of interleukin-6 (IL-6), which declined by 26%, and of high-sensitivity C-reactive protein (hsCRP), which dropped 46%. Also, weight loss was associated with changes in adipokine levels: Mean serum leptin concentration was decreased by 48% and serum level of adiponectin was increased by 21%, the authors reported.

The average serum level of procollagen type II N-terminal propeptide (PIIANP), a marker of cartilage synthesis, rose 32%, while the serum level of cartilage oligomeric matrix protein (COMP) decreased by 36%. "These results are the first to suggest a benefit of weight loss on both cartilage anabolism and catabolism," the authors wrote.

The researchers found a significant correlation between IL-6 level and WOMAC Questionnaire scores as well as between urinary type II collagen helical peptide (helix-II) and hsCRP. Variation in COMP concentration was significantly correlated with changes in VAS pain scores and WOMAC stiffness score, the authors wrote, adding, "Our findings extend the results of recent work showing a significant association of IL-6 circulating levels and the prevalence and incidence of knee OA."

Since the study was an open exploratory study, it was prone to bias in evaluation of results. Also, the sample size was small. The findings don’t imply causality between variables, "and thus should be carefully interpreted," the researchers wrote. Also, "the effect of changes in insulin resistance related to weight loss on cartilage homoeostasis needs further investigation."

The study was funded by Assistance Publique-Hôpitaux de Paris, Direction of Clinical Research, which promoted and supported the clinical investigation, a grant from the European community, and the Association Rhumatisme et Travail (Hôpital Lariboisière, Paris).

The authors reported no financial conflicts of interest.

Genzyme Transfers Operations

Genzyme Corp. has ended manufacturing operations at its Allston, Mass., plant for products sold in the United States, and the company has transferred the work to its Waterford, Ireland, plant and a contract manufacturer. The move comes several months after the company entered a consent decree with the Food and Drug Administration for quality violations in manufacturing some of its biggest products - imiglucerase (Cerezyme), agalsidase beta (Fabrazyme), and thyrotropin alfa (Thyrogen) - which the FDA had found to be contaminated with particles of rubber, fiber, and steel. Earlier last year, the company had to shut the Allston factory because of viral contamination. After the consent decree, Genzyme turned over to the government $175 million in unlawful profits from the sale of the products. “Genzyme is working closely with regulatory authorities globally to achieve this goal,” according to a company statement.

Court Upholds Cancer Suit

The Nevada Supreme Court upheld a $58 million award to three women, two of them now deceased, who claimed that Wyeth Pharmaceuticals' hormone replacement drugs – Premarin and Prempro – caused their breast cancer. “The evidence supported the jury's findings that Wyeth was negligent in failing to conduct appropriate studies on breast cancer and that it concealed material facts about its products' safety,” Justice Michael Cherry wrote in the court's opinion. The company had appealed a 2007 ruling, saying that the punitive damages award was excessive. Justice Cherry wrote that while the term “breast cancer” appeared 10 times in the Prempro labeling, “in many instances the term appeared in reassuring statements. …To the contrary, the evidence showed that before Prempro was marketed, there was scientific data that confirmed an increased risk in breast cancer with the prolonged use of estrogen plus progestin.” The case is one of thousands against Wyeth regarding the two drugs.

Texas Diabetes Rate Alarming

One in four (8 million) Texans will be diagnosed with diabetes by 2040 and that will constitute “a significant threat to the financial solvency of the Texas public and private health infrastructure,” according to a report by the nonprofit group Texas Health Institute. The diabetes rate has tripled in young adults in less than a decade, and the obesity rate in that group has doubled. The report also notes racial and ethnic disparities in diabetes rates, complications, and mortality, especially in people along the Texas-Mexico border. Novo Nordisk and Roche Diagnostics financed publication of the report.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the RAND Corporation. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at RAND, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance.

Genzyme Transfers Operations

Genzyme Corp. has ended manufacturing operations at its Allston, Mass., plant for products sold in the United States, and the company has transferred the work to its Waterford, Ireland, plant and a contract manufacturer. The move comes several months after the company entered a consent decree with the Food and Drug Administration for quality violations in manufacturing some of its biggest products - imiglucerase (Cerezyme), agalsidase beta (Fabrazyme), and thyrotropin alfa (Thyrogen) - which the FDA had found to be contaminated with particles of rubber, fiber, and steel. Earlier last year, the company had to shut the Allston factory because of viral contamination. After the consent decree, Genzyme turned over to the government $175 million in unlawful profits from the sale of the products. “Genzyme is working closely with regulatory authorities globally to achieve this goal,” according to a company statement.

Court Upholds Cancer Suit

The Nevada Supreme Court upheld a $58 million award to three women, two of them now deceased, who claimed that Wyeth Pharmaceuticals' hormone replacement drugs – Premarin and Prempro – caused their breast cancer. “The evidence supported the jury's findings that Wyeth was negligent in failing to conduct appropriate studies on breast cancer and that it concealed material facts about its products' safety,” Justice Michael Cherry wrote in the court's opinion. The company had appealed a 2007 ruling, saying that the punitive damages award was excessive. Justice Cherry wrote that while the term “breast cancer” appeared 10 times in the Prempro labeling, “in many instances the term appeared in reassuring statements. …To the contrary, the evidence showed that before Prempro was marketed, there was scientific data that confirmed an increased risk in breast cancer with the prolonged use of estrogen plus progestin.” The case is one of thousands against Wyeth regarding the two drugs.

Texas Diabetes Rate Alarming

One in four (8 million) Texans will be diagnosed with diabetes by 2040 and that will constitute “a significant threat to the financial solvency of the Texas public and private health infrastructure,” according to a report by the nonprofit group Texas Health Institute. The diabetes rate has tripled in young adults in less than a decade, and the obesity rate in that group has doubled. The report also notes racial and ethnic disparities in diabetes rates, complications, and mortality, especially in people along the Texas-Mexico border. Novo Nordisk and Roche Diagnostics financed publication of the report.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the RAND Corporation. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at RAND, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance.

Genzyme Transfers Operations

Genzyme Corp. has ended manufacturing operations at its Allston, Mass., plant for products sold in the United States, and the company has transferred the work to its Waterford, Ireland, plant and a contract manufacturer. The move comes several months after the company entered a consent decree with the Food and Drug Administration for quality violations in manufacturing some of its biggest products - imiglucerase (Cerezyme), agalsidase beta (Fabrazyme), and thyrotropin alfa (Thyrogen) - which the FDA had found to be contaminated with particles of rubber, fiber, and steel. Earlier last year, the company had to shut the Allston factory because of viral contamination. After the consent decree, Genzyme turned over to the government $175 million in unlawful profits from the sale of the products. “Genzyme is working closely with regulatory authorities globally to achieve this goal,” according to a company statement.

Court Upholds Cancer Suit

The Nevada Supreme Court upheld a $58 million award to three women, two of them now deceased, who claimed that Wyeth Pharmaceuticals' hormone replacement drugs – Premarin and Prempro – caused their breast cancer. “The evidence supported the jury's findings that Wyeth was negligent in failing to conduct appropriate studies on breast cancer and that it concealed material facts about its products' safety,” Justice Michael Cherry wrote in the court's opinion. The company had appealed a 2007 ruling, saying that the punitive damages award was excessive. Justice Cherry wrote that while the term “breast cancer” appeared 10 times in the Prempro labeling, “in many instances the term appeared in reassuring statements. …To the contrary, the evidence showed that before Prempro was marketed, there was scientific data that confirmed an increased risk in breast cancer with the prolonged use of estrogen plus progestin.” The case is one of thousands against Wyeth regarding the two drugs.

Texas Diabetes Rate Alarming

One in four (8 million) Texans will be diagnosed with diabetes by 2040 and that will constitute “a significant threat to the financial solvency of the Texas public and private health infrastructure,” according to a report by the nonprofit group Texas Health Institute. The diabetes rate has tripled in young adults in less than a decade, and the obesity rate in that group has doubled. The report also notes racial and ethnic disparities in diabetes rates, complications, and mortality, especially in people along the Texas-Mexico border. Novo Nordisk and Roche Diagnostics financed publication of the report.

Report: Send Technology Home

One solution to two major challenges facing health care systems worldwide could be the expansion of home health care technology, according to a report by the RAND Corporation. “The aging of the world's population and [the] fact that more diseases are treatable will create serious financial and manpower challenges for the world's health care systems,” Dr. Soeren Mattke, lead author and a senior scientist at RAND, said in a statement. It is possible to move technologies ranging from glucose meters to advanced telemedicine devices into homes, “where patients or family members can manage care,” said Dr. Mattke. He and his coauthors admitted in their report that barriers exist, such as insurance coverage, patients' readiness, and their compliance.

CT Growth an Emergency Situation

Computer tomography use has increased faster in emergency departments than in any other medical setting, according to a study in Radiology. Data from the 1995–2007 National Hospital Ambulatory Medical Care Survey showed that emergency department visits that included a CT exam increased from 2.7 million to 16.2 million, an annual growth rate of 16%. The percentage of visits associated with CT increased nearly fivefold, from 2.8% in 1995 to 13.9% in 2007. CT use was higher in older and white patients, and those who were admitted to the hospital or a facility in a metropolitan region. The chief complaints among patients who underwent CT exams were abdominal pain, headache, and chest pain, according to the report.

Stroke Deaths Fall Behind

Stroke is no longer the third leading cause of death in the United States, replaced after more than 5 decades by chronic lower respiratory diseases, according the Centers for Disease Control and Prevention. Heart disease and cancer hold their rankings at first and second. There were 133,750 deaths from stroke in 2008, compared with 141,075 deaths from chronic lower respiratory diseases, according to “Deaths: Preliminary Data for 2008.” The authors speculate that the new ranking may be due to changes in classification and coding of chronic lower respiratory diseases by the World Health Organization, and they said they will do further analysis. The report also shows that death rates from several conditions, including Alzheimer's disease, increased significantly in 2008.

Imaging Self-Referrals Derided

Doctors referring patients to their own imaging services cost American health care extra without delivering the practice's supposed advantages, according to several studies in Health Affairs. One paper reported that neurologists and orthopedists who bought magnetic resonance machines in the early 2000s “ordered substantially more scans once they began billing for MRI.” Another report – from researchers at the American College of Radiology – found that despite the promise of patient convenience, fewer than one in six people referred to doctors' own MRI or CT machines got their scans on the day of their office visits. And episodes of self-referral for imaging led to higher cost but not generally to reduced lengths of illness, according to another report in the journal's December issue.

Physician-Hospital Lawsuit Will End

A Texas judge indicated he would dismiss a suit seeking to repeal a section of the health reform law barring expansion and new construction of physician-owned hospitals. In canceling a trial date, U.S. District Court Judge Michael H. Schneider said that in a forthcoming final judgment he would rule against the Physician Hospitals of America claim that the ban on physician-owned hospitals is unconstitutional and vague. However, Judge Schneider said the court has jurisdiction to consider the case and that the law “has retroactive effect,” rulings that encouraged the plaintiffs in further appeals.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

CT Growth an Emergency Situation

Computer tomography use has increased faster in emergency departments than in any other medical setting, according to a study in Radiology. Data from the 1995–2007 National Hospital Ambulatory Medical Care Survey showed that emergency department visits that included a CT exam increased from 2.7 million to 16.2 million, an annual growth rate of 16%. The percentage of visits associated with CT increased nearly fivefold, from 2.8% in 1995 to 13.9% in 2007. CT use was higher in older and white patients, and those who were admitted to the hospital or a facility in a metropolitan region. The chief complaints among patients who underwent CT exams were abdominal pain, headache, and chest pain, according to the report.

Stroke Deaths Fall Behind

Stroke is no longer the third leading cause of death in the United States, replaced after more than 5 decades by chronic lower respiratory diseases, according the Centers for Disease Control and Prevention. Heart disease and cancer hold their rankings at first and second. There were 133,750 deaths from stroke in 2008, compared with 141,075 deaths from chronic lower respiratory diseases, according to “Deaths: Preliminary Data for 2008.” The authors speculate that the new ranking may be due to changes in classification and coding of chronic lower respiratory diseases by the World Health Organization, and they said they will do further analysis. The report also shows that death rates from several conditions, including Alzheimer's disease, increased significantly in 2008.

Imaging Self-Referrals Derided

Doctors referring patients to their own imaging services cost American health care extra without delivering the practice's supposed advantages, according to several studies in Health Affairs. One paper reported that neurologists and orthopedists who bought magnetic resonance machines in the early 2000s “ordered substantially more scans once they began billing for MRI.” Another report – from researchers at the American College of Radiology – found that despite the promise of patient convenience, fewer than one in six people referred to doctors' own MRI or CT machines got their scans on the day of their office visits. And episodes of self-referral for imaging led to higher cost but not generally to reduced lengths of illness, according to another report in the journal's December issue.

Physician-Hospital Lawsuit Will End

A Texas judge indicated he would dismiss a suit seeking to repeal a section of the health reform law barring expansion and new construction of physician-owned hospitals. In canceling a trial date, U.S. District Court Judge Michael H. Schneider said that in a forthcoming final judgment he would rule against the Physician Hospitals of America claim that the ban on physician-owned hospitals is unconstitutional and vague. However, Judge Schneider said the court has jurisdiction to consider the case and that the law “has retroactive effect,” rulings that encouraged the plaintiffs in further appeals.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

CT Growth an Emergency Situation

Computer tomography use has increased faster in emergency departments than in any other medical setting, according to a study in Radiology. Data from the 1995–2007 National Hospital Ambulatory Medical Care Survey showed that emergency department visits that included a CT exam increased from 2.7 million to 16.2 million, an annual growth rate of 16%. The percentage of visits associated with CT increased nearly fivefold, from 2.8% in 1995 to 13.9% in 2007. CT use was higher in older and white patients, and those who were admitted to the hospital or a facility in a metropolitan region. The chief complaints among patients who underwent CT exams were abdominal pain, headache, and chest pain, according to the report.

Stroke Deaths Fall Behind

Stroke is no longer the third leading cause of death in the United States, replaced after more than 5 decades by chronic lower respiratory diseases, according the Centers for Disease Control and Prevention. Heart disease and cancer hold their rankings at first and second. There were 133,750 deaths from stroke in 2008, compared with 141,075 deaths from chronic lower respiratory diseases, according to “Deaths: Preliminary Data for 2008.” The authors speculate that the new ranking may be due to changes in classification and coding of chronic lower respiratory diseases by the World Health Organization, and they said they will do further analysis. The report also shows that death rates from several conditions, including Alzheimer's disease, increased significantly in 2008.

Imaging Self-Referrals Derided

Doctors referring patients to their own imaging services cost American health care extra without delivering the practice's supposed advantages, according to several studies in Health Affairs. One paper reported that neurologists and orthopedists who bought magnetic resonance machines in the early 2000s “ordered substantially more scans once they began billing for MRI.” Another report – from researchers at the American College of Radiology – found that despite the promise of patient convenience, fewer than one in six people referred to doctors' own MRI or CT machines got their scans on the day of their office visits. And episodes of self-referral for imaging led to higher cost but not generally to reduced lengths of illness, according to another report in the journal's December issue.

Physician-Hospital Lawsuit Will End

A Texas judge indicated he would dismiss a suit seeking to repeal a section of the health reform law barring expansion and new construction of physician-owned hospitals. In canceling a trial date, U.S. District Court Judge Michael H. Schneider said that in a forthcoming final judgment he would rule against the Physician Hospitals of America claim that the ban on physician-owned hospitals is unconstitutional and vague. However, Judge Schneider said the court has jurisdiction to consider the case and that the law “has retroactive effect,” rulings that encouraged the plaintiffs in further appeals.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

One aim of the Affordable Care Act was to boost primary care, and one of the law's strategies was to create 10% incentive payments for primary care services provided by some physicians and other practitioners.

Medicare's final rule specifies that primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants whose practices comprise mostly primary care would qualify for the payments as of Jan. 1.

The Centers for Medicare and Medicaid Services excluded hospital inpatient care and emergency department work from qualifying practitioners for the incentive. Although many leaders in primary care endorsed the incentive program, several also said that the provision is not without disadvantages and limitations. Dr. Roland Goertz, president of the American Academy of Family Physicians, discussed the new primary care incentive program.

R

D

RN: What do qualifying physicians need to do to receive the incentive payments?

D

RN: Are there any disadvantages to the provision?

D

RN: Will this provision have an impact on the shortage of primary care physicians?

D

RN: What is the next step toward addressing the primary care physician shortage?

D

Once that has been addressed, we need to continue to close the income gap between primary care and other specialty physicians and continue to implement the patient-centered medical home.

These actions will make the primary care specialty of family medicine more attractive to medical students and will invigorate the primary care medical education process.

The broken Medicare physician payment SGR formula is the most important factor affecting all of medicine.

Source DR. GOERTZ

One aim of the Affordable Care Act was to boost primary care, and one of the law's strategies was to create 10% incentive payments for primary care services provided by some physicians and other practitioners.

Medicare's final rule specifies that primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants whose practices comprise mostly primary care would qualify for the payments as of Jan. 1.

The Centers for Medicare and Medicaid Services excluded hospital inpatient care and emergency department work from qualifying practitioners for the incentive. Although many leaders in primary care endorsed the incentive program, several also said that the provision is not without disadvantages and limitations. Dr. Roland Goertz, president of the American Academy of Family Physicians, discussed the new primary care incentive program.

R

D

RN: What do qualifying physicians need to do to receive the incentive payments?

D

RN: Are there any disadvantages to the provision?

D

RN: Will this provision have an impact on the shortage of primary care physicians?

D

RN: What is the next step toward addressing the primary care physician shortage?

D

Once that has been addressed, we need to continue to close the income gap between primary care and other specialty physicians and continue to implement the patient-centered medical home.

These actions will make the primary care specialty of family medicine more attractive to medical students and will invigorate the primary care medical education process.

The broken Medicare physician payment SGR formula is the most important factor affecting all of medicine.

Source DR. GOERTZ

One aim of the Affordable Care Act was to boost primary care, and one of the law's strategies was to create 10% incentive payments for primary care services provided by some physicians and other practitioners.

Medicare's final rule specifies that primary care physicians, nurse practitioners, clinical nurse specialists, and physician assistants whose practices comprise mostly primary care would qualify for the payments as of Jan. 1.

The Centers for Medicare and Medicaid Services excluded hospital inpatient care and emergency department work from qualifying practitioners for the incentive. Although many leaders in primary care endorsed the incentive program, several also said that the provision is not without disadvantages and limitations. Dr. Roland Goertz, president of the American Academy of Family Physicians, discussed the new primary care incentive program.

R

D

RN: What do qualifying physicians need to do to receive the incentive payments?

D

RN: Are there any disadvantages to the provision?

D

RN: Will this provision have an impact on the shortage of primary care physicians?

D

RN: What is the next step toward addressing the primary care physician shortage?

D

Once that has been addressed, we need to continue to close the income gap between primary care and other specialty physicians and continue to implement the patient-centered medical home.

These actions will make the primary care specialty of family medicine more attractive to medical students and will invigorate the primary care medical education process.

The broken Medicare physician payment SGR formula is the most important factor affecting all of medicine.

Source DR. GOERTZ