Heidi Splete

ATLANTA — The yellow fever vaccine is contraindicated for individuals receiving immunosuppressive therapies and for those with immunosuppressant conditions, but it can be used with caution in pregnant and breastfeeding women and in HIV-infected individuals with mild immunosuppression and no symptoms.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) reached this conclusion at its fall meeting based on an evaluation of vaccine-associated serious adverse events in certain populations. ACIP recommended that the CDC update its current advisory for the use of yellow fever vaccine for U.S. citizens traveling to high-risk areas.

“Approximately 30,000 deaths are caused by yellow fever each year,” according to Dr. J. Erin Staples of the CDC.

A traveler's risk for yellow fever is based on several factors, including season of travel, immunization status, activities while traveling, and duration of exposure. Decisions regarding vaccination must balance the risk of contracting the disease against the risk of vaccine side effects, Dr. Staples said. The yellow fever vaccine is a live, attenuated vaccine, given as a single dose with a booster every 10 years. Some countries require proof of vaccination for travelers arriving from high-risk areas, she noted.

Safety studies have shown that approximately 10%-30% of vaccinees report mild systemic adverse events. Recent data suggest that the rate of serious events among vaccinees is 0.8/100,000 doses. Serious adverse events associated with the vaccine can include anaphylaxis, yellow fever–associated neurologic disease, and yellow fever vaccine–associated viscerotropic disease, she said.

The risk of transmission via breastfeeding is unknown. The working group recommended that yellow fever vaccine should be available to breastfeeding women if their travel to a high-risk area cannot be avoided or postponed, she said.

If a pregnant woman is planning to visit a region where the vaccine's potential risks outweigh the likelihood of contracting yellow fever, she should receive a medical waiver to fulfill international travel requirements, Dr. Staples said.

A section of the recommendations spells out additional circumstances for providing medical waivers, Dr. Staples said.

The yellow fever working group of ACIP determined that, based on the latest safety information, yellow fever vaccination is contraindicated for anyone with immunosuppression, including individuals with primary immunodeficiencies, malignant neoplasms, thymus disorder, transplants, and HIV infection with severe immunodeficiencies. The vaccine also is contraindicated in persons receiving radiation therapy, chemotherapy, high-dose systemic corticosteroids, and immunomodulatory drugs. Likewise, the vaccine is contraindicated for infants younger than 6 months of age and individuals with hypersensitivity to any of the vaccine's components.

ATLANTA — The yellow fever vaccine is contraindicated for individuals receiving immunosuppressive therapies and for those with immunosuppressant conditions, but it can be used with caution in pregnant and breastfeeding women and in HIV-infected individuals with mild immunosuppression and no symptoms.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) reached this conclusion at its fall meeting based on an evaluation of vaccine-associated serious adverse events in certain populations. ACIP recommended that the CDC update its current advisory for the use of yellow fever vaccine for U.S. citizens traveling to high-risk areas.

“Approximately 30,000 deaths are caused by yellow fever each year,” according to Dr. J. Erin Staples of the CDC.

A traveler's risk for yellow fever is based on several factors, including season of travel, immunization status, activities while traveling, and duration of exposure. Decisions regarding vaccination must balance the risk of contracting the disease against the risk of vaccine side effects, Dr. Staples said. The yellow fever vaccine is a live, attenuated vaccine, given as a single dose with a booster every 10 years. Some countries require proof of vaccination for travelers arriving from high-risk areas, she noted.

Safety studies have shown that approximately 10%-30% of vaccinees report mild systemic adverse events. Recent data suggest that the rate of serious events among vaccinees is 0.8/100,000 doses. Serious adverse events associated with the vaccine can include anaphylaxis, yellow fever–associated neurologic disease, and yellow fever vaccine–associated viscerotropic disease, she said.

The risk of transmission via breastfeeding is unknown. The working group recommended that yellow fever vaccine should be available to breastfeeding women if their travel to a high-risk area cannot be avoided or postponed, she said.

If a pregnant woman is planning to visit a region where the vaccine's potential risks outweigh the likelihood of contracting yellow fever, she should receive a medical waiver to fulfill international travel requirements, Dr. Staples said.

A section of the recommendations spells out additional circumstances for providing medical waivers, Dr. Staples said.

The yellow fever working group of ACIP determined that, based on the latest safety information, yellow fever vaccination is contraindicated for anyone with immunosuppression, including individuals with primary immunodeficiencies, malignant neoplasms, thymus disorder, transplants, and HIV infection with severe immunodeficiencies. The vaccine also is contraindicated in persons receiving radiation therapy, chemotherapy, high-dose systemic corticosteroids, and immunomodulatory drugs. Likewise, the vaccine is contraindicated for infants younger than 6 months of age and individuals with hypersensitivity to any of the vaccine's components.

ATLANTA — The yellow fever vaccine is contraindicated for individuals receiving immunosuppressive therapies and for those with immunosuppressant conditions, but it can be used with caution in pregnant and breastfeeding women and in HIV-infected individuals with mild immunosuppression and no symptoms.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) reached this conclusion at its fall meeting based on an evaluation of vaccine-associated serious adverse events in certain populations. ACIP recommended that the CDC update its current advisory for the use of yellow fever vaccine for U.S. citizens traveling to high-risk areas.

“Approximately 30,000 deaths are caused by yellow fever each year,” according to Dr. J. Erin Staples of the CDC.

A traveler's risk for yellow fever is based on several factors, including season of travel, immunization status, activities while traveling, and duration of exposure. Decisions regarding vaccination must balance the risk of contracting the disease against the risk of vaccine side effects, Dr. Staples said. The yellow fever vaccine is a live, attenuated vaccine, given as a single dose with a booster every 10 years. Some countries require proof of vaccination for travelers arriving from high-risk areas, she noted.

Safety studies have shown that approximately 10%-30% of vaccinees report mild systemic adverse events. Recent data suggest that the rate of serious events among vaccinees is 0.8/100,000 doses. Serious adverse events associated with the vaccine can include anaphylaxis, yellow fever–associated neurologic disease, and yellow fever vaccine–associated viscerotropic disease, she said.

The risk of transmission via breastfeeding is unknown. The working group recommended that yellow fever vaccine should be available to breastfeeding women if their travel to a high-risk area cannot be avoided or postponed, she said.

If a pregnant woman is planning to visit a region where the vaccine's potential risks outweigh the likelihood of contracting yellow fever, she should receive a medical waiver to fulfill international travel requirements, Dr. Staples said.

A section of the recommendations spells out additional circumstances for providing medical waivers, Dr. Staples said.

The yellow fever working group of ACIP determined that, based on the latest safety information, yellow fever vaccination is contraindicated for anyone with immunosuppression, including individuals with primary immunodeficiencies, malignant neoplasms, thymus disorder, transplants, and HIV infection with severe immunodeficiencies. The vaccine also is contraindicated in persons receiving radiation therapy, chemotherapy, high-dose systemic corticosteroids, and immunomodulatory drugs. Likewise, the vaccine is contraindicated for infants younger than 6 months of age and individuals with hypersensitivity to any of the vaccine's components.

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

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

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

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

The RACE program divided North Carolina into five regions, with at least one PCI-capable hospital in each region.

The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after RACE implementation.

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

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

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

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

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

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina.

A video interview with Dr. Glickman is at www.youtube.com/cardiologynews

For details on the RACE initiative, visit www.nccacc.org/race.html

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

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

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

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

The RACE program divided North Carolina into five regions, with at least one PCI-capable hospital in each region.

The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after RACE implementation.

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

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

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

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

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

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina.

A video interview with Dr. Glickman is at www.youtube.com/cardiologynews

For details on the RACE initiative, visit www.nccacc.org/race.html

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

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

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

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

The RACE program divided North Carolina into five regions, with at least one PCI-capable hospital in each region.

The investigators compared 518 patients treated prior to the RACE initiative and 405 patients treated after the initiative. The patients ranged in age from 51 to 73 years, and the baseline characteristics were similar in patients seen before and after RACE implementation.

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

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

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

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

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

The research was supported by the American Heart Association, the Robert Wood Johnson Foundation, and Blue Cross Blue Shield of North Carolina.

A video interview with Dr. Glickman is at www.youtube.com/cardiologynews

For details on the RACE initiative, visit www.nccacc.org/race.html

ATLANTA — The meningococcal working group of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices believes that “ACIP should consider not adding meningococcal conjugate vaccines to the routine infant vaccine schedule at this time,” said working group member Dr. Amanda Cohn.

At its fall meeting, ACIP discussed safety and epidemiology data on meningococcal vaccines in development for infants. These products have not yet been licensed.

The low burden of meningococcal disease in infants raises the question of whether every vaccine that is shown to be safe and effective should be recommended if the burden of disease is low, said Dr. H. Cody Meissner, chair of the working group.

The last ACIP recommendations for meningococcal vaccines were published in May 2005, and an update is planned for 2010, he noted.

ACIP heard information about three potential meningococcal vaccines in development that would involve either a two-dose or four-dose series.

Early data have shown that the vaccine is highly immunogenic, but concerns persist about the already crowded infant vaccination schedule and catch-up recommendations, and the need for boosters to maintain protection until adolescence, Dr. Cohn commented.

ACIP will hear data about cost-effectiveness and vaccine acceptability at its February 2010 meeting, she noted.

ATLANTA — The meningococcal working group of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices believes that “ACIP should consider not adding meningococcal conjugate vaccines to the routine infant vaccine schedule at this time,” said working group member Dr. Amanda Cohn.

At its fall meeting, ACIP discussed safety and epidemiology data on meningococcal vaccines in development for infants. These products have not yet been licensed.

The low burden of meningococcal disease in infants raises the question of whether every vaccine that is shown to be safe and effective should be recommended if the burden of disease is low, said Dr. H. Cody Meissner, chair of the working group.

The last ACIP recommendations for meningococcal vaccines were published in May 2005, and an update is planned for 2010, he noted.

ACIP heard information about three potential meningococcal vaccines in development that would involve either a two-dose or four-dose series.

Early data have shown that the vaccine is highly immunogenic, but concerns persist about the already crowded infant vaccination schedule and catch-up recommendations, and the need for boosters to maintain protection until adolescence, Dr. Cohn commented.

ACIP will hear data about cost-effectiveness and vaccine acceptability at its February 2010 meeting, she noted.

ATLANTA — The meningococcal working group of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices believes that “ACIP should consider not adding meningococcal conjugate vaccines to the routine infant vaccine schedule at this time,” said working group member Dr. Amanda Cohn.

At its fall meeting, ACIP discussed safety and epidemiology data on meningococcal vaccines in development for infants. These products have not yet been licensed.

The low burden of meningococcal disease in infants raises the question of whether every vaccine that is shown to be safe and effective should be recommended if the burden of disease is low, said Dr. H. Cody Meissner, chair of the working group.

The last ACIP recommendations for meningococcal vaccines were published in May 2005, and an update is planned for 2010, he noted.

ACIP heard information about three potential meningococcal vaccines in development that would involve either a two-dose or four-dose series.

Early data have shown that the vaccine is highly immunogenic, but concerns persist about the already crowded infant vaccination schedule and catch-up recommendations, and the need for boosters to maintain protection until adolescence, Dr. Cohn commented.

ACIP will hear data about cost-effectiveness and vaccine acceptability at its February 2010 meeting, she noted.

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted in favor of a permissive recommendation to vaccinate males aged 9–26 years with the quadrivalent human papillomavirus vaccine.

ACIP also approved the statement that the human papillomavirus (HPV) vaccine would be most effective if given before young men become sexually active. Research has suggested that the vaccine “would be most effective if given prior to sexual debut,” said the CDC's Dr. Eileen Dunne, who presented background data and considerations for the quadrivalent HPV vaccine (Gardasil) in males.

Studies have shown that men have a similar prevalence of HPV compared with women, and that approximately 70% of men will have had vaginal sex by 19 years of age, Dr. Dunne said.

In clinical trials, the vaccine showed a 93% efficacy against HPV type 11 and 88% efficacy against HPV type 6, the two types of virus that have been associated with more than 90% of cases of genital warts in men.

The CDC's Harrell Chesson, Ph.D., presented cost-effectiveness data on male HPV vaccination, which suggested that vaccinating males would be most cost effective if HPV vaccination coverage in females was relatively low. In Dr. Chesson's model, the incremental cost per quality-of-life year gained was $47,500 for all outcomes, including cervical cancer and genital warts, if female vaccine coverage was 45% vs. $161,500 if coverage in women was 70%.

Adverse events were similar in the vaccine group vs. the placebo group. The most common adverse event was pain at the injection site, reported in 64% of the vaccine group and 53% of the placebo group.

Several studies have shown that HPV vaccination for boys and young men would be accepted by most health care providers, boys and men in the target age group, and parents, Dr. Dunne said.

The relatively high cost of the vaccine remains a challenge, at $130 per dose for private insurerers, but the estimated direct medical costs of genital warts in the United States is more than $2 million annually, Dr. Dunne said.

“Now boys and men aged 9–26 years can get the HPV4 vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, and the American College of Physicians liaison to ACIP, said in an interview. ACIP approved permissive, rather than routine, use of the vaccine, which means, she said, that the vaccine “won't be promoted” for males, “but it will be available,” and parents who ask can get it for their children.

The committee voted in favor of adding the quadrivalent HPV vaccine for males to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit www.cdc.gov/vaccines/recs/acip

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted in favor of a permissive recommendation to vaccinate males aged 9–26 years with the quadrivalent human papillomavirus vaccine.

ACIP also approved the statement that the human papillomavirus (HPV) vaccine would be most effective if given before young men become sexually active. Research has suggested that the vaccine “would be most effective if given prior to sexual debut,” said the CDC's Dr. Eileen Dunne, who presented background data and considerations for the quadrivalent HPV vaccine (Gardasil) in males.

Studies have shown that men have a similar prevalence of HPV compared with women, and that approximately 70% of men will have had vaginal sex by 19 years of age, Dr. Dunne said.

In clinical trials, the vaccine showed a 93% efficacy against HPV type 11 and 88% efficacy against HPV type 6, the two types of virus that have been associated with more than 90% of cases of genital warts in men.

The CDC's Harrell Chesson, Ph.D., presented cost-effectiveness data on male HPV vaccination, which suggested that vaccinating males would be most cost effective if HPV vaccination coverage in females was relatively low. In Dr. Chesson's model, the incremental cost per quality-of-life year gained was $47,500 for all outcomes, including cervical cancer and genital warts, if female vaccine coverage was 45% vs. $161,500 if coverage in women was 70%.

Adverse events were similar in the vaccine group vs. the placebo group. The most common adverse event was pain at the injection site, reported in 64% of the vaccine group and 53% of the placebo group.

Several studies have shown that HPV vaccination for boys and young men would be accepted by most health care providers, boys and men in the target age group, and parents, Dr. Dunne said.

The relatively high cost of the vaccine remains a challenge, at $130 per dose for private insurerers, but the estimated direct medical costs of genital warts in the United States is more than $2 million annually, Dr. Dunne said.

“Now boys and men aged 9–26 years can get the HPV4 vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, and the American College of Physicians liaison to ACIP, said in an interview. ACIP approved permissive, rather than routine, use of the vaccine, which means, she said, that the vaccine “won't be promoted” for males, “but it will be available,” and parents who ask can get it for their children.

The committee voted in favor of adding the quadrivalent HPV vaccine for males to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit www.cdc.gov/vaccines/recs/acip

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted in favor of a permissive recommendation to vaccinate males aged 9–26 years with the quadrivalent human papillomavirus vaccine.

ACIP also approved the statement that the human papillomavirus (HPV) vaccine would be most effective if given before young men become sexually active. Research has suggested that the vaccine “would be most effective if given prior to sexual debut,” said the CDC's Dr. Eileen Dunne, who presented background data and considerations for the quadrivalent HPV vaccine (Gardasil) in males.

Studies have shown that men have a similar prevalence of HPV compared with women, and that approximately 70% of men will have had vaginal sex by 19 years of age, Dr. Dunne said.

In clinical trials, the vaccine showed a 93% efficacy against HPV type 11 and 88% efficacy against HPV type 6, the two types of virus that have been associated with more than 90% of cases of genital warts in men.

The CDC's Harrell Chesson, Ph.D., presented cost-effectiveness data on male HPV vaccination, which suggested that vaccinating males would be most cost effective if HPV vaccination coverage in females was relatively low. In Dr. Chesson's model, the incremental cost per quality-of-life year gained was $47,500 for all outcomes, including cervical cancer and genital warts, if female vaccine coverage was 45% vs. $161,500 if coverage in women was 70%.

Adverse events were similar in the vaccine group vs. the placebo group. The most common adverse event was pain at the injection site, reported in 64% of the vaccine group and 53% of the placebo group.

Several studies have shown that HPV vaccination for boys and young men would be accepted by most health care providers, boys and men in the target age group, and parents, Dr. Dunne said.

The relatively high cost of the vaccine remains a challenge, at $130 per dose for private insurerers, but the estimated direct medical costs of genital warts in the United States is more than $2 million annually, Dr. Dunne said.

“Now boys and men aged 9–26 years can get the HPV4 vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, and the American College of Physicians liaison to ACIP, said in an interview. ACIP approved permissive, rather than routine, use of the vaccine, which means, she said, that the vaccine “won't be promoted” for males, “but it will be available,” and parents who ask can get it for their children.

The committee voted in favor of adding the quadrivalent HPV vaccine for males to the CDC's Vaccines for Children program.

For the latest information on ACIP vaccine recommendations, visit www.cdc.gov/vaccines/recs/acip

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

“Now women have two choices when it comes to a cervical cancer vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, Georgia, and the American College of Physicians liaison to ACIP, said in an interview. The bivalent vaccine contains an adjuvant, AS04, that “adds a little immunogenic punch,” she said. And now that clinicians have the option to choose between two vaccines, “we hope that the cost will come down,” Dr. Fryhofer added.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses. The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program. For more information, visit www.cdc.gov/vaccines/recs/acip

The bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

“Now women have two choices when it comes to a cervical cancer vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, Georgia, and the American College of Physicians liaison to ACIP, said in an interview. The bivalent vaccine contains an adjuvant, AS04, that “adds a little immunogenic punch,” she said. And now that clinicians have the option to choose between two vaccines, “we hope that the cost will come down,” Dr. Fryhofer added.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses. The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program. For more information, visit www.cdc.gov/vaccines/recs/acip

The bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

ATLANTA — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommended a bivalent human papillomavirus vaccine as an alternative to the quadrivalent vaccine for the prevention of cervical cancer and related precancerous conditions in women and girls aged 9–26 years. ACIP made the recommendation at its annual fall meeting

The bivalent human papillomavirus (HPV) vaccine (GlaxoSmithKline's Cervarix) was recently approved by the Food and Drug Administration. The vaccine provides clinicians with another option to vaccinate adolescent girls and young women against diseases caused by HPV types 16 and 18. But unlike the quadrivalent vaccine, the bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC, who presented the ACIP recommendations for the use of the bivalent vaccine.

The quadrivalent vaccine (Merck & Co.'s Gardasil) protects against genital warts associated with HPV types 6 and 11, in addition to protecting against diseases caused by HPV types 16 and 18.

ACIP recommended against a statement of no preference between the bivalent and quadrivalent vaccines after a lively debate. Instead, the recommendations will present the information about the two vaccines without a statement of preference or a statement of nonpreference. The recommendations state that the two vaccines can be used interchangeably to complete the three-dose series, but that using the same vaccine for the entire series is preferable. The bivalent vaccine, like the quadrivalent vaccine, is not a live vaccine, and it can be given simultaneously with other vaccines.

“Now women have two choices when it comes to a cervical cancer vaccine,” Dr. Sandra Fryhofer, an internist in private practice in Atlanta, Georgia, and the American College of Physicians liaison to ACIP, said in an interview. The bivalent vaccine contains an adjuvant, AS04, that “adds a little immunogenic punch,” she said. And now that clinicians have the option to choose between two vaccines, “we hope that the cost will come down,” Dr. Fryhofer added.

ACIP also voted to harmonize the age ranges for the two vaccines, with first doses given at ages 11–12 years and recommended second and third doses at 1–2 months and 6 months after the first dose. The recommended minimum dosing intervals remained as 4 weeks between the first and second dose and 12 weeks between the second and third doses. The vaccine can be initiated as young as 9 years, and catch-up vaccination is recommended for females aged 13–26 years.

The committee voted to add the bivalent vaccine to the CDC's Vaccines for Children program. For more information, visit www.cdc.gov/vaccines/recs/acip

The bivalent vaccine is not designed to protect against genital warts, noted Dr. Lauri Markowitz of the CDC.

Source Parker Smith/Elsevier Global Medical News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Go to www.youtube.com/InternalMedicineNews

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

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

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

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

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

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

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

Go to www.youtube.com/InternalMedicineNews

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

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

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

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

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

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

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

Go to www.youtube.com/InternalMedicineNews