Bruce Dixon

A pregnant woman's exposure to secondhand cigarette smoke may be just as risky to the fetus as is active smoking, according to a pooled data reanalysis conducted by Stephen G. Grant, Ph.D., of the University of Pittsburgh.

“This analysis shows not only that smoking during pregnancy causes genetic damage in the developing fetus that can be detected at birth, but also that passive, or secondary, exposure causes just as much damage as active smoking, and it's the same kind of damage,” Dr. Grant said in a statement.

In an interview, he said, “The women who go to the trouble of quitting smoking feel they have taken care of the problem. This is a cautionary exercise in which we say women have to change their lifestyles in other ways” such as having their husbands quit smoking and not going outside with their friends on smoke breaks even if they don't smoke themselves.

The analysis examined data from two contradictory studies on rates of mutation at the HPRT locus (a measure of in vivo mutagenesis) in newborn cord blood samples. Compared with samples from babies who had not been exposed to smoke in utero, exposed babies had significantly higher mutation rates. There were no significant differences in levels of induced mutation among children of exposed women (active smokers, women who had quit smoking when they learned they were pregnant, and women who were only passively exposed to smoke).

In the pooled data, the median HPRT mutation frequencies for actively and passively smoking mothers were both 0.87. The median for those who had quit smoking was 0.91, and for unexposed women, 0.60 (BMC Pediatr. 2005;5:20 [Epub ahead of print]).

A pregnant woman's exposure to secondhand cigarette smoke may be just as risky to the fetus as is active smoking, according to a pooled data reanalysis conducted by Stephen G. Grant, Ph.D., of the University of Pittsburgh.

“This analysis shows not only that smoking during pregnancy causes genetic damage in the developing fetus that can be detected at birth, but also that passive, or secondary, exposure causes just as much damage as active smoking, and it's the same kind of damage,” Dr. Grant said in a statement.

In an interview, he said, “The women who go to the trouble of quitting smoking feel they have taken care of the problem. This is a cautionary exercise in which we say women have to change their lifestyles in other ways” such as having their husbands quit smoking and not going outside with their friends on smoke breaks even if they don't smoke themselves.

The analysis examined data from two contradictory studies on rates of mutation at the HPRT locus (a measure of in vivo mutagenesis) in newborn cord blood samples. Compared with samples from babies who had not been exposed to smoke in utero, exposed babies had significantly higher mutation rates. There were no significant differences in levels of induced mutation among children of exposed women (active smokers, women who had quit smoking when they learned they were pregnant, and women who were only passively exposed to smoke).

In the pooled data, the median HPRT mutation frequencies for actively and passively smoking mothers were both 0.87. The median for those who had quit smoking was 0.91, and for unexposed women, 0.60 (BMC Pediatr. 2005;5:20 [Epub ahead of print]).

A pregnant woman's exposure to secondhand cigarette smoke may be just as risky to the fetus as is active smoking, according to a pooled data reanalysis conducted by Stephen G. Grant, Ph.D., of the University of Pittsburgh.

“This analysis shows not only that smoking during pregnancy causes genetic damage in the developing fetus that can be detected at birth, but also that passive, or secondary, exposure causes just as much damage as active smoking, and it's the same kind of damage,” Dr. Grant said in a statement.

In an interview, he said, “The women who go to the trouble of quitting smoking feel they have taken care of the problem. This is a cautionary exercise in which we say women have to change their lifestyles in other ways” such as having their husbands quit smoking and not going outside with their friends on smoke breaks even if they don't smoke themselves.

The analysis examined data from two contradictory studies on rates of mutation at the HPRT locus (a measure of in vivo mutagenesis) in newborn cord blood samples. Compared with samples from babies who had not been exposed to smoke in utero, exposed babies had significantly higher mutation rates. There were no significant differences in levels of induced mutation among children of exposed women (active smokers, women who had quit smoking when they learned they were pregnant, and women who were only passively exposed to smoke).

In the pooled data, the median HPRT mutation frequencies for actively and passively smoking mothers were both 0.87. The median for those who had quit smoking was 0.91, and for unexposed women, 0.60 (BMC Pediatr. 2005;5:20 [Epub ahead of print]).

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.”

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute myocardial infarction, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using these teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

The clinicians assigned to the team must be ready to respond quickly, Ms.Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated the use of the SBAR (situation, background, assessment, and recommendation) technique, developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Hospitals Face Growing Public Impatience

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year due to preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error. Overall, 92% of those polled said there should be public reporting of medical errors.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted.

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.”

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute myocardial infarction, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using these teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

The clinicians assigned to the team must be ready to respond quickly, Ms.Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated the use of the SBAR (situation, background, assessment, and recommendation) technique, developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Hospitals Face Growing Public Impatience

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year due to preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error. Overall, 92% of those polled said there should be public reporting of medical errors.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted.

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.”

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute myocardial infarction, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using these teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

The clinicians assigned to the team must be ready to respond quickly, Ms.Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated the use of the SBAR (situation, background, assessment, and recommendation) technique, developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Hospitals Face Growing Public Impatience

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year due to preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error. Overall, 92% of those polled said there should be public reporting of medical errors.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted.

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol change.

Molecular sequencing traced all postswitch isolates back to OPV administered 1–3 months previously.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense. “The findings of such studies are vital to formulate polio immunization policies in the postcertification era. Simultaneous global cessation of OPV after a mass immunization campaign to maximize population immunity and minimize vaccine-derived poliovirus circulation could be adopted if there is minimum risk of sustained vaccine-derived poliovirus circulation.”

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol change.

Molecular sequencing traced all postswitch isolates back to OPV administered 1–3 months previously.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense. “The findings of such studies are vital to formulate polio immunization policies in the postcertification era. Simultaneous global cessation of OPV after a mass immunization campaign to maximize population immunity and minimize vaccine-derived poliovirus circulation could be adopted if there is minimum risk of sustained vaccine-derived poliovirus circulation.”

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol change.

Molecular sequencing traced all postswitch isolates back to OPV administered 1–3 months previously.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense. “The findings of such studies are vital to formulate polio immunization policies in the postcertification era. Simultaneous global cessation of OPV after a mass immunization campaign to maximize population immunity and minimize vaccine-derived poliovirus circulation could be adopted if there is minimum risk of sustained vaccine-derived poliovirus circulation.”

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol was changed.

Molecular sequencing traced all postswitch isolates back to OPV. “Since polioviruses evolve at a constant rate of 1% nucleotide substitutions per year, environmental isolates 6–12 months post switch with 99.7%–100% sequence homology to parental Sabin strains infer that these viruses were derived from OPV administered 1–3 months previously,” said Dr. Huang and associates.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense.

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol was changed.

Molecular sequencing traced all postswitch isolates back to OPV. “Since polioviruses evolve at a constant rate of 1% nucleotide substitutions per year, environmental isolates 6–12 months post switch with 99.7%–100% sequence homology to parental Sabin strains infer that these viruses were derived from OPV administered 1–3 months previously,” said Dr. Huang and associates.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense.

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

Live, attenuated poliovirus vaccine strains do not persist for extended periods after the oral vaccine is replaced by the inactivated poliovirus vaccine in a developed country with a temperate climate, Q. Sue Huang, Ph.D., and colleagues reported.

The study is part of an ongoing effort to develop strategies on when and how to stop oral poliovirus vaccine (OPV) immunization once the disease is eradicated, said Dr. Huang of the Institute of Environmental Science and Research, Porirua, New Zealand (Lancet 2005;366:394–6).

The authors explained that after OPV vaccination, poliovirus is excreted by healthy children for 2–3 months and the virus' persistence in populations is limited. “Reports from several developing countries, though, indicate that circulating neurovirulent vaccine-derived poliovirus strains can be sustained for extended periods and cause poliomyelitis when population immunity is low.”

When in 2002 New Zealand's immunization schedule changed from OPV to inactivated poliovirus vaccine (IPV), Dr. Huang's team began to monitor the persistence of OPV strains excreted by the last cohorts of immunized children.

“We did systematic, population-based surveillance for OPV virus circulation and evolution before, during, and after the OPV/IPV switch with combined pediatric inpatient, acute flaccid paralysis, enterovirus laboratory, and environmental surveillance systems,” the investigators said.

The first three methods targeted people most likely to be excreting poliovirus, but only environmental surveillance—obtaining composite samples from sewage systems that serve 28% of the population—was able to detect polioviruses 2 months after the OPV to IPV switch.

“Before the OPV/IPV switch, the poliovirus isolation rate was 94%. This proportion decreased after the switch, but not as rapidly as with other surveillance methods. The decline was maintained in the posttransitional period (April 2002 to April 2003) such that, after May 2002, polioviruses were only detected once every 3 months,” the investigators said.

Enterovirus (pediatric inpatient) surveillance found no poliovirus isolates in stool samples 1 month after the vaccine protocol was changed.

Molecular sequencing traced all postswitch isolates back to OPV. “Since polioviruses evolve at a constant rate of 1% nucleotide substitutions per year, environmental isolates 6–12 months post switch with 99.7%–100% sequence homology to parental Sabin strains infer that these viruses were derived from OPV administered 1–3 months previously,” said Dr. Huang and associates.

The scientists reckoned that these viruses most likely originated in recently vaccinated children or their close contacts from an OPV-using country, which shows that New Zealand “remains vulnerable to vaccine or wild-type virus importation.”

Dr. Huang and associates said it's important that the study be repeated in tropical, developing countries where transmission of OPV viruses is likely to be more intense.

In an accompanying editorial, Calman MacLennan, M.D., and Jenny MacLennan, M.D., of the University of Malawi, Blantyre, said that while this study suggests that replacement of OPV with IPV can, in an environment like New Zealand's, greatly reduce, and perhaps prevent, persistence of vaccine-related polioviruses, “these findings do not address what happens if vaccination with OPV is stopped without switching to IPV and whether similar results would be obtained in tropical developing countries.

“While the lack of long-term persistence of vaccine-related poliovirus in New Zealand is encouraging, it does not yet allow for the cessation of poliovirus vaccination in any country,” they said (Lancet 2005;366:351–3).

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches. The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

About half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

During a reference committee meeting, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 M.D. graduates every year and 2,000 D.O. graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% of students said they were in favor of a combined match.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.” SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Also Decided at the AOA House

In other action at the meeting:

▸ End-of-life care white paper. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting-opioid policy. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education resolution. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Call for end to consumer drug ads. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Statement on minority health disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders and individuals of disadvantaged backgrounds.”

▸ Support for EHRs. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems, developed by certified vendors, that meet current national standards.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches. The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

About half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

During a reference committee meeting, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 M.D. graduates every year and 2,000 D.O. graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% of students said they were in favor of a combined match.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.” SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Also Decided at the AOA House

In other action at the meeting:

▸ End-of-life care white paper. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting-opioid policy. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education resolution. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Call for end to consumer drug ads. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Statement on minority health disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders and individuals of disadvantaged backgrounds.”

▸ Support for EHRs. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems, developed by certified vendors, that meet current national standards.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches. The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

About half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

During a reference committee meeting, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 M.D. graduates every year and 2,000 D.O. graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% of students said they were in favor of a combined match.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.” SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Also Decided at the AOA House

In other action at the meeting:

▸ End-of-life care white paper. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting-opioid policy. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education resolution. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Call for end to consumer drug ads. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Statement on minority health disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders and individuals of disadvantaged backgrounds.”

▸ Support for EHRs. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems, developed by certified vendors, that meet current national standards.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students apparently favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group,” Dr. Nichols said.

She presented results of two surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% said they favored a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students apparently favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group,” Dr. Nichols said.

She presented results of two surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% said they favored a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students apparently favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, Karen J. Nichols, D.O., AOA board member and trustee, and dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group,” Dr. Nichols said.

She presented results of two surveys conducted this year: an AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs. In the larger survey, 70% said they favored a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs,” said Dr. Nichols.

Student leaders were unconvinced that a combined match would be a good idea. SOMA President Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told this newspaper that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Approximately half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, AOA board member and trustee Karen J. Nichols, D.O., dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: An AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs.

In the larger survey, 70% of students said they were in favor of a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs.”

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA president Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told FAMILY PRACTICE NEWS that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Other Issues at the House of Delegates

▸ End-of-life care. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting opioids. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Direct-to-consumer advertising. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Health Disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders, and individuals of disadvantaged backgrounds.”

▸ Electronic health records. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems that meet current national standards.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Approximately half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, AOA board member and trustee Karen J. Nichols, D.O., dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: An AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs.

In the larger survey, 70% of students said they were in favor of a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs.”

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA president Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told FAMILY PRACTICE NEWS that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Other Issues at the House of Delegates

▸ End-of-life care. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting opioids. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Direct-to-consumer advertising. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Health Disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders, and individuals of disadvantaged backgrounds.”

▸ Electronic health records. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems that meet current national standards.

CHICAGO — The American Osteopathic Association's House of Delegates at its annual meeting agreed to keep a controversial combined osteopathic/allopathic resident match proposal on life support for 1 more year, following lengthy testimony on the concept of combining the organization's Intern/Resident Registration Program with the National Resident Matching Program.

The original resolution on a combined match, presented by the Bureau of Osteopathic Education and the AOA Council on Postdoctoral Training, called for keeping the status quo—that is, two separate matches.

The resolution was amended in deference to the position of the two largest osteopathic student organizations, the Council of Osteopathic Student Government Presidents and the Student Osteopathic Medical Association (SOMA), which back further exploration of the issue.

As passed, the resolution resolves “that the AOA, in cooperation with the American Association of Colleges of Osteopathic Medicine, conduct a thorough analysis and evaluation of the benefits, detriments, and outcomes for the profession with respect to continuing a separate match vs. adoption of a single joint match and report the findings back to the AOA House of Delegates in 2006.”

Approximately half of graduating osteopathic medical students participate in the Intern/Resident Registration Program, which announces its results 1 month before the allopathic National Resident Matching Program (NRMP). Most of the remaining students apply through the NRMP to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Many students favor a joint match, believing the opportunity to rank osteopathic and allopathic programs simultaneously would give them additional program options without the need to choose one match or the other.

In reference committee, AOA board member and trustee Karen J. Nichols, D.O., dean of the Chicago College of Osteopathic Medicine, said a combined match would undermine the profession's “equal but separate” status, a view generally held by the AOA leadership. The existing match system provides students adequate opportunity to attain advanced placement into programs and training positions accredited by both AOA and ACGME, as well as to link from traditional internships into accredited residencies, she said.

“If there are 10,000 MD graduates every year and 2,000 DO graduates every year, and you put them together, who do you think is going to be running the program? The bigger group. So basically, we would be abdicating control over a major part of our training system,” Dr. Nichols said.

She reinforced her presentation with the results of two student surveys conducted this year: An AOA survey of 2,800 graduating doctors of osteopathy and her own survey of 300 students at her institution and the Arizona College of Osteopathic Medicine, conducted 1 month after completion of both match programs.

In the larger survey, 70% of students said they were in favor of a combined match. Furthermore, 75% responded that they had matched into their first-choice program, and 90% reported matching into their first- or second-choice program.

Results of the AOA survey suggested that the students who listed allopathic residencies as their first choice were most likely to add AOA positions if a combined match was offered. “If the student's first choice was an osteopathic residency, that was no problem,” said Dr. Nichols. “The group we were trying to tease out were those who listed allopathic first and osteopathic second. We chose this group because we had such a high percentage of students successfully matching in their first or second choice, and this is really the only group that would have been able to add more students to osteopathic programs.”

Student leaders at the meeting were unconvinced that a combined match would be a good idea. SOMA president Marty Knott said his organization believes “we don't know enough about the potential impact of a combined match, and it's hard for us as students to say how this will affect our profession.”

SOMA trustee and AOA alternate delegate Sean N. Martin, with the Virginia College of Osteopathic Medicine, told FAMILY PRACTICE NEWS that the major determinants of students' residency choices are location and quality.

If students “want to remain near their families or want to live in a particular area, they should be able to do that. If we can just take all the energy that we're using on the pros and cons of a joint match and rechannel that to come up with creative ways to increase the number of residency programs or dually accredited residency programs, I think that would be … in the best interests of the profession,” he said.

Other Issues at the House of Delegates

▸ End-of-life care. Delegates approved a white paper on end-of-life care and encouraged all osteopathic physicians to maintain competency in end-of-life care through educational programs such as the Web-based Osteopathic Education for Physicians on End-of-Life Care modules; to stay current with their state statues on the topic; and to engage patients and their families in discussion and documentation of advance care planning, including advance directives, hospice care, and palliative care.

▸ Long-acting opioids. Delegates passed a policy on long-acting opioid medication, stating that all patients have a basic right to medically appropriate intervention and/or treatment of acute and chronic pain and that it is “the right of all physicians to provide medically-appropriate intervention and treatment modalities that will achieve safe and effective pain control for all their patients.” The action follows formal opposition by the College of Osteopathic Family Physicians Board of Governors to “any federal law or regulation that attempts to limit the ability of family physicians to legally prescribe, administer, or dispense controlled substances.”

▸ Counterfeit-drug education. Delegates assented to a resolution that supports the efforts by the Food and Drug Administration to educate osteopathic physicians on how to identify counterfeit drugs, which account for “approximately 10% of the global medicine market.” DOs are encouraged to report counterfeit drugs through the FDA's Counterfeit Alert Network.

▸ Direct-to-consumer advertising. Delegates voted to encourage pharmaceutical companies to stop product-specific direct-to-consumer advertising. The resolution asks governments to adopt policies or legislation to promote disease-specific public health education as the focus of such advertising.

▸ Health Disparities. Delegates adopted a position statement on minority health disparities aimed at training culturally competent physicians and “increasing representation for African Americans, Hispanic Americans, Asian Americans, Native Americans, Pacific Islanders, and individuals of disadvantaged backgrounds.”

▸ Electronic health records. Delegates voted to support the implementation of electronic health records with e-prescribing capabilities and osteopathic principles and practices terminology. Delegates also backed the use of systems that meet current national standards.

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

More than 2,000 hospitals in the United States have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said.

“You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies targeted to identify missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated use of the SBAR (situation, background, assessment, and recommendation) technique, which was developed by a group at Kaiser Permanente of Colorado.

SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition, Dr. Whittington said.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” he said.

SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Public Would Like Some Results

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to do accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

More than 2,000 hospitals in the United States have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said.

“You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies targeted to identify missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated use of the SBAR (situation, background, assessment, and recommendation) technique, which was developed by a group at Kaiser Permanente of Colorado.

SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition, Dr. Whittington said.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” he said.

SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Public Would Like Some Results

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to do accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

More than 2,000 hospitals in the United States have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said.

“You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes, relationships, and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies targeted to identify missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, Ms. Simmonds added.

She and Dr. Whittington advocated use of the SBAR (situation, background, assessment, and recommendation) technique, which was developed by a group at Kaiser Permanente of Colorado.

SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition, Dr. Whittington said.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” he said.

SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Public Would Like Some Results

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 document, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults, conducted by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to do accomplish these things, but it takes time,” Mr. Wade said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute MI, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, she added.

Ms. Simmonds and Dr. Whittington advocated use of the SBAR technique (situation, background, assessment, and recommendation), which was developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” Dr. Whittington said. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Americans Want Medical Error Reports

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 report, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” he said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute MI, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, she added.

Ms. Simmonds and Dr. Whittington advocated use of the SBAR technique (situation, background, assessment, and recommendation), which was developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” Dr. Whittington said. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Americans Want Medical Error Reports

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 report, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” he said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — Expanded use of rapid-response teams should be a key element in efforts to reduce hospital mortality, speakers said at the annual meeting of the Society of Hospital Medicine.

“Few of us get good team training,” said John Whittington, M.D., coordinator of clinical informatics and patient safety officer at OSF Healthcare System, based in Peoria, Ill. “A rapid-response team of clinicians brings critical care expertise to the bedside, where they can assess, stabilize, improve communication, educate, support and assist with patient transfer when necessary.” As part of a systems approach to patient care, this SWAT approach helps to eliminate the cumbersome chain-of-command process.

Development of rapid-response teams is a cornerstone of the systems-based approach advocated by the “100,000 Lives Campaign” of the Institute for Healthcare Improvement, Cambridge, Mass. Supported by the American Medical Association and other private and public sector health care organizations, the campaign aims to prevent 100,000 unintended deaths by June 2006.

Other goals of the 100,000 Lives Campaign include delivery of evidence-based care for patients with acute MI, implementation of “medication reconciliation” to prevent prescribing errors, and use of science-based methods to prevent central-line infections, ventilator-associated pneumonia, and surgical-site infections.

More than 2,000 hospitals have joined the effort, Dr. Whittington said. “We decided that instead of a disease-specific focus, we'd go to a systems-specific focus to float the whole boat.” By improving teamwork and communications, “you can improve the whole situation in a hospital.”

“We can achieve a significant drop in all-cause mortality” by using rapid-response teams, he said. “You also see a significant drop in code rate per 1,000 discharges.” By improving outcomes and job satisfaction, rapid-response teams also may boost employee retention levels and reduce costs.

Dr. Whittington cited an Australian study showing that 76% of cardiac arrests followed more than 1 hour of ongoing instability (Med. J. Aust. 1999;171:22–5). This and other studies identifying missed warning signs show that there are “burning opportunities” for rapid-response teamwork in hospitals, he said.

Terri Simmonds, R.N., director of critical care and patient safety at the Institute for Healthcare Improvement, said that a rapid-response team might be staffed with a respiratory therapist, an intensivist, a hospitalist, a resident, and a physician assistant, depending on a hospital's situation and resources.

But when it comes to creating such a team, “the devil is in the details,” she said.

The clinicians who are assigned to the team must be ready to respond quickly, Ms. Simmonds said. “Many organizations set a minimum response time of 5–10 minutes, so that when the nurse on the floor activates the rapid-response team, she knows these individuals are going to show up in 5–10 minutes—and with smiles on their faces.”

Members of the rapid-response team need access to proven protocols so that they can take immediate action, she added.

Ms. Simmonds and Dr. Whittington advocated use of the SBAR technique (situation, background, assessment, and recommendation), which was developed by a group at Kaiser Permanente of Colorado. SBAR improves patient care by providing a framework for communication between members of the health care team about a patient's condition.

“Nurses are taught not to make diagnoses, and doctors are taught to get right to the punchline,” Dr. Whittington said. SBAR can encourage nurses to make recommendations that can improve the decision-making abilities of physicians who are willing to listen.

Americans Want Medical Error Reports

Nearly 6 years after an alarming Institute of Medicine report on hospital mortality, public trust in the nation's hospitals remains shaky, a spokesman for the American Hospital Association said at the meeting.

In that much-debated 1999 report, the IOM estimated that 45,000–98,000 U.S. patients were dying each year because of preventable medical errors.

“A lot of money and effort are being poured into patient safety, a lot of advocacy groups are inside our institutions, and a lot of hospitals are trying to create cultures of safety and all the rest, yet we have no data. … We have nothing that can assure the public that we're any safer today than we were 5 years ago,” Richard H. Wade said. The public “is going to begin to ask questions such as: 'How do you oversee the medical franchise inside your walls? How well are doctors doing at policing and overseeing each other so that the quality of care you put before us can be trusted?'”

In a 2004 poll of 2,012 adults by the Kaiser Family Foundation, 55% of those asked were dissatisfied with the quality of the care they received in the hospital, he said. Also, 70% of those polled said they would have greater confidence in a hospital that voluntarily reported errors. One-third of the participants said they or a family member had experienced a preventable medical error during a hospital stay; of that group, 70% said they were never told about being the victim of an error.

Overall, 92% of those polled said there should be public reporting of medical errors, up from 62% in a similar poll conducted in 2002.

None of this is lost on state and federal legislators who have drafted—or are drafting—legislation to make data on hospital medical errors open to public scrutiny, Mr. Wade noted. “Everybody wants to take charge of quality inside hospitals. … The government's trying to do it, and there's a lot of pressure to demonstrate the quality of care in the hospital.”

“Why haven't hospitals taken the lead to do these things themselves? We're trying to accomplish these things, but it takes time,” he said, pointing to the Hospital Quality Alliance sponsored by the AHA, the Association of American Medical Colleges, and the Federation of American Hospitals.

“We sat down 2 years ago and decided to begin to put data in front of the public,” he said. The resulting Web site,

www.hospitalcompare.com

CHICAGO — The Society of Hospital Medicine has taken a major step toward defining the core content areas and competencies for practicing hospitalists.

Members of SHM got their first glimpse of a draft document at the society's annual meeting. Authors of the curriculum hope that the document, which is considered a crucial part of becoming a bona fide specialty, will be published in early 2006, possibly in the first issue of the Journal of Hospital Medicine, which is scheduled for publication in January.

“The current iteration of the core curriculum that we've developed was really borne from the first education summit that SHM held in September 2002,” Michael J. Pistoria, D.O., chairman of the curriculum task force, said during the meeting in Chicago. “The concept of the core curriculum was really one of trying to find who we are and what we are. We know that what we do we do very well, [but] we don't always know how or why, and we don't know maybe how to teach [to achieve] the best possible hospitalists.”

The core curriculum will be a valuable resource for adult and pediatric hospitalists and for medical education, said Dr. Pistoria, associate program director at Lehigh Valley Hospital in Allentown, Pa.

“For example, a program director who wants to design a hospitalist track within his or her residency program, or a hospitalist fellowship, or even simply a class on congestive heart failure—say a lecture series—would have some of the core elements of that training,” he said. “And we felt we had significant buy-in from medical education.”

The content of the core curriculum will be available to institutions that decide to have a hospitalist track in their medical residency programs, or it could be part of the development of a hospitalist track within a fellowship, said coauthor Sylvia McKean, M.D., of Brigham and Women's Hospital, Boston. “For example, some programs have general internal medicine fellowships that take different paths, and they could use this for those people who are interested in doing research in hospital medicine and are eager to go down a hospitalist track.”

It's important to note that hospitalists do more than provide inpatient care, Dr. McKean said. They also “have the opportunity to lead, participate, and coordinate quality improvement projects in the local hospital.”

According to the American Hospital Association, some 1,200 U.S. hospitals now have hospitalist programs employing an estimated 10,000 physicians. More than 4,000 of these doctors are SHM members.

In addition to Dr. Pistoria and Dr. McKean, the core curriculum authors included: Alpesh Amin, M.D., University of California, Irvine; Tina Budnitz, Society of Hospital Medicine; and Daniel Dressler, M.D., Emory University, Atlanta.

CHICAGO — The Society of Hospital Medicine has taken a major step toward defining the core content areas and competencies for practicing hospitalists.

Members of SHM got their first glimpse of a draft document at the society's annual meeting. Authors of the curriculum hope that the document, which is considered a crucial part of becoming a bona fide specialty, will be published in early 2006, possibly in the first issue of the Journal of Hospital Medicine, which is scheduled for publication in January.

“The current iteration of the core curriculum that we've developed was really borne from the first education summit that SHM held in September 2002,” Michael J. Pistoria, D.O., chairman of the curriculum task force, said during the meeting in Chicago. “The concept of the core curriculum was really one of trying to find who we are and what we are. We know that what we do we do very well, [but] we don't always know how or why, and we don't know maybe how to teach [to achieve] the best possible hospitalists.”

The core curriculum will be a valuable resource for adult and pediatric hospitalists and for medical education, said Dr. Pistoria, associate program director at Lehigh Valley Hospital in Allentown, Pa.

“For example, a program director who wants to design a hospitalist track within his or her residency program, or a hospitalist fellowship, or even simply a class on congestive heart failure—say a lecture series—would have some of the core elements of that training,” he said. “And we felt we had significant buy-in from medical education.”

The content of the core curriculum will be available to institutions that decide to have a hospitalist track in their medical residency programs, or it could be part of the development of a hospitalist track within a fellowship, said coauthor Sylvia McKean, M.D., of Brigham and Women's Hospital, Boston. “For example, some programs have general internal medicine fellowships that take different paths, and they could use this for those people who are interested in doing research in hospital medicine and are eager to go down a hospitalist track.”

It's important to note that hospitalists do more than provide inpatient care, Dr. McKean said. They also “have the opportunity to lead, participate, and coordinate quality improvement projects in the local hospital.”

According to the American Hospital Association, some 1,200 U.S. hospitals now have hospitalist programs employing an estimated 10,000 physicians. More than 4,000 of these doctors are SHM members.

In addition to Dr. Pistoria and Dr. McKean, the core curriculum authors included: Alpesh Amin, M.D., University of California, Irvine; Tina Budnitz, Society of Hospital Medicine; and Daniel Dressler, M.D., Emory University, Atlanta.

CHICAGO — The Society of Hospital Medicine has taken a major step toward defining the core content areas and competencies for practicing hospitalists.

Members of SHM got their first glimpse of a draft document at the society's annual meeting. Authors of the curriculum hope that the document, which is considered a crucial part of becoming a bona fide specialty, will be published in early 2006, possibly in the first issue of the Journal of Hospital Medicine, which is scheduled for publication in January.

“The current iteration of the core curriculum that we've developed was really borne from the first education summit that SHM held in September 2002,” Michael J. Pistoria, D.O., chairman of the curriculum task force, said during the meeting in Chicago. “The concept of the core curriculum was really one of trying to find who we are and what we are. We know that what we do we do very well, [but] we don't always know how or why, and we don't know maybe how to teach [to achieve] the best possible hospitalists.”

The core curriculum will be a valuable resource for adult and pediatric hospitalists and for medical education, said Dr. Pistoria, associate program director at Lehigh Valley Hospital in Allentown, Pa.

“For example, a program director who wants to design a hospitalist track within his or her residency program, or a hospitalist fellowship, or even simply a class on congestive heart failure—say a lecture series—would have some of the core elements of that training,” he said. “And we felt we had significant buy-in from medical education.”

The content of the core curriculum will be available to institutions that decide to have a hospitalist track in their medical residency programs, or it could be part of the development of a hospitalist track within a fellowship, said coauthor Sylvia McKean, M.D., of Brigham and Women's Hospital, Boston. “For example, some programs have general internal medicine fellowships that take different paths, and they could use this for those people who are interested in doing research in hospital medicine and are eager to go down a hospitalist track.”

It's important to note that hospitalists do more than provide inpatient care, Dr. McKean said. They also “have the opportunity to lead, participate, and coordinate quality improvement projects in the local hospital.”

According to the American Hospital Association, some 1,200 U.S. hospitals now have hospitalist programs employing an estimated 10,000 physicians. More than 4,000 of these doctors are SHM members.

In addition to Dr. Pistoria and Dr. McKean, the core curriculum authors included: Alpesh Amin, M.D., University of California, Irvine; Tina Budnitz, Society of Hospital Medicine; and Daniel Dressler, M.D., Emory University, Atlanta.