Heidi Splete

WASHINGTON – Type 2 diabetes did not increase the risk of onset or progression of Alzheimer's disease in older adults, according to results from a study of more than 700 individuals presented in a poster at the annual meeting of the American Geriatrics Society.

The prevalences of Alzheimer's disease (AD) and type 2 diabetes are rising, and data from previous studies suggest an association between the two conditions.

In this prospective study, Youngjee Choi of the Alzheimer's Disease Research Center and a medical student at Washington University in St. Louis, and colleagues examined the frequency of type 2 diabetes in 506 adults (196 men and 310 women) with dementia and 318 adults (127 men and 191 women) without dementia.

The study participants, who were enrolled in a longitudinal study of aging and dementia, had an average age of 77 years. The mental status of the participants was determined using the Clinical Dementia Rating, which is sensitive to individual cognitive decline. The study excluded individuals with diabetes who used insulin.

Significantly more of the participants with dementia had type 2 diabetes at baseline than did the nondemented participants (10.7% vs. 5.7%).

But a Cox regression analysis showed no association between type 2 diabetes and the onset or progression of AD during a 12-year follow-up period, although AD and type 2 diabetes were significantly associated at baseline in this sample.

Independent of type 2 diabetes, dementia progression was significantly higher among the participants who were demented at baseline, compared with those who were not. Older age and the presence of the APOE ?4 allele significantly increased the risk of AD onset in nondemented individuals. Older age, the presence of the APOE ?4 allele, and being female and having less education were significantly associated with dementia progression in those who met criteria for AD at baseline.

The study did not use a community-based sample, which may have caused selection bias, and the duration of disease and level of glucose control for the participants with type 2 diabetes were unknown, the researchers noted.

The study was supported in part by grants from the National Institutes of Health and the Summer Training on Aging Research Topics-Mental Health program. None of the researchers disclosed any financial conflicts.

WASHINGTON – Type 2 diabetes did not increase the risk of onset or progression of Alzheimer's disease in older adults, according to results from a study of more than 700 individuals presented in a poster at the annual meeting of the American Geriatrics Society.

The prevalences of Alzheimer's disease (AD) and type 2 diabetes are rising, and data from previous studies suggest an association between the two conditions.

In this prospective study, Youngjee Choi of the Alzheimer's Disease Research Center and a medical student at Washington University in St. Louis, and colleagues examined the frequency of type 2 diabetes in 506 adults (196 men and 310 women) with dementia and 318 adults (127 men and 191 women) without dementia.

The study participants, who were enrolled in a longitudinal study of aging and dementia, had an average age of 77 years. The mental status of the participants was determined using the Clinical Dementia Rating, which is sensitive to individual cognitive decline. The study excluded individuals with diabetes who used insulin.

Significantly more of the participants with dementia had type 2 diabetes at baseline than did the nondemented participants (10.7% vs. 5.7%).

But a Cox regression analysis showed no association between type 2 diabetes and the onset or progression of AD during a 12-year follow-up period, although AD and type 2 diabetes were significantly associated at baseline in this sample.

Independent of type 2 diabetes, dementia progression was significantly higher among the participants who were demented at baseline, compared with those who were not. Older age and the presence of the APOE ?4 allele significantly increased the risk of AD onset in nondemented individuals. Older age, the presence of the APOE ?4 allele, and being female and having less education were significantly associated with dementia progression in those who met criteria for AD at baseline.

The study did not use a community-based sample, which may have caused selection bias, and the duration of disease and level of glucose control for the participants with type 2 diabetes were unknown, the researchers noted.

The study was supported in part by grants from the National Institutes of Health and the Summer Training on Aging Research Topics-Mental Health program. None of the researchers disclosed any financial conflicts.

WASHINGTON – Type 2 diabetes did not increase the risk of onset or progression of Alzheimer's disease in older adults, according to results from a study of more than 700 individuals presented in a poster at the annual meeting of the American Geriatrics Society.

The prevalences of Alzheimer's disease (AD) and type 2 diabetes are rising, and data from previous studies suggest an association between the two conditions.

In this prospective study, Youngjee Choi of the Alzheimer's Disease Research Center and a medical student at Washington University in St. Louis, and colleagues examined the frequency of type 2 diabetes in 506 adults (196 men and 310 women) with dementia and 318 adults (127 men and 191 women) without dementia.

The study participants, who were enrolled in a longitudinal study of aging and dementia, had an average age of 77 years. The mental status of the participants was determined using the Clinical Dementia Rating, which is sensitive to individual cognitive decline. The study excluded individuals with diabetes who used insulin.

Significantly more of the participants with dementia had type 2 diabetes at baseline than did the nondemented participants (10.7% vs. 5.7%).

But a Cox regression analysis showed no association between type 2 diabetes and the onset or progression of AD during a 12-year follow-up period, although AD and type 2 diabetes were significantly associated at baseline in this sample.

Independent of type 2 diabetes, dementia progression was significantly higher among the participants who were demented at baseline, compared with those who were not. Older age and the presence of the APOE ?4 allele significantly increased the risk of AD onset in nondemented individuals. Older age, the presence of the APOE ?4 allele, and being female and having less education were significantly associated with dementia progression in those who met criteria for AD at baseline.

The study did not use a community-based sample, which may have caused selection bias, and the duration of disease and level of glucose control for the participants with type 2 diabetes were unknown, the researchers noted.

The study was supported in part by grants from the National Institutes of Health and the Summer Training on Aging Research Topics-Mental Health program. None of the researchers disclosed any financial conflicts.

BALTIMORE – Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8-12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention–healthy, overweight, or obese.

Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

“I also ran a logistic regression analysis to determine how much variance in children's quality of life scores [reported by both parents and children] was predicted by weight and sleep problems,” Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview.

Sleep and weight each contributed to poor quality of life scores reported by the children.

Both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life.

Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote. The results support findings from previous studies that show a high prevalence of sleep problems among obese children.

Ms. Davis had no financial conflicts to disclose.

BALTIMORE – Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8-12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention–healthy, overweight, or obese.

Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

“I also ran a logistic regression analysis to determine how much variance in children's quality of life scores [reported by both parents and children] was predicted by weight and sleep problems,” Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview.

Sleep and weight each contributed to poor quality of life scores reported by the children.

Both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life.

Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote. The results support findings from previous studies that show a high prevalence of sleep problems among obese children.

Ms. Davis had no financial conflicts to disclose.

BALTIMORE – Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8-12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention–healthy, overweight, or obese.

Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

“I also ran a logistic regression analysis to determine how much variance in children's quality of life scores [reported by both parents and children] was predicted by weight and sleep problems,” Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview.

Sleep and weight each contributed to poor quality of life scores reported by the children.

Both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life.

Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote. The results support findings from previous studies that show a high prevalence of sleep problems among obese children.

Ms. Davis had no financial conflicts to disclose.

WASHINGTON — As more clinicians practice computed tomographic colonography, they will learn the language in which to report their findings, Dr. Michael Zalis said at a meeting on CT colonography sponsored by the AGA (American Gastoenterological Association) Institute.

“We need to organize our reporting in response to the growth of CTC,” said Dr. Zalis, a radiologist specializing in abdominal imaging and intervention at Massachusetts General Hospital, Boston.

The American Cancer Society and a task force representing several other medical societies have endorsed CTC as a co-lorectal screening method, which means that Medicare coverage of CTC will likely increase, he added.

There are many benefits to using a standard set of terms to report CTC findings, Dr. Zalis said. Standard language can make patient management easier. For example, as CTC becomes more common, a patient may have an exam performed by one practitioner in one location and a follow-up visit with someone else in another location—even another state.

Common terms not only facilitate comparisons across sites, they also facilitate large-scale analysis of CTC by the government and by insurance carriers, Dr. Zalis noted. But standard CTC reporting terms also help physicians track their personal quality metrics on items such as false-positive rates and call back rates, he said.

The CT Colonography Reporting and Data System (C-RADS) project was a collaborative effort that developed terms and guidelines for CTC with categories for describing colonic and extracolonic findings.

Whether CTC will be regulated in the same way as mammography remains to be seen, but the establishment of C-RADS may prepare clinicians to handle similar regulation if it develops.

“For CT colonography, the target of detection is a precursor to colon cancer, the advanced adenoma, usually defined as a lesion greater than 1 cm in size,” Dr. Zalis said.

“The vast majority of even the intermediate-size lesions that we observe are not the advanced adenomas,” he said. And only about 5% of polyps between 0.6 cm and 1 cm are advanced adenomas, according to findings from large surgical series, he said.

The C-RADS characterization of polyps uses a scale from 0 (inadequate prep) to 4 (colonic mass, likely malignant). For example, a C1 means no visible abnormalities of the colon and no polyps of 6 mm or larger. (See box.)

The C-RADS criteria recommend not reporting diminutive lesions that are less than 6 mm in size.

“Hyperplastic polyps per se are not the target for screening in colorectal carcinoma,” Dr. Zalis said. “We are not being cavalier, but we are going to recognize that the clinical significance of these lesions is very small.”

When a clinician finds intermediate polyps (6–9 mm), the C-RADS criteria recommend reporting the polyps and opting for short-interval surveillance if there are one to two; the criteria recommend considering optical colonoscopy for patients with three or more midsized polyps.

“Polyps grow slowly, and any intermediate polyps tend to be stable and may even regress over time,” Dr. Zalis explained.

Patients with polyps that are 10 mm or larger should be referred for a follow-up colonoscopy, as should patients with three or more polyps in the 6- to 9- mm category, he said.

And a patient with a potentially malignant colonic mass should be sent for a surgical consultation.

The screening interval for optical colonoscopy is 10 years. CTC might approach that at some point, but for now the recommended interval is 5 years, Dr. Zalis said.

“We are early in our experience with CTC and the data aren't there yet to support a longer interval,” but that interval may increase with more data,” he noted.

Extracolonic findings must be documented and classified in the interest of good patient care, although fewer than 10% of patients will have clinically significant extracolonic findings, Dr. Zalis said. “But the findings will be there, so they have to be handled in an appropriate way.

“We have to carefully balance the mandate to identify clinically significant findings with the costs of each false positive,” he said. “We don't want to be causing unnecessary work-ups for obviously benign lesions.”

Although CTC has limitations, an attentive clinician can do a reasonable characterization of extracolonic findings and can reduce the likelihood of extracolonic work-ups and the resulting costs.

The C-RADS classification of extracolonic findings ranges from 0 (technical failure) to 4 (a potentially significant finding, such as a renal mass or liposarcoma. (See box.)

Details of clinically significant findings classified as E4 should be communicated to referring physicians according to accepted practice guidelines, Dr. Zalis said.

There are limitations with C-RADS, and the intent was to come up with a practical reporting scheme based on the data that were available, Dr. Zalis said.

Surveillance and screening intervals, especially for small polyps, and more advanced decision models will be forthcoming. And additional reporting for CTC may include some sort of confidence indicator, he said.

A confidence indicator would allow an interpreting clinician to communicate a level of confidence to an endoscopist so he or she can decide how hard to look for something before declaring that it is a false positive.

“Of course there will be nuances that we can't capture on the first round, but we needed to start somewhere, and we expect the criteria will expand with experience,” he added.

Dr. Zalis disclosed that he has received grant and research support from GE Healthcare Inc.

Classification of CTC Findings

These 10 categories, provided by Dr. Zalis, represent the C-RADS classification of colonic and extracolonic findings on computed tomographic colonography, with a few examples (but not a comprehensive list) for each category:

Colonic Findings

▸ C0: Inadequate study/awaiting prior comparisons. Use this category in cases of inadequate prep or insufflation, or when the image can't be read because of excess fluid or feces.

▸ C1: Normal colon or benign lesion. Use this category for cases of no polyp greater than 6 mm, and continue routine screening.

▸ C2: Indeterminate lesion. Use this category for cases of fewer than three polyps 6–9 mm.

▸ C3: Polyp, possibly advanced adenoma. Use this category for cases of three or more polyps 6–9 mm or any polyp 10 mm or larger; a follow-up colonoscopy is recommended.

▸ C4: Colonic mass, likely malignant. Use this category when a lesion compromises the bowel lumen, or there is evidence of extracolonic invasion; surgical consultation is recommended.

Extracolonic Findings

▸ E0: Limited exam. Use this category when an exam is compromised by an artifact so that evaluation of extracolonic soft tissues is limited.

▸ E1: Normal exam or anatomic variant. Use this category when no extracolonic abnormalities are visible, or if there is an anatomic variant such as a retroaortic left renal vein.

▸ E2: Clinically insignificant finding. Use this category when no work-up is indicated, such as for simple cysts or a vertebral hemangioma.

▸ E3: Likely insignificant finding, incompletely characterized, such as a minimally complex renal cyst. Use this category when a work-up may be needed, based on practice and patient preference.

▸ E4: Potentially significant finding. Use this category for a solid renal mass or liposarcoma, and be sure to communicate the details to the referring physician.

WASHINGTON — As more clinicians practice computed tomographic colonography, they will learn the language in which to report their findings, Dr. Michael Zalis said at a meeting on CT colonography sponsored by the AGA (American Gastoenterological Association) Institute.

“We need to organize our reporting in response to the growth of CTC,” said Dr. Zalis, a radiologist specializing in abdominal imaging and intervention at Massachusetts General Hospital, Boston.

The American Cancer Society and a task force representing several other medical societies have endorsed CTC as a co-lorectal screening method, which means that Medicare coverage of CTC will likely increase, he added.

There are many benefits to using a standard set of terms to report CTC findings, Dr. Zalis said. Standard language can make patient management easier. For example, as CTC becomes more common, a patient may have an exam performed by one practitioner in one location and a follow-up visit with someone else in another location—even another state.

Common terms not only facilitate comparisons across sites, they also facilitate large-scale analysis of CTC by the government and by insurance carriers, Dr. Zalis noted. But standard CTC reporting terms also help physicians track their personal quality metrics on items such as false-positive rates and call back rates, he said.

The CT Colonography Reporting and Data System (C-RADS) project was a collaborative effort that developed terms and guidelines for CTC with categories for describing colonic and extracolonic findings.

Whether CTC will be regulated in the same way as mammography remains to be seen, but the establishment of C-RADS may prepare clinicians to handle similar regulation if it develops.

“For CT colonography, the target of detection is a precursor to colon cancer, the advanced adenoma, usually defined as a lesion greater than 1 cm in size,” Dr. Zalis said.

“The vast majority of even the intermediate-size lesions that we observe are not the advanced adenomas,” he said. And only about 5% of polyps between 0.6 cm and 1 cm are advanced adenomas, according to findings from large surgical series, he said.

The C-RADS characterization of polyps uses a scale from 0 (inadequate prep) to 4 (colonic mass, likely malignant). For example, a C1 means no visible abnormalities of the colon and no polyps of 6 mm or larger. (See box.)

The C-RADS criteria recommend not reporting diminutive lesions that are less than 6 mm in size.

“Hyperplastic polyps per se are not the target for screening in colorectal carcinoma,” Dr. Zalis said. “We are not being cavalier, but we are going to recognize that the clinical significance of these lesions is very small.”

When a clinician finds intermediate polyps (6–9 mm), the C-RADS criteria recommend reporting the polyps and opting for short-interval surveillance if there are one to two; the criteria recommend considering optical colonoscopy for patients with three or more midsized polyps.

“Polyps grow slowly, and any intermediate polyps tend to be stable and may even regress over time,” Dr. Zalis explained.

Patients with polyps that are 10 mm or larger should be referred for a follow-up colonoscopy, as should patients with three or more polyps in the 6- to 9- mm category, he said.

And a patient with a potentially malignant colonic mass should be sent for a surgical consultation.

The screening interval for optical colonoscopy is 10 years. CTC might approach that at some point, but for now the recommended interval is 5 years, Dr. Zalis said.

“We are early in our experience with CTC and the data aren't there yet to support a longer interval,” but that interval may increase with more data,” he noted.

Extracolonic findings must be documented and classified in the interest of good patient care, although fewer than 10% of patients will have clinically significant extracolonic findings, Dr. Zalis said. “But the findings will be there, so they have to be handled in an appropriate way.

“We have to carefully balance the mandate to identify clinically significant findings with the costs of each false positive,” he said. “We don't want to be causing unnecessary work-ups for obviously benign lesions.”

Although CTC has limitations, an attentive clinician can do a reasonable characterization of extracolonic findings and can reduce the likelihood of extracolonic work-ups and the resulting costs.

The C-RADS classification of extracolonic findings ranges from 0 (technical failure) to 4 (a potentially significant finding, such as a renal mass or liposarcoma. (See box.)

Details of clinically significant findings classified as E4 should be communicated to referring physicians according to accepted practice guidelines, Dr. Zalis said.

There are limitations with C-RADS, and the intent was to come up with a practical reporting scheme based on the data that were available, Dr. Zalis said.

Surveillance and screening intervals, especially for small polyps, and more advanced decision models will be forthcoming. And additional reporting for CTC may include some sort of confidence indicator, he said.

A confidence indicator would allow an interpreting clinician to communicate a level of confidence to an endoscopist so he or she can decide how hard to look for something before declaring that it is a false positive.

“Of course there will be nuances that we can't capture on the first round, but we needed to start somewhere, and we expect the criteria will expand with experience,” he added.

Dr. Zalis disclosed that he has received grant and research support from GE Healthcare Inc.

Classification of CTC Findings

These 10 categories, provided by Dr. Zalis, represent the C-RADS classification of colonic and extracolonic findings on computed tomographic colonography, with a few examples (but not a comprehensive list) for each category:

Colonic Findings

▸ C0: Inadequate study/awaiting prior comparisons. Use this category in cases of inadequate prep or insufflation, or when the image can't be read because of excess fluid or feces.

▸ C1: Normal colon or benign lesion. Use this category for cases of no polyp greater than 6 mm, and continue routine screening.

▸ C2: Indeterminate lesion. Use this category for cases of fewer than three polyps 6–9 mm.

▸ C3: Polyp, possibly advanced adenoma. Use this category for cases of three or more polyps 6–9 mm or any polyp 10 mm or larger; a follow-up colonoscopy is recommended.

▸ C4: Colonic mass, likely malignant. Use this category when a lesion compromises the bowel lumen, or there is evidence of extracolonic invasion; surgical consultation is recommended.

Extracolonic Findings

▸ E0: Limited exam. Use this category when an exam is compromised by an artifact so that evaluation of extracolonic soft tissues is limited.

▸ E1: Normal exam or anatomic variant. Use this category when no extracolonic abnormalities are visible, or if there is an anatomic variant such as a retroaortic left renal vein.

▸ E2: Clinically insignificant finding. Use this category when no work-up is indicated, such as for simple cysts or a vertebral hemangioma.

▸ E3: Likely insignificant finding, incompletely characterized, such as a minimally complex renal cyst. Use this category when a work-up may be needed, based on practice and patient preference.

▸ E4: Potentially significant finding. Use this category for a solid renal mass or liposarcoma, and be sure to communicate the details to the referring physician.

WASHINGTON — As more clinicians practice computed tomographic colonography, they will learn the language in which to report their findings, Dr. Michael Zalis said at a meeting on CT colonography sponsored by the AGA (American Gastoenterological Association) Institute.

“We need to organize our reporting in response to the growth of CTC,” said Dr. Zalis, a radiologist specializing in abdominal imaging and intervention at Massachusetts General Hospital, Boston.

The American Cancer Society and a task force representing several other medical societies have endorsed CTC as a co-lorectal screening method, which means that Medicare coverage of CTC will likely increase, he added.

There are many benefits to using a standard set of terms to report CTC findings, Dr. Zalis said. Standard language can make patient management easier. For example, as CTC becomes more common, a patient may have an exam performed by one practitioner in one location and a follow-up visit with someone else in another location—even another state.

Common terms not only facilitate comparisons across sites, they also facilitate large-scale analysis of CTC by the government and by insurance carriers, Dr. Zalis noted. But standard CTC reporting terms also help physicians track their personal quality metrics on items such as false-positive rates and call back rates, he said.

The CT Colonography Reporting and Data System (C-RADS) project was a collaborative effort that developed terms and guidelines for CTC with categories for describing colonic and extracolonic findings.

Whether CTC will be regulated in the same way as mammography remains to be seen, but the establishment of C-RADS may prepare clinicians to handle similar regulation if it develops.

“For CT colonography, the target of detection is a precursor to colon cancer, the advanced adenoma, usually defined as a lesion greater than 1 cm in size,” Dr. Zalis said.

“The vast majority of even the intermediate-size lesions that we observe are not the advanced adenomas,” he said. And only about 5% of polyps between 0.6 cm and 1 cm are advanced adenomas, according to findings from large surgical series, he said.

The C-RADS characterization of polyps uses a scale from 0 (inadequate prep) to 4 (colonic mass, likely malignant). For example, a C1 means no visible abnormalities of the colon and no polyps of 6 mm or larger. (See box.)

The C-RADS criteria recommend not reporting diminutive lesions that are less than 6 mm in size.

“Hyperplastic polyps per se are not the target for screening in colorectal carcinoma,” Dr. Zalis said. “We are not being cavalier, but we are going to recognize that the clinical significance of these lesions is very small.”

When a clinician finds intermediate polyps (6–9 mm), the C-RADS criteria recommend reporting the polyps and opting for short-interval surveillance if there are one to two; the criteria recommend considering optical colonoscopy for patients with three or more midsized polyps.

“Polyps grow slowly, and any intermediate polyps tend to be stable and may even regress over time,” Dr. Zalis explained.

Patients with polyps that are 10 mm or larger should be referred for a follow-up colonoscopy, as should patients with three or more polyps in the 6- to 9- mm category, he said.

And a patient with a potentially malignant colonic mass should be sent for a surgical consultation.

The screening interval for optical colonoscopy is 10 years. CTC might approach that at some point, but for now the recommended interval is 5 years, Dr. Zalis said.

“We are early in our experience with CTC and the data aren't there yet to support a longer interval,” but that interval may increase with more data,” he noted.

Extracolonic findings must be documented and classified in the interest of good patient care, although fewer than 10% of patients will have clinically significant extracolonic findings, Dr. Zalis said. “But the findings will be there, so they have to be handled in an appropriate way.

“We have to carefully balance the mandate to identify clinically significant findings with the costs of each false positive,” he said. “We don't want to be causing unnecessary work-ups for obviously benign lesions.”

Although CTC has limitations, an attentive clinician can do a reasonable characterization of extracolonic findings and can reduce the likelihood of extracolonic work-ups and the resulting costs.

The C-RADS classification of extracolonic findings ranges from 0 (technical failure) to 4 (a potentially significant finding, such as a renal mass or liposarcoma. (See box.)

Details of clinically significant findings classified as E4 should be communicated to referring physicians according to accepted practice guidelines, Dr. Zalis said.

There are limitations with C-RADS, and the intent was to come up with a practical reporting scheme based on the data that were available, Dr. Zalis said.

Surveillance and screening intervals, especially for small polyps, and more advanced decision models will be forthcoming. And additional reporting for CTC may include some sort of confidence indicator, he said.

A confidence indicator would allow an interpreting clinician to communicate a level of confidence to an endoscopist so he or she can decide how hard to look for something before declaring that it is a false positive.

“Of course there will be nuances that we can't capture on the first round, but we needed to start somewhere, and we expect the criteria will expand with experience,” he added.

Dr. Zalis disclosed that he has received grant and research support from GE Healthcare Inc.

Classification of CTC Findings

These 10 categories, provided by Dr. Zalis, represent the C-RADS classification of colonic and extracolonic findings on computed tomographic colonography, with a few examples (but not a comprehensive list) for each category:

Colonic Findings

▸ C0: Inadequate study/awaiting prior comparisons. Use this category in cases of inadequate prep or insufflation, or when the image can't be read because of excess fluid or feces.

▸ C1: Normal colon or benign lesion. Use this category for cases of no polyp greater than 6 mm, and continue routine screening.

▸ C2: Indeterminate lesion. Use this category for cases of fewer than three polyps 6–9 mm.

▸ C3: Polyp, possibly advanced adenoma. Use this category for cases of three or more polyps 6–9 mm or any polyp 10 mm or larger; a follow-up colonoscopy is recommended.

▸ C4: Colonic mass, likely malignant. Use this category when a lesion compromises the bowel lumen, or there is evidence of extracolonic invasion; surgical consultation is recommended.

Extracolonic Findings

▸ E0: Limited exam. Use this category when an exam is compromised by an artifact so that evaluation of extracolonic soft tissues is limited.

▸ E1: Normal exam or anatomic variant. Use this category when no extracolonic abnormalities are visible, or if there is an anatomic variant such as a retroaortic left renal vein.

▸ E2: Clinically insignificant finding. Use this category when no work-up is indicated, such as for simple cysts or a vertebral hemangioma.

▸ E3: Likely insignificant finding, incompletely characterized, such as a minimally complex renal cyst. Use this category when a work-up may be needed, based on practice and patient preference.

▸ E4: Potentially significant finding. Use this category for a solid renal mass or liposarcoma, and be sure to communicate the details to the referring physician.

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals—eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

"We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released," she said. "The answer is a resounding 'yes.'"

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%). Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also said their institutions were not doing as much as they could or should to prevent and control MRSA.

"The reason for that is not going to be news to anyone," said Kathy Warye, CEO of APIC. "We are still seeing some infection control professionals struggling to get the support they need." But the overall trend is encouraging, she said. "We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

Meanwhile, the death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

"We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job," Ms. Frain said.

"I have a CEO who gets it," said Marcia Patrick, R.N., the infection control director for the MultiCare Health System in Tacoma, Wash. "In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially." Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For information about preventing infections, visit www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a randomized, controlled trial.

Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “Motor-learning” exercises involve goal-oriented stepping and walking.

Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns with tighter turns. The group also walked on a treadmill to practice increasing speed.

The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits.

After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than did the 24 adults in the standard intervention group.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions, compared with what they felt at the study's beginning.

Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

SAN DIEGO — A Latino population had a significantly lower sustained virologic response to the standard treatment for hepatitis C virus, compared with a non-Latino population, suggesting that targeted treatments based on race and genetics may be keys to better management of chronic hepatitis C, according to data from a prospective study presented at the annual Digestive Disease Week.

Hepatitis C virus (HCV) is common in the Latino population, and data from previous studies have shown that Latinos have a more rapid progression to chronic HCV and cirrhosis, Dr. Maribel Rodriguez-Torres said in an interview.

Latinos are the largest minority population in the United States, so this represents a potentially huge number of patients with severe liver disease, she noted.

Dr. Rodriguez-Torres of the Fundacion de Investigacion de Diego in San Juan, P.R., and her colleagues compared pooled data in a multicenter, open-label study of 269 Latino adults with HCV and 300 non-Latino adults with HCV. Patients in both groups received the standard HCV treatment of 180 mcg of peginterferon α−2a (Pegasys) weekly and 1000–1200 mg of ribavirin daily based on body weight. Hoffmann-La Roche Inc., manufacturer of Pegasys and the Copegus formulation of ribavirin, sponsored the study.

After 6 months, 49.3% of the non-Latino patients had achieved a sustained virologic response (SVR), compared with 33.5% of the Latinos, a statistically significant difference. The almost 16% lower SVR suggests that more studies are needed to determine how best to treat HCV in the Latino population, the investigators noted.

“The standard treatment is capable of curing 40%–51% of people with HCV, but we want to have the highest possible cure rates for all populations,” said Dr. John Vierling of Baylor College of Medicine, Houston, who moderated a discussion of the findings.

“We need to optimize the treatment we have,” Dr. Rodriguez-Torres commented. Data from ongoing studies suggest that using higher doses or perhaps a longer duration of the standard therapy in treatment-resistant patients with higher viral loads and higher body mass indexes may improve outcomes, she explained.

“The most important next step is to make Latinos a priority in clinical research for HCV,” she added.

Dr. Rodriguez-Torres disclosed that he had received funding from Hoffmann-La Roche.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Both increased weight and sleep problems were associated with children's reports of poor quality of life, based on results from a study of 100 children aged 8–12 years.

Previous studies have linked poor quality of life to overweight and to sleep problems in children but this study is one of the few to investigate the joint contribution of weight and sleep to quality of life, said Kelly Ann Davis, who presented the results in a poster at the annual meeting of the Associated Professional Sleep Societies.

Ms. Davis and her colleagues used several types of statistical analysis to determine whether there were significant differences in sleep patterns for children in three different weight categories as defined by the Centers for Disease Control and Prevention—healthy, overweight, or obese. Parents and children completed the Children's Sleep Habits Questionnaire, the Pediatric Sleep Questionnaire, and the Pediatric Quality of Life 4.0. Each child's height and weight was measured by a health care professional.

In a logistic regression analysis, both sleep and weight were significant predictors of poor scores on the child-reported measures of psychosocial function and total quality of life, accounting for 48% and 33% of the variance, respectively, Ms. Davis, a research technician at the Children's Hospital of Philadelphia, said in an interview. In addition, weight, but not sleep, was a significant predictor of low scores on child-reported physical function tests, accounting for 23% of the variance.

In a breakdown of the children's sleep patterns, the researchers found that obese children had significantly more symptoms of sleep-disordered breathing, compared with both overweight and healthy weight children, and both obese and overweight children had significantly more symptoms of excessive daytime sleepiness, compared with healthy weight children. In addition, overweight children had significantly longer sleep duration and significantly longer sleep onset latency, compared with healthy weight children.

Sleep was not a significant predictor of low scores on parent-reported measures of the child's quality of life. Increased weight was the only significant predictor of low scores, and it accounted for 11% of the variance in physical function scores and 12% of the variance in both psychological function scores and total quality of life scores.

“It is important for health care professionals to be aware of the association between weight and sleep and ask parents of overweight children about their child's sleep,” Ms. Davis wrote.

Ms. Davis reported that she had no financial conflicts to disclose.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

BALTIMORE — Two measures of lung function—a higher forced expiratory volume in 1 second/forced vital capacity ratio and lower total lung capacity—may predict the presence of obstructive sleep apnea in chronic pulmonary disease patients, according to a poster presented at the annual meeting of the Associated Professional Sleep Societies

Dr. Ramez Sunna and colleagues at the University of Missouri, Columbia, reviewed all adult patients who underwent both pulmonary function testing and polysomnography between 2000 and 2007 at a tertiary care medical center.

Overall, 279 patients (61%) met the criteria for obstructive sleep apnea (OSA), 167 patients (37%) met the criteria for chronic obstructive pulmonary disease (COPD), and 11 patients (2%) did not have either condition.

A total of 101 patients (60%) had both COPD and OSA, but there was no significant correlation between the severity of the COPD and the severity of the OSA.

But the researchers analyzed the COPD patients independently and found that those with both COPD and OSA had a significantly higher forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, compared with COPD patients without OSA (61.03% vs. 54.61%), although both of these values fell below healthy levels. The association remained significant after controlling for variables.

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON —A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and greater need for medical services.

“In fact, a disproportionate number of successful suicides [occurs] in people who are over the age of 65,” Dr. Saliba said.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population.

Several screening tools for mood disorders are in use, but they haven't been compared with one another or with any validated psychiatric-assessment tool, Dr. Saliba said.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, bad feelings about oneself, and trouble with concentration. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression. The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both these tests are validated, “gold standard” tools, Dr. Saliba said.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

A majority of the residents, including the large number with cognitive impairment, could complete the PHQ-9, Dr. Saliba said.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS

During the past year, more than 75% of infection prevention and control professionals have taken extra steps to prevent transmission of methicillin-resistant Staphylococcus aureus in health care facilities, according to results of a survey conducted by the Association for Professionals in Infection Control and Epidemiology. The results were presented in a June 17 teleconference.

The nationwide survey was conducted in the wake of a 2007 report that showed a surprisingly high prevalence of MRSA in hospitals–eight times higher than previously estimated, and not limited to the intensive care units, said Janet E. Frain, R.N., president of the Association for Professionals in Infection Control and Epidemiology (APIC) and a certified professional in health care quality.

“We conducted the Pace of Progress poll among our members to find out if news about the escalating problem of MRSA had led to increased efforts on the part of health care institutions to combat MRSA in the 1 year since our study results were released,” she said. “The answer is a resounding 'yes.'”

The poll results included data from 2,041 infection control professionals, representing 17% of the APIC's nearly 12,000 members.

Staff education was the most common new action among those who reported taking additional steps to prevent and control MRSA (64%).

Other measures included stricter use of gowns and gloves for anyone who tests positive for MRSA (53%); improved compliance with house cleaning, equipment cleaning, and decontamination practices (49%); and targeted patient MRSA screening (49%).

But more than half of the survey respondents (54%) also reported that their institutions were not doing as much as they could or should to prevent and control MRSA.

“The reason for that is not going to be news to anyone,” said Kathy Warye, chief executive officer of APIC. “We are still seeing some infection control professionals struggling to get the support they need.” But the overall trend of the poll is encouraging, she said. “We believe that the prevalence study results empowered our members to acquire additional resources, including adding extra staff dedicated to infection control.

“Infection prevention and control is in the spotlight today for a variety of reasons,” she said. “The resources need to catch up.”

The death rate from MRSA is estimated to be more than 2.5 times higher than the death rate from Staphylococcus aureus organisms that are susceptible to methicillin, according to APIC.

Support from the health care administration is essential for successful infection control procedures, whether the organism is MRSA or any other pathogen such as Pseudomonas or Clostridium difficile.

“We are talking about a complete culture change within the organization, where infection prevention and control is everyone's job,” Ms. Frain said.

“I have a CEO who gets it,” said Marcia Patrick, R.N., who serves as the infection control director for the MultiCare Health System in Tacoma, Wash. “In October 2008, Medicare will stop paying for things that shouldn't happen, such as urinary tract infections from Foley catheters. If hospitals aren't working on reducing these things, they are going to be in a world of hurt financially.”

Support for infection control practices has to come from the top down and from the bottom up to be successful, she said.

Successful infection control strategies that have been implemented at her facility include improving hand hygiene by installing alcohol gel dispensers in convenient places, adding an infection control professional to the staff, and using data-mining software to review culture reports and identify infections quickly.

For more information about preventing infections, visit the Association for Professionals in Infection Control Web site at www.apic.orgwww.preventinfection.org

ELSEVIER GLOBAL MEDICAL NEWS