Heidi Splete

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Approximately 87% of large, high-volume emergency departments “board” admitted patients for more than 2 hours, based on the latest estimates from the National Hospital Ambulatory Medical Care Survey of 337 emergency departments.

Large emergency departments—defined as those that handle more than 50,000 visits per year—make up only 18% of all EDs in the United States, but they manage approximately 44% of all ED visits, Linda McCaig of the Centers for Disease Control and Prevention said at a workshop sponsored by the Institute of Medicine.

Ms. McCaig shared ED estimates for items that were added to the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) hospital induction interview in the wake of the 2006 IOM report on emergency care in the United States.

The report raised concerns about overcrowding, fragmentation of care, lack of disaster preparedness, and the need for better emergency care for children.

The NHAMCS was designed to collect, analyze, and share information about the health care in emergency departments and outpatient medical departments. The data are collected from a national sample of hospitals across the United States, excluding federal, military, and Veterans Affairs facilities.

Data are taken from patient record forms, which are completed by hospital staff based on instructions from the CDC.

Overall, 63% of EDs board patients, including 83% of medium-sized EDs (20,000-50,000 visits per year) and 39% of small EDs (fewer than 20,000 visits per year).

Just over half (51%) of all EDs reported having a designated inpatient bed coordinator to help manage patient flow, including 71% of large EDs, 63% of medium EDs, and 34% of small EDs.

One-third of all EDs in the United States don't use any type of electronic medical records, including 18% of large EDs, 26% of medium EDs, and 54% of small EDs, Ms. McCaig said.

These NHAMCS data provide an example of how EDs are responding to the recommendations from the 2006 IOM report, which include creating a coordinated, regionalized system for emergency care and putting an end to the practice of boarding ED patients and diverting ambulances.

“This meeting and the two that will follow in the next few months are an opportunity, 3 years later, to revisit the committee's recommendations, to assess what progress we have made in achieving the committee's overall vision of a regionalized, coordinated, and accountable emergency care system,” said Dr. Arthur Kellermann, a professor and associate dean for health policy at Emory University in Atlanta, who served as the workshop chair.

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exposure to environmental asthma triggers at home was significantly associated with an increased risk of asthma-related hospitalizations in children younger than 4 years, compared with older children, based on data from 306 children up to 18 years old.

The percentage of hospitalizations for asthma in younger children also rose significantly with the number of home triggers, said Elizabeth Banda of the University of Illinois at Chicago.

Ms. Banda and her colleagues reviewed data from children with asthma enrolled in an asthma prevention program. The children were divided into three age groups: 0-4 years, 5-11 years, and 12 and older. The researchers collected data on hospitalizations and on the indoor allergens in each child's home via questionnaires.

Compared with older children, asthma hospitalizations in children aged 0-4 years were more than three times as likely to be associated with smoke, molds, or dampness; more than four times as likely to be associated with basement use and rodents; and more than five times as likely to be associated with roaches and clutter. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Also, in children 0-4 years of age, the risk of asthma hospitalization was 9 times greater if they were exposed to five to six of these home conditions, compared with zero to four, and nearly 16 times greater if they were exposed to more than six.

The results were limited by the small sample size, cross-sectional design, and a lack of information about the degree of exposure to indoor environmental allergens. The findings suggest that younger children may be at greater risk because they spend more time in the home being exposed to indoor environmental triggers, compared with older children, the researchers said.

The study was supported by Merck Childhood Asthma Network Inc. Ms. Banda said she had no financial conflicts to disclose.

ELSEVIER GLOBAL MEDICAL NEWS

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

None of 26 health care workers infected with the novel influenza A (H1N1) virus fully followed the Centers for Disease Control and Prevention's recommended infection control practices, based on CDC data presented at a press briefing.

“The single most important thing is that infectious patients be identified at the front door,” said Dr. Michael Bell of the CDC's National Center for Preparedness, Detection, and Control of Infectious Diseases. “Identifying them up front is essential to let health care personnel know that they should be doing the things that we recommend,” he said.

The CDC investigators determined that 13 (50%) of the 26 cases were contracted in health care settings, with 12 cases of transmission from patients to health care providers and 1 case of transmission from one health care provider to another.

A total of 11 providers of the 12 cases of patient-to-provider transmission reported their use of protective equipment when caring for a patient infected with the H1N1 virus. None reported always using gloves, gowns, and either a mask or an N95 respirator. Only three said they always wore a mask or N95 respirator, five said they always wore gloves, and none said they used eye protection.

The CDC's recommendations for health care personnel include staying home when ill, washing hands frequently, and using protective gear including surgical masks, N95 respirators, gloves, and surgical gowns, as well as eye protection.

The results suggest that health care providers aren't overrepresented among reported cases of the H1N1 virus so far.

The data emphasize the need for health care facilities to adhere to infection control recommendations, identify and triage potentially infectious patients, provide infection control resources, and train staff in infection control practices, the CDC researchers noted.

The study was limited by several factors, however, including potential recall bias, the small number of cases, and the lack of information about several infection control practices, including hand hygiene, the CDC researchers wrote (MMWR 2009;58:641-5).

Data on additional cases in health care providers are under review, Dr. Bell said.

Transmission of the H1N1 virus in the United States is expected to continue throughout the summer and increase in the fall, Dr. Daniel Jernigan, a medical epidemiologist in the CDC's Influenza Division, said during the briefing.

On its Web site, the CDC has posted H1N1 guidance for those attending summer camps, Dr. Jernigan said.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

WASHINGTON — The prevalence of asthma as a principal reason for hospitalization has remained steady, but its prevalence as a secondary diagnosis has increased by 113% in hospitalized adults and by 54% in hospitalized children, based on approximately 9 years of data from two large databases.

The number of adult hospital stays with asthma as a secondary diagnosis rose from 753,800 in 1997 to nearly 1.5 million in 2005. (For 2006, the number was estimated at slightly more than 1.6 million, based on incomplete data.) The number of pediatric hospital stays with asthma as a secondary diagnosis rose from 128,300 in 1997 to 197,000 in 2006.

The five most common reasons for hospital stays in 2006 in adults with asthma as secondary diagnosis were pneumonia (6.6%), heart failure (3.9%), nonspecific chest pain (3.8%), osteoarthritis (3.3%), and mood disorders (3.3%). The five most common reasons for hospital stays in children with asthma as a secondary diagnosis were pneumonia (27%), acute bronchitis (8.8%), mood disorders (5.5%), appendicitis (2.7%), and fluid and electrolyte disorders (2.4%), reported Chaya Merrill, M.P.H., Dr.P.H., of Thomson Reuters, and her colleagues.

They reviewed data from the Healthcare Cost and Utilization Project (HCUP), a collection of databases supported by the Agency for Healthcare Research and Quality. The results were presented in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The data for the study were obtained from the Nationwide Inpatient Sample (NIS), which includes 90% of adult hospitalizations, and the Kids' Inpatient Database (KID), which represents 80% of pediatric hospitalizations.

In adults, the hospitalizations involving asthma as either a primary or secondary diagnosis were highest in those aged 65 years and older. Overall, hospitalization rates rose with increasing age, starting at 18 years.

In children, hospitalizations involving asthma as a primary or secondary diagnosis were highest in those younger than 1 year (about 8 per 1,000 children) and lowest among those aged 15-17 years (about 2 per 1,000 children).

In adults, average rates of hospitalization with asthma as a secondary condition were highest in the Northwest and Midwest, and were lower in the South and West (10.6, 8.7, 6.9, and 6.0 stays per 1,000 persons, respectively). In children, average rates of hospitalization with asthma as a secondary condition were 3 stays per 1,000 persons in the Northeast, Midwest, and South, and 2 stays per 1,000 persons in the West.

For both adults and children, rates of hospitalization with asthma as either a primary or secondary diagnosis were higher in communities with a median income of $38,000 or less than in wealthier communities, the researchers noted.

The study was sponsored by the Agency for Healthcare Research and Quality, a branch of the United States Department of Health and Human Services.

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN

Dermatologists who master the use of facial nerve blocks can make nonsurgical procedures more comfortable for patients, according to Dr. Howard K. Steinman.

The concept of "nonsurgical" cosmetic procedures creates an expectation that the procedures may be painless, said Dr. Steinman, who is in private practice in Chula Vista, Calif. Facial nerve blocks help doctors deliver on that expectation.

Other advantages include minimizing tissue distortion and allowing physicians to use smaller doses of local anesthetic, which means less risk of systemic toxicity, he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation (SDEF).

Because facial nerve blocks provide significant regional anesthesia with minimal vasoconstriction, physicians still may wish to inject local anesthesia containing epinephrine, he said. Prime locations include the forehead, nose, nasolabial fold, cheek and upper lip, and chin and lower lip.

The injections for forehead nerve blocks are placed to block the supraorbital, supratrochlear, and infratrochlear nerves as they exit the skull. "Enter just lateral to the supraorbital notch above the eyebrow and advance the needle submuscularly just above the brow to the middle of the medial canthus," Dr. Steinman explained.

For an external nasal nerve block, inject the block just lateral to the midline just below the junction of the lateral cartilage and the nasal bone, he said. Advance the needle from this single point.

An infraorbital block may be placed using either an external or internal (intraoral) approach. Dr. Steinman said that he prefers the intraoral approach. To take the intraoral route, place the third finger of the nondominant hand near the midline of the inferior orbital rim, and retract the lip between your nondominant thumb and index finger. "Insert the needle above the canine tooth at the gingival buccal sulcus—advance the needle about 1 cm towards your third finger while injecting," said Dr. Steinman. Alternatively, take the percutaneous route: Palpate for the infraorbital foramen and insert the needle perpendicular to the skin just below it to near the maxillary bone, and inject anesthetic.

Similarly, nerve blocks injected in the chin and lower lip can be performed with an internal or external approach.

Injections through the labial mucosa to anesthetize just the upper and lower lip also can be part of a facial nerve block protocol, said Dr. Steinman. Start with the upper lip by applying topical anesthesia gel and injecting small amounts of anesthesia approximately half a centimeter above the gingival-labial sulcus above the oral commissure, he explained.

Then inject submucosally, medially from this point along the sulcus to the frenulum and repeat on the opposite side. Be sure to inject a small amount of anesthesia at the midline, directly from the sulcus next to the frenulum toward the nasal septum, he added.

For the lower lip, start at the point below the oral commissure on the contralateral side and inject submucosally in the sulcus. The mucosal block will not anesthetize the skin at the oral commissures, so those areas must be anesthetized by direct submucosal injections after applying anesthetic gel.

He reported having no financial conflicts to disclose. SDEFand this news organization are owned by Elsevier.

An injection in the midline toward the nose will block the midline upper lip. COURTESY DR. HOWARD K. STEINMAN

PENTAGON CITY, VA. — Women with complex vulvar pain reported greater decreases in sexual function but similar levels of sexual desire and frequency of intercourse, compared with women with provoked vestibulodynia, a study of 189 women shows.

Provoked vestibulodynia (PVD) is the most common subtype of vulvodynia, and it involves pain that is localized at the vaginal opening and triggered by sexual intercourse, said Kelly B. Smith, of Queens University in Kingston (Ont.).

But the characteristics and side effects of other forms of vulvodynia have not been well studied, Ms. Smith said.

To compare pain locations and sexual function between women with localized vs. generalized pain, Ms. Smith and her colleagues reviewed data from 72 women with provoked vestibulodynia, 44 women who reported complex vulvar pain (defined as pain not localized or provoked), and 73 controls. The results were presented at the annual meeting of the Society for Sex Therapy and Research.

All the women were in heterosexual relationships. The average age of the women who reported pain was 36 years, and the average age of the controls was 27 years. The women with PVD had experienced pain for an average of 7 years, and the women with complex pain had experienced pain for an average of 8 years. The participants were assessed using an online survey and the Female Sexual Function Index, the Golombok-Rust Inventory of Sexual Satisfaction, the Dyadic Adjustment Scale, and the Dyadic Sexual Communication Scale.

Most of the women with complex pain reported generalized and localized pain, both provoked and unprovoked. A woman could report pain over her whole vulvar region generally, and then report localized pain during intercourse, Ms. Smith explained. A total of 41% of the women with complex pain reported generalized and localized pain, in addition to provoked and unprovoked pain.

Overall, the women with complex pain had worse sexual function, and more problems specifically with arousal, lubrication, orgasm, and penetration pain, compared to the women with PVD. But the complex pain and PVD groups had similar scores on measures of desire, sexual satisfaction, relationship quality, and sex frequency. “Even though women with pain were more sexually dysfunctional, they valued sex just as much as control women,” she said.

The reported frequency of intercourse was similar among women in the PVD group vs. the complex pain group, but a highly significant difference was found between the pain groups and the controls. The control women reported sex an average of 52 times during the last 6 months, compared with an average of 12 times in 6 months in the two pain groups.

There were no differences in terms of self-reported desire and no differences in sexual satisfaction between the complex pain and PVD groups, and no significant differences were observed in overall relationship quality. “But when we looked at controls, the women with pain of any type had worse relationship quality compared to controls, and less affection and cohesion with their partners,” Ms. Smith said.

The results support findings from previous studies, and the data suggest that vulvodynia has distinct pain characteristics and might be more complicated than previously thought, Ms. Smith said.

The study was limited by a lack of information about sexual partners of women with PVD vs. those with complex pain, she noted.

Additional research is needed to address issues including the presentation and etiology of vulvodynia, as well as implications for treatment.

Ms. Smith had no financial conflicts to disclose.

PENTAGON CITY, VA. — Women with complex vulvar pain reported greater decreases in sexual function but similar levels of sexual desire and frequency of intercourse, compared with women with provoked vestibulodynia, a study of 189 women shows.

Provoked vestibulodynia (PVD) is the most common subtype of vulvodynia, and it involves pain that is localized at the vaginal opening and triggered by sexual intercourse, said Kelly B. Smith, of Queens University in Kingston (Ont.).

But the characteristics and side effects of other forms of vulvodynia have not been well studied, Ms. Smith said.

To compare pain locations and sexual function between women with localized vs. generalized pain, Ms. Smith and her colleagues reviewed data from 72 women with provoked vestibulodynia, 44 women who reported complex vulvar pain (defined as pain not localized or provoked), and 73 controls. The results were presented at the annual meeting of the Society for Sex Therapy and Research.

All the women were in heterosexual relationships. The average age of the women who reported pain was 36 years, and the average age of the controls was 27 years. The women with PVD had experienced pain for an average of 7 years, and the women with complex pain had experienced pain for an average of 8 years. The participants were assessed using an online survey and the Female Sexual Function Index, the Golombok-Rust Inventory of Sexual Satisfaction, the Dyadic Adjustment Scale, and the Dyadic Sexual Communication Scale.

Most of the women with complex pain reported generalized and localized pain, both provoked and unprovoked. A woman could report pain over her whole vulvar region generally, and then report localized pain during intercourse, Ms. Smith explained. A total of 41% of the women with complex pain reported generalized and localized pain, in addition to provoked and unprovoked pain.

Overall, the women with complex pain had worse sexual function, and more problems specifically with arousal, lubrication, orgasm, and penetration pain, compared to the women with PVD. But the complex pain and PVD groups had similar scores on measures of desire, sexual satisfaction, relationship quality, and sex frequency. “Even though women with pain were more sexually dysfunctional, they valued sex just as much as control women,” she said.

The reported frequency of intercourse was similar among women in the PVD group vs. the complex pain group, but a highly significant difference was found between the pain groups and the controls. The control women reported sex an average of 52 times during the last 6 months, compared with an average of 12 times in 6 months in the two pain groups.

There were no differences in terms of self-reported desire and no differences in sexual satisfaction between the complex pain and PVD groups, and no significant differences were observed in overall relationship quality. “But when we looked at controls, the women with pain of any type had worse relationship quality compared to controls, and less affection and cohesion with their partners,” Ms. Smith said.

The results support findings from previous studies, and the data suggest that vulvodynia has distinct pain characteristics and might be more complicated than previously thought, Ms. Smith said.

The study was limited by a lack of information about sexual partners of women with PVD vs. those with complex pain, she noted.

Additional research is needed to address issues including the presentation and etiology of vulvodynia, as well as implications for treatment.

Ms. Smith had no financial conflicts to disclose.

PENTAGON CITY, VA. — Women with complex vulvar pain reported greater decreases in sexual function but similar levels of sexual desire and frequency of intercourse, compared with women with provoked vestibulodynia, a study of 189 women shows.

Provoked vestibulodynia (PVD) is the most common subtype of vulvodynia, and it involves pain that is localized at the vaginal opening and triggered by sexual intercourse, said Kelly B. Smith, of Queens University in Kingston (Ont.).

But the characteristics and side effects of other forms of vulvodynia have not been well studied, Ms. Smith said.

To compare pain locations and sexual function between women with localized vs. generalized pain, Ms. Smith and her colleagues reviewed data from 72 women with provoked vestibulodynia, 44 women who reported complex vulvar pain (defined as pain not localized or provoked), and 73 controls. The results were presented at the annual meeting of the Society for Sex Therapy and Research.

All the women were in heterosexual relationships. The average age of the women who reported pain was 36 years, and the average age of the controls was 27 years. The women with PVD had experienced pain for an average of 7 years, and the women with complex pain had experienced pain for an average of 8 years. The participants were assessed using an online survey and the Female Sexual Function Index, the Golombok-Rust Inventory of Sexual Satisfaction, the Dyadic Adjustment Scale, and the Dyadic Sexual Communication Scale.

Most of the women with complex pain reported generalized and localized pain, both provoked and unprovoked. A woman could report pain over her whole vulvar region generally, and then report localized pain during intercourse, Ms. Smith explained. A total of 41% of the women with complex pain reported generalized and localized pain, in addition to provoked and unprovoked pain.

Overall, the women with complex pain had worse sexual function, and more problems specifically with arousal, lubrication, orgasm, and penetration pain, compared to the women with PVD. But the complex pain and PVD groups had similar scores on measures of desire, sexual satisfaction, relationship quality, and sex frequency. “Even though women with pain were more sexually dysfunctional, they valued sex just as much as control women,” she said.

The reported frequency of intercourse was similar among women in the PVD group vs. the complex pain group, but a highly significant difference was found between the pain groups and the controls. The control women reported sex an average of 52 times during the last 6 months, compared with an average of 12 times in 6 months in the two pain groups.

There were no differences in terms of self-reported desire and no differences in sexual satisfaction between the complex pain and PVD groups, and no significant differences were observed in overall relationship quality. “But when we looked at controls, the women with pain of any type had worse relationship quality compared to controls, and less affection and cohesion with their partners,” Ms. Smith said.

The results support findings from previous studies, and the data suggest that vulvodynia has distinct pain characteristics and might be more complicated than previously thought, Ms. Smith said.

The study was limited by a lack of information about sexual partners of women with PVD vs. those with complex pain, she noted.

Additional research is needed to address issues including the presentation and etiology of vulvodynia, as well as implications for treatment.

Ms. Smith had no financial conflicts to disclose.

A revised high-tech tool from the Department of Health and Human Services might make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said. “We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized.

The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use. “We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a variety of serious medical conditions like cardiovascular disease, diabetes, and [some] cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview. But many time-strapped clinicians don't collect family history during office visits. “The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15-20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“The new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

“If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Clinicians can continue to remind patients to provide as much family history as possible, but it might take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

A revised high-tech tool from the Department of Health and Human Services might make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said. “We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized.

The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use. “We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a variety of serious medical conditions like cardiovascular disease, diabetes, and [some] cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview. But many time-strapped clinicians don't collect family history during office visits. “The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15-20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“The new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

“If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Clinicians can continue to remind patients to provide as much family history as possible, but it might take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

A revised high-tech tool from the Department of Health and Human Services might make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.

“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.

In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said. “We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized.

The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use. “We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.

“Family history can provide important insights into future risk of developing a variety of serious medical conditions like cardiovascular disease, diabetes, and [some] cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview. But many time-strapped clinicians don't collect family history during office visits. “The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.

My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov

For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.

According to the Department of Health and Human Services, building the basics of a family health history should take about 15-20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.

Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.

“The new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”

“If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”

Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.

An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.

And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.

Clinicians can continue to remind patients to provide as much family history as possible, but it might take time to resolve technical and privacy issues before an electronic family health history becomes a seamless part of an electronic medical record, he said.

Dr. Scott had no financial conflicts to disclose. Dr. Feero is an employee of the National Institutes of Health, which is part of the Department of Health and Human Services.

PENTAGON CITY, VA. — Educating depressed patients about the sexual side effects of selective serotonin reuptake inhibitors could mitigate their experiences with those side effects, results of a study of 92 adults who were first-time users of the medication show.

Many physicians do not feel comfortable talking to patients about the possible sexual side effects of SSRIs, said Tierney K. Ahrold and Cindy M. Meston, Ph.D., of the department of psychology at the University of Texas at Austin.

Some doctors might worry that forewarning patients about side effects might change their expectations of the side effects, or change their attributions of the symptoms, the researchers noted. But other studies have shown that patients who learn about sexual side effects before they start taking SSRIs have less anxiety about the side effects, and the side effects are less severe, compared with patients who are not informed.

To test the impact of educating patients about the sexual side effects of SSRIs, the researchers enrolled 13 men and 79 women who were new to using SSRIs for depression and divided them into four groups. All participants completed assessments of sexual functional and satisfaction, medication attribution, psychological symptoms, and SSRI use at baseline, 2 weeks, and 8 weeks.

In addition, 26 patients received an online educational intervention that de-emphasized sexual side effects of SSRIs; 30 patients received an online intervention that emphasized the severity and likelihood of sexual side effects; and 24 patients received an online intervention that was informative but neutral about sexual side effects. The remaining 12 patients served as controls.

The average age of the patients was 33 years, and their medications included sertraline, fluoxetine, paroxetine, citalopram, escitalopram, and fluvoxamine. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

Overall, patients who were educated that SSRIs could contribute to sexual problems reported less sexual dysfunction at follow-up visits, compared with the controls. But there were no significant differences in sexual dysfunction scores among the intervention groups, the researchers noted.

A significant correlation was found between change in sexual dysfunction scores and change in medication attribution, meaning that patients who attributed their sexual problems to their medications rather than blaming themselves were less likely to report sexual dysfunction.

The women in the intervention groups reported greater improvement in sexual function, compared with the men, but this difference might be attributable to the greater number of women in the study.

The clinical implication of the study is that depressed patients tend to blame themselves for any type of problem, including sexual problems. But if they know that they can attribute sexual problems to the SSRIs (at least to some extent), that might take some of the pressure off, and the problems might improve, Ms. Ahrold said in an interview.

“Being as honest as we possibly can is best for the patient,” she said. The trick is to find ways of managing the side effects that do occur, she added.

The results suggest that shifting a patient's focus from internal (personal) factors to external (medication) factors changes his or her experience of those side effects.

The way the information is presented to patients is not as important as whether the information is presented at all, although more research is needed to confirm these results, the researchers wrote.

The researchers had no financial conflicts to disclose.

PENTAGON CITY, VA. — Educating depressed patients about the sexual side effects of selective serotonin reuptake inhibitors could mitigate their experiences with those side effects, results of a study of 92 adults who were first-time users of the medication show.

Many physicians do not feel comfortable talking to patients about the possible sexual side effects of SSRIs, said Tierney K. Ahrold and Cindy M. Meston, Ph.D., of the department of psychology at the University of Texas at Austin.

Some doctors might worry that forewarning patients about side effects might change their expectations of the side effects, or change their attributions of the symptoms, the researchers noted. But other studies have shown that patients who learn about sexual side effects before they start taking SSRIs have less anxiety about the side effects, and the side effects are less severe, compared with patients who are not informed.

To test the impact of educating patients about the sexual side effects of SSRIs, the researchers enrolled 13 men and 79 women who were new to using SSRIs for depression and divided them into four groups. All participants completed assessments of sexual functional and satisfaction, medication attribution, psychological symptoms, and SSRI use at baseline, 2 weeks, and 8 weeks.

In addition, 26 patients received an online educational intervention that de-emphasized sexual side effects of SSRIs; 30 patients received an online intervention that emphasized the severity and likelihood of sexual side effects; and 24 patients received an online intervention that was informative but neutral about sexual side effects. The remaining 12 patients served as controls.

The average age of the patients was 33 years, and their medications included sertraline, fluoxetine, paroxetine, citalopram, escitalopram, and fluvoxamine. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

Overall, patients who were educated that SSRIs could contribute to sexual problems reported less sexual dysfunction at follow-up visits, compared with the controls. But there were no significant differences in sexual dysfunction scores among the intervention groups, the researchers noted.

A significant correlation was found between change in sexual dysfunction scores and change in medication attribution, meaning that patients who attributed their sexual problems to their medications rather than blaming themselves were less likely to report sexual dysfunction.

The women in the intervention groups reported greater improvement in sexual function, compared with the men, but this difference might be attributable to the greater number of women in the study.

The clinical implication of the study is that depressed patients tend to blame themselves for any type of problem, including sexual problems. But if they know that they can attribute sexual problems to the SSRIs (at least to some extent), that might take some of the pressure off, and the problems might improve, Ms. Ahrold said in an interview.

“Being as honest as we possibly can is best for the patient,” she said. The trick is to find ways of managing the side effects that do occur, she added.

The results suggest that shifting a patient's focus from internal (personal) factors to external (medication) factors changes his or her experience of those side effects.

The way the information is presented to patients is not as important as whether the information is presented at all, although more research is needed to confirm these results, the researchers wrote.

The researchers had no financial conflicts to disclose.

PENTAGON CITY, VA. — Educating depressed patients about the sexual side effects of selective serotonin reuptake inhibitors could mitigate their experiences with those side effects, results of a study of 92 adults who were first-time users of the medication show.

Many physicians do not feel comfortable talking to patients about the possible sexual side effects of SSRIs, said Tierney K. Ahrold and Cindy M. Meston, Ph.D., of the department of psychology at the University of Texas at Austin.

Some doctors might worry that forewarning patients about side effects might change their expectations of the side effects, or change their attributions of the symptoms, the researchers noted. But other studies have shown that patients who learn about sexual side effects before they start taking SSRIs have less anxiety about the side effects, and the side effects are less severe, compared with patients who are not informed.

To test the impact of educating patients about the sexual side effects of SSRIs, the researchers enrolled 13 men and 79 women who were new to using SSRIs for depression and divided them into four groups. All participants completed assessments of sexual functional and satisfaction, medication attribution, psychological symptoms, and SSRI use at baseline, 2 weeks, and 8 weeks.

In addition, 26 patients received an online educational intervention that de-emphasized sexual side effects of SSRIs; 30 patients received an online intervention that emphasized the severity and likelihood of sexual side effects; and 24 patients received an online intervention that was informative but neutral about sexual side effects. The remaining 12 patients served as controls.

The average age of the patients was 33 years, and their medications included sertraline, fluoxetine, paroxetine, citalopram, escitalopram, and fluvoxamine. The study results were presented in a poster at the annual meeting of the Society for Sex Therapy and Research.

Overall, patients who were educated that SSRIs could contribute to sexual problems reported less sexual dysfunction at follow-up visits, compared with the controls. But there were no significant differences in sexual dysfunction scores among the intervention groups, the researchers noted.

A significant correlation was found between change in sexual dysfunction scores and change in medication attribution, meaning that patients who attributed their sexual problems to their medications rather than blaming themselves were less likely to report sexual dysfunction.

The women in the intervention groups reported greater improvement in sexual function, compared with the men, but this difference might be attributable to the greater number of women in the study.

The clinical implication of the study is that depressed patients tend to blame themselves for any type of problem, including sexual problems. But if they know that they can attribute sexual problems to the SSRIs (at least to some extent), that might take some of the pressure off, and the problems might improve, Ms. Ahrold said in an interview.

“Being as honest as we possibly can is best for the patient,” she said. The trick is to find ways of managing the side effects that do occur, she added.

The results suggest that shifting a patient's focus from internal (personal) factors to external (medication) factors changes his or her experience of those side effects.

The way the information is presented to patients is not as important as whether the information is presented at all, although more research is needed to confirm these results, the researchers wrote.

The researchers had no financial conflicts to disclose.

WASHINGTON — The Obama administration recently launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, "Act Against Aids," is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS.

"People don't recognize that they are at risk, and they engage in high-risk behavior," Dr. Fenton said at a press briefing.

The goal of the campaign is to educate the public about the risks of HIV and encourage them to get the right information to protect themselves and their communities.

The campaign kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, "Every 9.5 minutes."

According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected about every 9.5 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, who is assistant to the president and director of the White House Domestic Policy Council.

Targeted outreach is also planned for the gay, bisexual, and Latino communities, she added.

Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

"This [effort] is likely to have an impact on health seeking behaviors," he said.

Consumer information regarding the HIV campaign can be found online at www.NineAndaHalfMinutes.org

WASHINGTON — The Obama administration recently launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, "Act Against Aids," is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS.

"People don't recognize that they are at risk, and they engage in high-risk behavior," Dr. Fenton said at a press briefing.

The goal of the campaign is to educate the public about the risks of HIV and encourage them to get the right information to protect themselves and their communities.

The campaign kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, "Every 9.5 minutes."

According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected about every 9.5 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, who is assistant to the president and director of the White House Domestic Policy Council.

Targeted outreach is also planned for the gay, bisexual, and Latino communities, she added.

Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

"This [effort] is likely to have an impact on health seeking behaviors," he said.

Consumer information regarding the HIV campaign can be found online at www.NineAndaHalfMinutes.org

WASHINGTON — The Obama administration recently launched the first major U.S. initiative against HIV/AIDS in more than a decade.

The 5-year campaign, "Act Against Aids," is a joint effort of the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the White House to educate the public about HIV/AIDS, which remains a serious problem in the United States despite advances in treatment that allow more patients to survive.

Recent data from the Kaiser Family Foundation show that concern about HIV infection has declined in recent years, said Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS.

"People don't recognize that they are at risk, and they engage in high-risk behavior," Dr. Fenton said at a press briefing.

The goal of the campaign is to educate the public about the risks of HIV and encourage them to get the right information to protect themselves and their communities.

The campaign kicks off with a series of public service announcements, including radio ads, online ads, and public transportation ads, with the theme, "Every 9.5 minutes."

According to data from the CDC, approximately 56,000 Americans become infected with HIV each year, which translates to one person becoming infected about every 9.5 minutes.

The campaign also will target specific communities that are at increased risk for HIV, starting with the African American community, said Melody Barnes, who is assistant to the president and director of the White House Domestic Policy Council.

Targeted outreach is also planned for the gay, bisexual, and Latino communities, she added.

Doctors need to know that the Act Against AIDS campaign will be working to raise awareness about HIV infection and encourage testing, Dr. Fenton said in an interview.

"This [effort] is likely to have an impact on health seeking behaviors," he said.

Consumer information regarding the HIV campaign can be found online at www.NineAndaHalfMinutes.org

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on whites because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded.

About 50% of the study participants met the criteria for osteopenia, and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine.

Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group. She had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on whites because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded.

About 50% of the study participants met the criteria for osteopenia, and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine.

Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group. She had no financial conflicts to disclose.

RIO GRANDE, P.R. — Approximately one in four elderly black women have osteoporosis, findings from a small study suggest.

Physicians should not ignore the possibility of osteoporosis in their older black female patients, although these women are not usually considered at high risk, compared with other demographic groups, said Dr. Sally P. Weaver, research director of the McLennan County Medical Education and Research Foundation, Waco, Tex.

Previous studies of osteoporosis in women have focused mainly on whites because of evidence of an elevated risk for osteoporosis in that population. Yet older women of any ethnicity are prone to age-related fractures if their bone mineral density (BMD) is low, she said in an interview.

Dr. Weaver and her colleagues measured BMD scans from the electronic health records of 44 black women aged 70 years and older. Patients with conditions that could affect bone turnover, vitamin D absorption, or calcium absorption were excluded.

About 50% of the study participants met the criteria for osteopenia, and 10% met the criteria for osteoporosis at the left femoral neck. Approximately 25% met criteria for osteopenia or osteoporosis at the lumbar spine.

Dr. Weaver presented the results in a poster at the annual meeting of the North American Primary Care Research Group. She had no financial conflicts to disclose.