Heidi Splete

Source: State of California Office of Clinical Preventive Medicine

WASHINGTON — Physicians have limited time to devote to preventive care, but a short questionnaire mailed to patients prior to their visit or administered in the waiting room could change this.

A 20-item questionnaire to promote brief prevention counseling during patient visits was presented at the annual meeting of the American College of Preventive Medicine by Larry Dickey, M.D., of the California Department of Health Services, Sacramento.

Dr. Dickey shared the “Staying Healthy” Assessment questionnaires developed by his department that are now standard for all Medicaid patients in California. Pilot studies of the questionnaires show that they were well received by patients, and their use triggered doctors to provide brief preventive medicine counseling, but formal evaluations are pending.

The sample below is for Medicaid patients aged 18 years and older. To view the questionnaires for all age groups in PDF form, visit www.dhs.ca.gov/ps/ocpm/html/staying%20healthy.htm

Answers for the questionnaire include choices of “yes,” “no,” or “skip.”

1. Do you receive health care from anyone besides a medical doctor, such as an acupuncturist, herbalist, curandero, or other healer?

2. Do you see the dentist at least once a year?

3. Do you drink milk or eat yogurt or cheese at least three times each day?

4. Do you eat at least five servings of fruits or vegetables each day?

5. Do you try to limit the amount of fried or fast foods that you eat?

6. Do you exercise or do moderate physical activity such as walking or gardening 5 days a week?

7. Do you think you need to lose or gain weight?

8. Do you often feel sad, down, or hopeless?

9. Do you have friends or family members who smoke in your house?

10. Do you often spend time outdoors without sunscreen or other protection such as a hat or shirt?

11. Do you smoke cigarettes or cigars or use any other kinds of tobacco?

12. Do you use any drugs or medicines to go to sleep, relax, calm down, feel better, or lose weight?

13. Do you often have more than two drinks containing alcohol in 1 day?

14. Do you think you or your partner could be pregnant?

15. Do you think you or your partner could have a sexually transmitted disease?

16. Have you or your partner(s) had sex without using birth control in the last year?

17. Have you or your partner(s) had sex with other people in the past year?

18. Have you or your partner(s) had sex without a condom in the past year?

19. Have you ever been forced or pressured to have sex?

20. Have you ever been hit, slapped, kicked, or physically hurt by someone?

Do you have other questions/concerns about your health? (Please identify.)

Source: State of California Office of Clinical Preventive Medicine

WASHINGTON — Physicians have limited time to devote to preventive care, but a short questionnaire mailed to patients prior to their visit or administered in the waiting room could change this.

A 20-item questionnaire to promote brief prevention counseling during patient visits was presented at the annual meeting of the American College of Preventive Medicine by Larry Dickey, M.D., of the California Department of Health Services, Sacramento.

Dr. Dickey shared the “Staying Healthy” Assessment questionnaires developed by his department that are now standard for all Medicaid patients in California. Pilot studies of the questionnaires show that they were well received by patients, and their use triggered doctors to provide brief preventive medicine counseling, but formal evaluations are pending.

The sample below is for Medicaid patients aged 18 years and older. To view the questionnaires for all age groups in PDF form, visit www.dhs.ca.gov/ps/ocpm/html/staying%20healthy.htm

Answers for the questionnaire include choices of “yes,” “no,” or “skip.”

1. Do you receive health care from anyone besides a medical doctor, such as an acupuncturist, herbalist, curandero, or other healer?

2. Do you see the dentist at least once a year?

3. Do you drink milk or eat yogurt or cheese at least three times each day?

4. Do you eat at least five servings of fruits or vegetables each day?

5. Do you try to limit the amount of fried or fast foods that you eat?

6. Do you exercise or do moderate physical activity such as walking or gardening 5 days a week?

7. Do you think you need to lose or gain weight?

8. Do you often feel sad, down, or hopeless?

9. Do you have friends or family members who smoke in your house?

10. Do you often spend time outdoors without sunscreen or other protection such as a hat or shirt?

11. Do you smoke cigarettes or cigars or use any other kinds of tobacco?

12. Do you use any drugs or medicines to go to sleep, relax, calm down, feel better, or lose weight?

13. Do you often have more than two drinks containing alcohol in 1 day?

14. Do you think you or your partner could be pregnant?

15. Do you think you or your partner could have a sexually transmitted disease?

16. Have you or your partner(s) had sex without using birth control in the last year?

17. Have you or your partner(s) had sex with other people in the past year?

18. Have you or your partner(s) had sex without a condom in the past year?

19. Have you ever been forced or pressured to have sex?

20. Have you ever been hit, slapped, kicked, or physically hurt by someone?

Do you have other questions/concerns about your health? (Please identify.)

Source: State of California Office of Clinical Preventive Medicine

WASHINGTON — Physicians have limited time to devote to preventive care, but a short questionnaire mailed to patients prior to their visit or administered in the waiting room could change this.

A 20-item questionnaire to promote brief prevention counseling during patient visits was presented at the annual meeting of the American College of Preventive Medicine by Larry Dickey, M.D., of the California Department of Health Services, Sacramento.

Dr. Dickey shared the “Staying Healthy” Assessment questionnaires developed by his department that are now standard for all Medicaid patients in California. Pilot studies of the questionnaires show that they were well received by patients, and their use triggered doctors to provide brief preventive medicine counseling, but formal evaluations are pending.

The sample below is for Medicaid patients aged 18 years and older. To view the questionnaires for all age groups in PDF form, visit www.dhs.ca.gov/ps/ocpm/html/staying%20healthy.htm

Answers for the questionnaire include choices of “yes,” “no,” or “skip.”

1. Do you receive health care from anyone besides a medical doctor, such as an acupuncturist, herbalist, curandero, or other healer?

2. Do you see the dentist at least once a year?

3. Do you drink milk or eat yogurt or cheese at least three times each day?

4. Do you eat at least five servings of fruits or vegetables each day?

5. Do you try to limit the amount of fried or fast foods that you eat?

6. Do you exercise or do moderate physical activity such as walking or gardening 5 days a week?

7. Do you think you need to lose or gain weight?

8. Do you often feel sad, down, or hopeless?

9. Do you have friends or family members who smoke in your house?

10. Do you often spend time outdoors without sunscreen or other protection such as a hat or shirt?

11. Do you smoke cigarettes or cigars or use any other kinds of tobacco?

12. Do you use any drugs or medicines to go to sleep, relax, calm down, feel better, or lose weight?

13. Do you often have more than two drinks containing alcohol in 1 day?

14. Do you think you or your partner could be pregnant?

15. Do you think you or your partner could have a sexually transmitted disease?

16. Have you or your partner(s) had sex without using birth control in the last year?

17. Have you or your partner(s) had sex with other people in the past year?

18. Have you or your partner(s) had sex without a condom in the past year?

19. Have you ever been forced or pressured to have sex?

20. Have you ever been hit, slapped, kicked, or physically hurt by someone?

Do you have other questions/concerns about your health? (Please identify.)

Pneumococcal Serogroups Emerge

In a retrospective review of Streptococcus pneumoniae cases from 1996 to 2003, the incidence decreased 27% after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar) in 2001, reported Carrie L. Byington, M.D., of the University of Utah, Salt Lake City, and her colleagues. In a study of children younger than 18 years treated at Intermountain Health Care, Salt Lake City, the overall percentage of cases from serogroups in PCV7 decreased after the introduction of the vaccine, but the number of invasive infections due to serotypes not included in PCV7 increased (Clin. Infect. Dis. 2005; 41:21–9). The investigators identified 1,535 episodes of invasive pneumococcal disease, and the 86 children infected with non-PCV7 isolates had hospital stays twice as long as the 146 children infected with PCV7 isolates. Although the incidence of bacteremia and pneumonia decreased from the pre- to postvaccine periods (6.9 vs. 4.6 cases/100,000 children and 31 vs. 16 cases per 100,000 children, respectively), the incidence of parapneumonic empyema increased (10.3 vs. 14.3 cases/100,000 children). At approximately 5 years after PCV7's introduction, “the effect of colonization of nonvaccine S. pneumoniae serotypes depends entirely on whether new serotypes cause disease,” Sarah S. Long, M.D., of Drexel University, Philadelphia, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:30–4).

Procalcitonin Predicts Reflux

A high concentration of procalcitonin was a significant independent predictor of vesicoureteral reflux (VUR) in a study of 136 infants aged 1 month to 4 years, said Sandrine Leroy, M.D., of Saint-Vincent-de-Paul Hospital, Paris, and colleagues (Pediatrics

http://pediatrics.aappublications.org/cgi/content/abstract/115/6/e706

Strep Lingers in Nose

An early clinical recurrence of acute otitis media (AOM) was significantly more likely if Streptococcus pneumoniae remained in the nose at the end of antibiotic treatment, said Shai Libson, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel. Nasopharangeal aspirate samples were obtained after successful antibiotic treatment for AOM (J. Infect. Dis. 2005;191:1869–75). The study included 494 children aged 3–36 months who presented to an emergency room with AOM from Jan. 1, 1996, to Dec. 31, 2002. Overall, 208 (42%) of the cultures were positive for S. pneumoniae, and 86 (41%) of these patients also had yielded positive S. pneumoniae nasal cultures prior to their antibiotic treatment. In addition, 66 of the 208 (32%) patients with positive cultures after treatment developed another episode of AOM within 3 weeks, compared with 64 of 286 (22%) patients who had negative cultures after treatment. There were no significant differences between patients who did and did not have clinical AOM recurrence. The persistence of S. pneumoniae in the nose, despite its eradication from the middle ear fluid, suggests the need for further research into the impact of antibiotics on nasopharyngeal carriage, Keith P. Klugman, M.D., and Kerry J. Walsh, M.D., of Emory University, Atlanta, wrote in an accompanying editorial (J. Infect. Dis. 2005;191:1790–2).

Strep's Role in Acute Otitis Media

AOM caused by Streptococcus pyogenes was associated with older age and higher rates of tympanic perforation and mastoiditis, compared with AOM caused by other pathogens, said Nili Segal, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel (Clin. Infect. Dis. 2005;41:35–41). In the study of 11,311 episodes, overall, those caused by S. pyogenes, also known as group A β-hemolytic Streptococcus (GAS), were significantly less often associated with fever or upper respiratory tract infection, compared with non-GAS episodes (60% vs. 77% and 35% vs. 55%, respectively). GAS episodes also were significantly less likely to be bilateral, or to be associated with antibiotic treatment during the month prior to the infection. The increased risk of mastoiditis supports data from previous studies, Stanford T. Shulman, M.D., and Robert R. Tanz, M.D., of Northwestern University, Chicago, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:42–4). Episodes of GAS otitis media may be preceded by pharyngeal colonization; this colonization may contribute to the increased frequency of mastoiditis in these patients.

Pneumococcal Serogroups Emerge

In a retrospective review of Streptococcus pneumoniae cases from 1996 to 2003, the incidence decreased 27% after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar) in 2001, reported Carrie L. Byington, M.D., of the University of Utah, Salt Lake City, and her colleagues. In a study of children younger than 18 years treated at Intermountain Health Care, Salt Lake City, the overall percentage of cases from serogroups in PCV7 decreased after the introduction of the vaccine, but the number of invasive infections due to serotypes not included in PCV7 increased (Clin. Infect. Dis. 2005; 41:21–9). The investigators identified 1,535 episodes of invasive pneumococcal disease, and the 86 children infected with non-PCV7 isolates had hospital stays twice as long as the 146 children infected with PCV7 isolates. Although the incidence of bacteremia and pneumonia decreased from the pre- to postvaccine periods (6.9 vs. 4.6 cases/100,000 children and 31 vs. 16 cases per 100,000 children, respectively), the incidence of parapneumonic empyema increased (10.3 vs. 14.3 cases/100,000 children). At approximately 5 years after PCV7's introduction, “the effect of colonization of nonvaccine S. pneumoniae serotypes depends entirely on whether new serotypes cause disease,” Sarah S. Long, M.D., of Drexel University, Philadelphia, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:30–4).

Procalcitonin Predicts Reflux

A high concentration of procalcitonin was a significant independent predictor of vesicoureteral reflux (VUR) in a study of 136 infants aged 1 month to 4 years, said Sandrine Leroy, M.D., of Saint-Vincent-de-Paul Hospital, Paris, and colleagues (Pediatrics

http://pediatrics.aappublications.org/cgi/content/abstract/115/6/e706

Strep Lingers in Nose

An early clinical recurrence of acute otitis media (AOM) was significantly more likely if Streptococcus pneumoniae remained in the nose at the end of antibiotic treatment, said Shai Libson, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel. Nasopharangeal aspirate samples were obtained after successful antibiotic treatment for AOM (J. Infect. Dis. 2005;191:1869–75). The study included 494 children aged 3–36 months who presented to an emergency room with AOM from Jan. 1, 1996, to Dec. 31, 2002. Overall, 208 (42%) of the cultures were positive for S. pneumoniae, and 86 (41%) of these patients also had yielded positive S. pneumoniae nasal cultures prior to their antibiotic treatment. In addition, 66 of the 208 (32%) patients with positive cultures after treatment developed another episode of AOM within 3 weeks, compared with 64 of 286 (22%) patients who had negative cultures after treatment. There were no significant differences between patients who did and did not have clinical AOM recurrence. The persistence of S. pneumoniae in the nose, despite its eradication from the middle ear fluid, suggests the need for further research into the impact of antibiotics on nasopharyngeal carriage, Keith P. Klugman, M.D., and Kerry J. Walsh, M.D., of Emory University, Atlanta, wrote in an accompanying editorial (J. Infect. Dis. 2005;191:1790–2).

Strep's Role in Acute Otitis Media

AOM caused by Streptococcus pyogenes was associated with older age and higher rates of tympanic perforation and mastoiditis, compared with AOM caused by other pathogens, said Nili Segal, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel (Clin. Infect. Dis. 2005;41:35–41). In the study of 11,311 episodes, overall, those caused by S. pyogenes, also known as group A β-hemolytic Streptococcus (GAS), were significantly less often associated with fever or upper respiratory tract infection, compared with non-GAS episodes (60% vs. 77% and 35% vs. 55%, respectively). GAS episodes also were significantly less likely to be bilateral, or to be associated with antibiotic treatment during the month prior to the infection. The increased risk of mastoiditis supports data from previous studies, Stanford T. Shulman, M.D., and Robert R. Tanz, M.D., of Northwestern University, Chicago, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:42–4). Episodes of GAS otitis media may be preceded by pharyngeal colonization; this colonization may contribute to the increased frequency of mastoiditis in these patients.

Pneumococcal Serogroups Emerge

In a retrospective review of Streptococcus pneumoniae cases from 1996 to 2003, the incidence decreased 27% after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar) in 2001, reported Carrie L. Byington, M.D., of the University of Utah, Salt Lake City, and her colleagues. In a study of children younger than 18 years treated at Intermountain Health Care, Salt Lake City, the overall percentage of cases from serogroups in PCV7 decreased after the introduction of the vaccine, but the number of invasive infections due to serotypes not included in PCV7 increased (Clin. Infect. Dis. 2005; 41:21–9). The investigators identified 1,535 episodes of invasive pneumococcal disease, and the 86 children infected with non-PCV7 isolates had hospital stays twice as long as the 146 children infected with PCV7 isolates. Although the incidence of bacteremia and pneumonia decreased from the pre- to postvaccine periods (6.9 vs. 4.6 cases/100,000 children and 31 vs. 16 cases per 100,000 children, respectively), the incidence of parapneumonic empyema increased (10.3 vs. 14.3 cases/100,000 children). At approximately 5 years after PCV7's introduction, “the effect of colonization of nonvaccine S. pneumoniae serotypes depends entirely on whether new serotypes cause disease,” Sarah S. Long, M.D., of Drexel University, Philadelphia, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:30–4).

Procalcitonin Predicts Reflux

A high concentration of procalcitonin was a significant independent predictor of vesicoureteral reflux (VUR) in a study of 136 infants aged 1 month to 4 years, said Sandrine Leroy, M.D., of Saint-Vincent-de-Paul Hospital, Paris, and colleagues (Pediatrics

http://pediatrics.aappublications.org/cgi/content/abstract/115/6/e706

Strep Lingers in Nose

An early clinical recurrence of acute otitis media (AOM) was significantly more likely if Streptococcus pneumoniae remained in the nose at the end of antibiotic treatment, said Shai Libson, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel. Nasopharangeal aspirate samples were obtained after successful antibiotic treatment for AOM (J. Infect. Dis. 2005;191:1869–75). The study included 494 children aged 3–36 months who presented to an emergency room with AOM from Jan. 1, 1996, to Dec. 31, 2002. Overall, 208 (42%) of the cultures were positive for S. pneumoniae, and 86 (41%) of these patients also had yielded positive S. pneumoniae nasal cultures prior to their antibiotic treatment. In addition, 66 of the 208 (32%) patients with positive cultures after treatment developed another episode of AOM within 3 weeks, compared with 64 of 286 (22%) patients who had negative cultures after treatment. There were no significant differences between patients who did and did not have clinical AOM recurrence. The persistence of S. pneumoniae in the nose, despite its eradication from the middle ear fluid, suggests the need for further research into the impact of antibiotics on nasopharyngeal carriage, Keith P. Klugman, M.D., and Kerry J. Walsh, M.D., of Emory University, Atlanta, wrote in an accompanying editorial (J. Infect. Dis. 2005;191:1790–2).

Strep's Role in Acute Otitis Media

AOM caused by Streptococcus pyogenes was associated with older age and higher rates of tympanic perforation and mastoiditis, compared with AOM caused by other pathogens, said Nili Segal, M.D., and associates at Ben-Gurion University of the Negev, Beer-Sheva, Israel (Clin. Infect. Dis. 2005;41:35–41). In the study of 11,311 episodes, overall, those caused by S. pyogenes, also known as group A β-hemolytic Streptococcus (GAS), were significantly less often associated with fever or upper respiratory tract infection, compared with non-GAS episodes (60% vs. 77% and 35% vs. 55%, respectively). GAS episodes also were significantly less likely to be bilateral, or to be associated with antibiotic treatment during the month prior to the infection. The increased risk of mastoiditis supports data from previous studies, Stanford T. Shulman, M.D., and Robert R. Tanz, M.D., of Northwestern University, Chicago, wrote in an accompanying editorial (Clin. Infect. Dis. 2005;41:42–4). Episodes of GAS otitis media may be preceded by pharyngeal colonization; this colonization may contribute to the increased frequency of mastoiditis in these patients.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004.

Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred so far this year.

“Drug use was a significant risk factor,” Mr. Shanahan said. Approximately 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the association between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005.

The ages of the 97 patients ranged from 15–81 years, with an average age of 24 years; 14 of the 97 patients were 18 years or younger.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004.

Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred so far this year.

“Drug use was a significant risk factor,” Mr. Shanahan said. Approximately 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the association between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005.

The ages of the 97 patients ranged from 15–81 years, with an average age of 24 years; 14 of the 97 patients were 18 years or younger.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004.

Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred so far this year.

“Drug use was a significant risk factor,” Mr. Shanahan said. Approximately 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the association between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005.

The ages of the 97 patients ranged from 15–81 years, with an average age of 24 years; 14 of the 97 patients were 18 years or younger.

WASHINGTON — Race was a strong predictor of premature coronary artery disease, with white and Asian Indian patients more likely to have PCAD than black and Hispanic patients in a study of 416 patients aged 40 years and younger, Amit Amin, M.D., reported at the Clinical Research 2005 meeting.

Dr. Amin, of the John H. Strong Hospital of Cook County, Ill., and his colleagues conducted a retrospective study of cardiac risk factors in patients who underwent coronary angiography between 1993 and 2001. The study may be the first to assess premature coronary artery disease (PCAD) in a predominantly nonwhite population, Dr. Amin noted in an oral presentation of a poster.

About 30% of the patients were black, and 20% were Hispanic; their mean age was 36 years. The overall prevalence of PCAD in the study population was 33%. Diabetes, dyslipidemia, and smoking were significant predictors of PCAD in the study population as a whole, Dr. Amin said at the meeting, sponsored by the American Federation for Medical Research.

Dyslipidemia had no significant impact on PCAD in the subset that combined white and Asian Indian patients, but dyslipidemia increased the odds of PCAD approximately threefold in the subset of black and Hispanic patients.

About half the study population had risk factors of hypertension and smoking. Dyslipidemia, diabetes, and smoking were among the strongest modifiable risk factors; obesity was not a significant independent risk factor for PCAD in this study.

The overall mortality rate was 5.8% at about 3.5 years' follow-up.

WASHINGTON — Race was a strong predictor of premature coronary artery disease, with white and Asian Indian patients more likely to have PCAD than black and Hispanic patients in a study of 416 patients aged 40 years and younger, Amit Amin, M.D., reported at the Clinical Research 2005 meeting.

Dr. Amin, of the John H. Strong Hospital of Cook County, Ill., and his colleagues conducted a retrospective study of cardiac risk factors in patients who underwent coronary angiography between 1993 and 2001. The study may be the first to assess premature coronary artery disease (PCAD) in a predominantly nonwhite population, Dr. Amin noted in an oral presentation of a poster.

About 30% of the patients were black, and 20% were Hispanic; their mean age was 36 years. The overall prevalence of PCAD in the study population was 33%. Diabetes, dyslipidemia, and smoking were significant predictors of PCAD in the study population as a whole, Dr. Amin said at the meeting, sponsored by the American Federation for Medical Research.

Dyslipidemia had no significant impact on PCAD in the subset that combined white and Asian Indian patients, but dyslipidemia increased the odds of PCAD approximately threefold in the subset of black and Hispanic patients.

About half the study population had risk factors of hypertension and smoking. Dyslipidemia, diabetes, and smoking were among the strongest modifiable risk factors; obesity was not a significant independent risk factor for PCAD in this study.

The overall mortality rate was 5.8% at about 3.5 years' follow-up.

WASHINGTON — Race was a strong predictor of premature coronary artery disease, with white and Asian Indian patients more likely to have PCAD than black and Hispanic patients in a study of 416 patients aged 40 years and younger, Amit Amin, M.D., reported at the Clinical Research 2005 meeting.

Dr. Amin, of the John H. Strong Hospital of Cook County, Ill., and his colleagues conducted a retrospective study of cardiac risk factors in patients who underwent coronary angiography between 1993 and 2001. The study may be the first to assess premature coronary artery disease (PCAD) in a predominantly nonwhite population, Dr. Amin noted in an oral presentation of a poster.

About 30% of the patients were black, and 20% were Hispanic; their mean age was 36 years. The overall prevalence of PCAD in the study population was 33%. Diabetes, dyslipidemia, and smoking were significant predictors of PCAD in the study population as a whole, Dr. Amin said at the meeting, sponsored by the American Federation for Medical Research.

Dyslipidemia had no significant impact on PCAD in the subset that combined white and Asian Indian patients, but dyslipidemia increased the odds of PCAD approximately threefold in the subset of black and Hispanic patients.

About half the study population had risk factors of hypertension and smoking. Dyslipidemia, diabetes, and smoking were among the strongest modifiable risk factors; obesity was not a significant independent risk factor for PCAD in this study.

The overall mortality rate was 5.8% at about 3.5 years' follow-up.

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36 and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14). Body temperatures above 38° were not significantly associated with in-hospital mortality, but they were significantly associated with lower mortality after 1 year (adjusted risk ratio, 0.80).

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36 and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14). Body temperatures above 38° were not significantly associated with in-hospital mortality, but they were significantly associated with lower mortality after 1 year (adjusted risk ratio, 0.80).

WASHINGTON — Body temperature below 36° C at hospital admission was independently associated with a lower survival rate in a study of 56,659 patients with advanced heart failure.

Disordered thermoregulation is common in patients with advanced heart failure, and body temperature measurements may improve risk assessment in these patients, Brahmajee K. Nallamothu, M.D., wrote in a poster presented at the Clinical Research 2005 meeting sponsored by the American Federation for Medical Research.

Dr. Nallamothu, a cardiologist at the University of Michigan, Ann Arbor, and his associates reviewed data on patients aged 65 years and older who were participating in the National Heart Care Project.

The mean body temperature upon hospital admission was 36.5° C, and most of the patients' admission temperatures were between 36 and 38° C. However, 10,754 (18.5%) of the patients had body temperatures below 36° C and 1,145 (1.9%) had body temperatures above 38° C.

After multivariate analysis, patients with body temperatures below 36° had significantly higher mortality, both in hospital (adjusted risk ratio, 1.28) and at 1 year after their hospitalizations (adjusted risk ratio, 1.14). Body temperatures above 38° were not significantly associated with in-hospital mortality, but they were significantly associated with lower mortality after 1 year (adjusted risk ratio, 0.80).

ORLANDO — Pediatricians have a reputation for being generous in caring for—and about—their patients. But that doesn't mean they should cut corners on coding, said Charles Scott, M.D., a pediatrician in private practice in Medford, N.J.

Pediatricians should be coding for every service that is done, Dr. Scott said at a meeting sponsored by the American Academy of Pediatrics. “Don't apologize for the care you have rendered on the child's behalf.”

Shrinking third-party payments, along with increasing expenses, more paperwork, and less patient appreciation, all eat into a pediatrician's pockets at the end of the day, and it's important to find legitimate ways to generate revenue, preferably without adding office personnel, Dr. Scott said.

“Those nickels and dimes add up,” he said. “Insurers won't allow us to pass our costs on to consumers, so accurate and thorough billing is essential to help your practice survive and thrive.”

Principles that can help manage costs and maximize payments in pediatric practice include avoiding freebies—such as “just taking a peek” at the second child—and avoiding professional courtesy with respect to copays. Physicians should also use additional codes when appropriate, such as those for visits after hours and on Sundays.

In addition, collecting copayments; charging for emergency visits; splinting and strapping supplies; and charging to complete forms for school, camp, or day care can make a significant difference in the bottom line.

“The small charges that some people forget can really add to your bottom line,” Dr. Scott said.

The insurance companies, unlike physicians, aren't concerned about the costs of operating a practice, so the challenge for doctors is to find innovative, ethical ways to generate revenue, Dr. Scott said. By being diligent about coding, as well as adding a few procedures, a physician can keep work exciting and generate extra revenue without increasing overhead costs, Dr. Scott added. He noted some small charges that can add up to big money:

▸ Don't leave any copayments on the table. Every patient has to pay, including those who are fellow physicians. Collect the copayments prior to the visit.

▸ Charge for second-child tagalongs. If a parent asks you to take a look at a second child, register the patient, collect the copay, conduct a thorough and appropriate evaluation, and bill for the visit.

▸ Don't offer professional courtesies. Most colleagues will take their kids to a pediatrician. But it's illegal to charge only the amount that the insurance will pay. You can't write off copays as a professional courtesy—that's considered fraud.

▸ Remember the copayment usually is higher for the emergency department than for the office visit. Tell patients that. And if the insurance won't pay for the relatively lower office charge plus the emergency code, remind the insurer that you saved them money by preventing an ED visit—something you won't do in the future should one of their plan's patients call again. Further, let the patient know that the insurer doesn't want you to see them if there should be an emergency in the future. Let the patient yell at the insurer for lack of recognition of a code that benefits all parties.

Events that constitute office emergencies include lacerations, respiratory distress, seizures, trauma, parents rushing in to demand an appointment, and a child who needs an immediate evaluation before a specialist's office closes. These deserve an additional premium for your immediate availability for that emergency.

▸ Consider simultaneous sick and well exams. There's no question that you can find some additional diagnosis at every well-child visit. It is rare that a child comes in who is 100% healthy. To code for a sick visit at the same time, the other diagnosis has to have taken more of your time than the well visit alone would have taken. Simultaneous sick and well exams don't always take much more time than a simple checkup, and you can code for the extra work. However, it has to be reasonable to spend time this way, and sometimes a separate second visit is the better bet when an insurer is intransigent.

For example, if a child comes in for a well visit and you identify an illness such as otitis media, writing a prescription takes time. You can use codes for both sick and well exams simultaneously. You can use the -25 modifier to identify that the “sick visit” part of the examination was separate.

In another example, if a child comes in for a well visit, and you want to talk in depth about an issue that arises, spend the time to do so if you prefer—but also code for that time. Alternatively, reschedule a separate visit to discuss the specific problem—such as school issues, bed-wetting, or attention-deficit hyperactivity disorder—and use a higher-level E/M (evaluation and management) code for that second visit.

▸ Bill for supplies. Consider relying on parents' good will and ask them to replace the item used, such as an ace bandage, sling, crutches, or a splint. But check the Health Care Financing Administration's Common Procedural Coding System for the codes to use if you need to bill for supplies you have purchased.

▸ Charge for filling out forms. Consider setting a fee, posted in your office, to fill out forms for camp, school sports, and day care centers. Collect this fee up front.

▸ When dealing with insurance companies, try to speak with a pediatric medical director. He or she may be more responsive to a pediatrician's issues, but remember that the insurance companies can do whatever they want. They can even pay two different doctors different amounts for the same service.

The process of deciding which code is the most appropriate depends on several factors. Complex or chronic conditions that take more time, such as check-ups for premature infants, should have some expectation of added E/M codes.

The bottom line is that pediatrics is a business as well as a calling, and you need to stay in business to help patients, Dr. Scott said. Do not apologize for fees, he added, saying it makes sense—and cents—to charge appropriately for services given.

ORLANDO — Pediatricians have a reputation for being generous in caring for—and about—their patients. But that doesn't mean they should cut corners on coding, said Charles Scott, M.D., a pediatrician in private practice in Medford, N.J.

Pediatricians should be coding for every service that is done, Dr. Scott said at a meeting sponsored by the American Academy of Pediatrics. “Don't apologize for the care you have rendered on the child's behalf.”

Shrinking third-party payments, along with increasing expenses, more paperwork, and less patient appreciation, all eat into a pediatrician's pockets at the end of the day, and it's important to find legitimate ways to generate revenue, preferably without adding office personnel, Dr. Scott said.

“Those nickels and dimes add up,” he said. “Insurers won't allow us to pass our costs on to consumers, so accurate and thorough billing is essential to help your practice survive and thrive.”

Principles that can help manage costs and maximize payments in pediatric practice include avoiding freebies—such as “just taking a peek” at the second child—and avoiding professional courtesy with respect to copays. Physicians should also use additional codes when appropriate, such as those for visits after hours and on Sundays.

In addition, collecting copayments; charging for emergency visits; splinting and strapping supplies; and charging to complete forms for school, camp, or day care can make a significant difference in the bottom line.

“The small charges that some people forget can really add to your bottom line,” Dr. Scott said.

The insurance companies, unlike physicians, aren't concerned about the costs of operating a practice, so the challenge for doctors is to find innovative, ethical ways to generate revenue, Dr. Scott said. By being diligent about coding, as well as adding a few procedures, a physician can keep work exciting and generate extra revenue without increasing overhead costs, Dr. Scott added. He noted some small charges that can add up to big money:

▸ Don't leave any copayments on the table. Every patient has to pay, including those who are fellow physicians. Collect the copayments prior to the visit.

▸ Charge for second-child tagalongs. If a parent asks you to take a look at a second child, register the patient, collect the copay, conduct a thorough and appropriate evaluation, and bill for the visit.

▸ Don't offer professional courtesies. Most colleagues will take their kids to a pediatrician. But it's illegal to charge only the amount that the insurance will pay. You can't write off copays as a professional courtesy—that's considered fraud.

▸ Remember the copayment usually is higher for the emergency department than for the office visit. Tell patients that. And if the insurance won't pay for the relatively lower office charge plus the emergency code, remind the insurer that you saved them money by preventing an ED visit—something you won't do in the future should one of their plan's patients call again. Further, let the patient know that the insurer doesn't want you to see them if there should be an emergency in the future. Let the patient yell at the insurer for lack of recognition of a code that benefits all parties.

Events that constitute office emergencies include lacerations, respiratory distress, seizures, trauma, parents rushing in to demand an appointment, and a child who needs an immediate evaluation before a specialist's office closes. These deserve an additional premium for your immediate availability for that emergency.

▸ Consider simultaneous sick and well exams. There's no question that you can find some additional diagnosis at every well-child visit. It is rare that a child comes in who is 100% healthy. To code for a sick visit at the same time, the other diagnosis has to have taken more of your time than the well visit alone would have taken. Simultaneous sick and well exams don't always take much more time than a simple checkup, and you can code for the extra work. However, it has to be reasonable to spend time this way, and sometimes a separate second visit is the better bet when an insurer is intransigent.

For example, if a child comes in for a well visit and you identify an illness such as otitis media, writing a prescription takes time. You can use codes for both sick and well exams simultaneously. You can use the -25 modifier to identify that the “sick visit” part of the examination was separate.

In another example, if a child comes in for a well visit, and you want to talk in depth about an issue that arises, spend the time to do so if you prefer—but also code for that time. Alternatively, reschedule a separate visit to discuss the specific problem—such as school issues, bed-wetting, or attention-deficit hyperactivity disorder—and use a higher-level E/M (evaluation and management) code for that second visit.

▸ Bill for supplies. Consider relying on parents' good will and ask them to replace the item used, such as an ace bandage, sling, crutches, or a splint. But check the Health Care Financing Administration's Common Procedural Coding System for the codes to use if you need to bill for supplies you have purchased.

▸ Charge for filling out forms. Consider setting a fee, posted in your office, to fill out forms for camp, school sports, and day care centers. Collect this fee up front.

▸ When dealing with insurance companies, try to speak with a pediatric medical director. He or she may be more responsive to a pediatrician's issues, but remember that the insurance companies can do whatever they want. They can even pay two different doctors different amounts for the same service.

The process of deciding which code is the most appropriate depends on several factors. Complex or chronic conditions that take more time, such as check-ups for premature infants, should have some expectation of added E/M codes.

The bottom line is that pediatrics is a business as well as a calling, and you need to stay in business to help patients, Dr. Scott said. Do not apologize for fees, he added, saying it makes sense—and cents—to charge appropriately for services given.

ORLANDO — Pediatricians have a reputation for being generous in caring for—and about—their patients. But that doesn't mean they should cut corners on coding, said Charles Scott, M.D., a pediatrician in private practice in Medford, N.J.

Pediatricians should be coding for every service that is done, Dr. Scott said at a meeting sponsored by the American Academy of Pediatrics. “Don't apologize for the care you have rendered on the child's behalf.”

Shrinking third-party payments, along with increasing expenses, more paperwork, and less patient appreciation, all eat into a pediatrician's pockets at the end of the day, and it's important to find legitimate ways to generate revenue, preferably without adding office personnel, Dr. Scott said.

“Those nickels and dimes add up,” he said. “Insurers won't allow us to pass our costs on to consumers, so accurate and thorough billing is essential to help your practice survive and thrive.”

Principles that can help manage costs and maximize payments in pediatric practice include avoiding freebies—such as “just taking a peek” at the second child—and avoiding professional courtesy with respect to copays. Physicians should also use additional codes when appropriate, such as those for visits after hours and on Sundays.

In addition, collecting copayments; charging for emergency visits; splinting and strapping supplies; and charging to complete forms for school, camp, or day care can make a significant difference in the bottom line.

“The small charges that some people forget can really add to your bottom line,” Dr. Scott said.

The insurance companies, unlike physicians, aren't concerned about the costs of operating a practice, so the challenge for doctors is to find innovative, ethical ways to generate revenue, Dr. Scott said. By being diligent about coding, as well as adding a few procedures, a physician can keep work exciting and generate extra revenue without increasing overhead costs, Dr. Scott added. He noted some small charges that can add up to big money:

▸ Don't leave any copayments on the table. Every patient has to pay, including those who are fellow physicians. Collect the copayments prior to the visit.

▸ Charge for second-child tagalongs. If a parent asks you to take a look at a second child, register the patient, collect the copay, conduct a thorough and appropriate evaluation, and bill for the visit.

▸ Don't offer professional courtesies. Most colleagues will take their kids to a pediatrician. But it's illegal to charge only the amount that the insurance will pay. You can't write off copays as a professional courtesy—that's considered fraud.

▸ Remember the copayment usually is higher for the emergency department than for the office visit. Tell patients that. And if the insurance won't pay for the relatively lower office charge plus the emergency code, remind the insurer that you saved them money by preventing an ED visit—something you won't do in the future should one of their plan's patients call again. Further, let the patient know that the insurer doesn't want you to see them if there should be an emergency in the future. Let the patient yell at the insurer for lack of recognition of a code that benefits all parties.

Events that constitute office emergencies include lacerations, respiratory distress, seizures, trauma, parents rushing in to demand an appointment, and a child who needs an immediate evaluation before a specialist's office closes. These deserve an additional premium for your immediate availability for that emergency.

▸ Consider simultaneous sick and well exams. There's no question that you can find some additional diagnosis at every well-child visit. It is rare that a child comes in who is 100% healthy. To code for a sick visit at the same time, the other diagnosis has to have taken more of your time than the well visit alone would have taken. Simultaneous sick and well exams don't always take much more time than a simple checkup, and you can code for the extra work. However, it has to be reasonable to spend time this way, and sometimes a separate second visit is the better bet when an insurer is intransigent.

For example, if a child comes in for a well visit and you identify an illness such as otitis media, writing a prescription takes time. You can use codes for both sick and well exams simultaneously. You can use the -25 modifier to identify that the “sick visit” part of the examination was separate.

In another example, if a child comes in for a well visit, and you want to talk in depth about an issue that arises, spend the time to do so if you prefer—but also code for that time. Alternatively, reschedule a separate visit to discuss the specific problem—such as school issues, bed-wetting, or attention-deficit hyperactivity disorder—and use a higher-level E/M (evaluation and management) code for that second visit.

▸ Bill for supplies. Consider relying on parents' good will and ask them to replace the item used, such as an ace bandage, sling, crutches, or a splint. But check the Health Care Financing Administration's Common Procedural Coding System for the codes to use if you need to bill for supplies you have purchased.

▸ Charge for filling out forms. Consider setting a fee, posted in your office, to fill out forms for camp, school sports, and day care centers. Collect this fee up front.

▸ When dealing with insurance companies, try to speak with a pediatric medical director. He or she may be more responsive to a pediatrician's issues, but remember that the insurance companies can do whatever they want. They can even pay two different doctors different amounts for the same service.

The process of deciding which code is the most appropriate depends on several factors. Complex or chronic conditions that take more time, such as check-ups for premature infants, should have some expectation of added E/M codes.

The bottom line is that pediatrics is a business as well as a calling, and you need to stay in business to help patients, Dr. Scott said. Do not apologize for fees, he added, saying it makes sense—and cents—to charge appropriately for services given.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004. Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred.

“Drug use was a significant risk factor,” Mr. Shanahan said. About 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the link between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005. The ages of the 97 patients ranged from 15 to 81 years; 14 of the 97 patients were aged 18 years or younger.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004. Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred.

“Drug use was a significant risk factor,” Mr. Shanahan said. About 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the link between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005. The ages of the 97 patients ranged from 15 to 81 years; 14 of the 97 patients were aged 18 years or younger.

An outbreak of syphilis in southern Idaho that began in 2003 probably has peaked, according to Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

Four babies with congenital syphilis were born in Idaho in 2003, and three were born in 2004. “We started seeing a rise in total cases of syphilis in 2002 and 2003; we are hopefully over the hump now,” Mr. Shanahan said. In addition to the congenital cases, 45 cases of syphilis were reported in the state in 2003, and 78 cases were reported in 2004. Although 21 cases of syphilis have been reported in 2005, no congenital cases have occurred.

“Drug use was a significant risk factor,” Mr. Shanahan said. About 70% of patients in Idaho's third district were methamphetamine or other drug users. Consequently, management strategies to control the outbreak include spreading the word about the link between drug use and syphilis, and educating the public through organizations that work with drug addicts.

The incidence of illness was highest in southwest Idaho, which reported 97 of the state's 144 cases of syphilis from 2003 to 2005. The ages of the 97 patients ranged from 15 to 81 years; 14 of the 97 patients were aged 18 years or younger.

Adding Adenoidectomy No Help

Adenoidectomy in conjunction with tympanostomy tubes failed to reduce the incidence of otitis media, compared with the use of tubes only, in a randomized trial of 217 children aged 12–48 months, said Sari Hammarén-Malmi, M.D., of the University of Helsinki (Finland), and associates (Pediatrics 2005;116:185–9). The children had suffered recurrent acute otitis media (OM), defined as at least three episodes during the 6 months prior to the study, or had chronic otitis media with effusion. Overall, the mean number of episodes of OM in children who had both adenoidectomy and tube placement was 1.7, compared with 1.4 in children who had tube placement only.

In addition, adenoidectomy provided no benefit in reducing the risk of frequent recurrent episodes or when the two groups were subdivided by clinical diagnosis or by frequency of previous episodes.

MRSA Rising in Tennessee

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) among healthy children in Nashville, Tenn., increased from 0.8% in 2001 to 9.2% in 2004, reported Clarence B. Creech II, M.D., of Vanderbilt University Medical Center in Nashville, and his colleagues. In a study sponsored in part by Wyeth Pharmaceuticals, the researchers collected nasal swabs from 500 patients, aged 2 weeks to 21 years, who presented to one of two sites in Nashville, either a clinic or a private practice, for general health maintenance visits between April and September 2004. The researchers found MRSA in 46 of 182 S. aureus isolates (25%) in 2004, compared with 4 of 145 S. aureus isolates (3%) found in 2001.

Of the 46 MRSA isolates identified in 2004, 45 were susceptible to gentamicin, rifampin, and trimethoprim-sulfamethoxazole. In addition, 25 of the 46 isolates (54%) were resistant to erythromycin, 12 (26%) were resistant to clindamycin, and inducible clindamycin resistance appeared in 8 of the 25 (32%) erythromycin-resistant isolates.

Congenital CMV and Hearing Loss

Hearing loss was significantly associated with increased amounts of cytomegalovirus (CMV) in the urine in a screening study of 76 infants with congenital CMV, said Suresh B. Boppana, M.D., of the University of Alabama at Birmingham, and colleagues (J. Pediatr. 2005;146:817–23). The children were observed for an average of 34 months and underwent an average of six hearing evaluations. Overall, 8 of 18 children with symptomatic CMV (44%) had sensorineural hearing loss, compared with 4 of 58 children with asymptomatic infections (7%).

The mean urine CMV level among infants with symptomatic infections was significantly greater than in infants with asymptomatic infections (2.4 × 105 plaque-forming units/mL vs. 3.9 × 104 pfu/mL). The amount of CMV DNA in peripheral blood samples also was significantly higher among children with symptomatic infections.

A total of 4 of the 12 children with sensorineural hearing loss were born at less than 37 weeks' gestation, compared with 6 of the 64 children with normal hearing who were preterm. The results suggest that measuring the virus load in early infancy may help identify children with asymptomatic CMV who would be at increased risk for hearing loss.

Two Doses of Flu Vaccine Protective

The 2003–2004 influenza vaccine was significantly protective against influenza in an analysis of 29,726 Colorado children aged 6–23 months and aged 6 months to 8 years, reported Debra P. Ritzwoller, Ph.D., of Kaiser Permanente Colorado in Denver, and her colleagues (Pediatrics 2005;116:153–9).

The 2003–2004 flu season in Colorado began in November 2003, at which time 7.3% of children aged 6–23 months were fully vaccinated (two doses) and 19.6% partially vaccinated (one dose) In addition, 7.5% and 7.9% of children aged 2–8 years were fully and partially vaccinated, respectively. The predominant circulating virus that year was slightly different from the one used in the vaccine for that flu season.

However, despite this discrepancy, vaccine effectiveness was 25% and 49%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6–23 months. The vaccine effectiveness was 23% and 51%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6 months to 8 years. Statistically significant reductions in pneumonia and influenza also occurred in partially vaccinated children aged 6 months to 8 years, but reductions were not significant among partially vaccinated children younger than 6 months.

Adding Adenoidectomy No Help

Adenoidectomy in conjunction with tympanostomy tubes failed to reduce the incidence of otitis media, compared with the use of tubes only, in a randomized trial of 217 children aged 12–48 months, said Sari Hammarén-Malmi, M.D., of the University of Helsinki (Finland), and associates (Pediatrics 2005;116:185–9). The children had suffered recurrent acute otitis media (OM), defined as at least three episodes during the 6 months prior to the study, or had chronic otitis media with effusion. Overall, the mean number of episodes of OM in children who had both adenoidectomy and tube placement was 1.7, compared with 1.4 in children who had tube placement only.

In addition, adenoidectomy provided no benefit in reducing the risk of frequent recurrent episodes or when the two groups were subdivided by clinical diagnosis or by frequency of previous episodes.

MRSA Rising in Tennessee

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) among healthy children in Nashville, Tenn., increased from 0.8% in 2001 to 9.2% in 2004, reported Clarence B. Creech II, M.D., of Vanderbilt University Medical Center in Nashville, and his colleagues. In a study sponsored in part by Wyeth Pharmaceuticals, the researchers collected nasal swabs from 500 patients, aged 2 weeks to 21 years, who presented to one of two sites in Nashville, either a clinic or a private practice, for general health maintenance visits between April and September 2004. The researchers found MRSA in 46 of 182 S. aureus isolates (25%) in 2004, compared with 4 of 145 S. aureus isolates (3%) found in 2001.

Of the 46 MRSA isolates identified in 2004, 45 were susceptible to gentamicin, rifampin, and trimethoprim-sulfamethoxazole. In addition, 25 of the 46 isolates (54%) were resistant to erythromycin, 12 (26%) were resistant to clindamycin, and inducible clindamycin resistance appeared in 8 of the 25 (32%) erythromycin-resistant isolates.

Congenital CMV and Hearing Loss

Hearing loss was significantly associated with increased amounts of cytomegalovirus (CMV) in the urine in a screening study of 76 infants with congenital CMV, said Suresh B. Boppana, M.D., of the University of Alabama at Birmingham, and colleagues (J. Pediatr. 2005;146:817–23). The children were observed for an average of 34 months and underwent an average of six hearing evaluations. Overall, 8 of 18 children with symptomatic CMV (44%) had sensorineural hearing loss, compared with 4 of 58 children with asymptomatic infections (7%).

The mean urine CMV level among infants with symptomatic infections was significantly greater than in infants with asymptomatic infections (2.4 × 105 plaque-forming units/mL vs. 3.9 × 104 pfu/mL). The amount of CMV DNA in peripheral blood samples also was significantly higher among children with symptomatic infections.

A total of 4 of the 12 children with sensorineural hearing loss were born at less than 37 weeks' gestation, compared with 6 of the 64 children with normal hearing who were preterm. The results suggest that measuring the virus load in early infancy may help identify children with asymptomatic CMV who would be at increased risk for hearing loss.

Two Doses of Flu Vaccine Protective

The 2003–2004 influenza vaccine was significantly protective against influenza in an analysis of 29,726 Colorado children aged 6–23 months and aged 6 months to 8 years, reported Debra P. Ritzwoller, Ph.D., of Kaiser Permanente Colorado in Denver, and her colleagues (Pediatrics 2005;116:153–9).

The 2003–2004 flu season in Colorado began in November 2003, at which time 7.3% of children aged 6–23 months were fully vaccinated (two doses) and 19.6% partially vaccinated (one dose) In addition, 7.5% and 7.9% of children aged 2–8 years were fully and partially vaccinated, respectively. The predominant circulating virus that year was slightly different from the one used in the vaccine for that flu season.

However, despite this discrepancy, vaccine effectiveness was 25% and 49%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6–23 months. The vaccine effectiveness was 23% and 51%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6 months to 8 years. Statistically significant reductions in pneumonia and influenza also occurred in partially vaccinated children aged 6 months to 8 years, but reductions were not significant among partially vaccinated children younger than 6 months.

Adding Adenoidectomy No Help

Adenoidectomy in conjunction with tympanostomy tubes failed to reduce the incidence of otitis media, compared with the use of tubes only, in a randomized trial of 217 children aged 12–48 months, said Sari Hammarén-Malmi, M.D., of the University of Helsinki (Finland), and associates (Pediatrics 2005;116:185–9). The children had suffered recurrent acute otitis media (OM), defined as at least three episodes during the 6 months prior to the study, or had chronic otitis media with effusion. Overall, the mean number of episodes of OM in children who had both adenoidectomy and tube placement was 1.7, compared with 1.4 in children who had tube placement only.

In addition, adenoidectomy provided no benefit in reducing the risk of frequent recurrent episodes or when the two groups were subdivided by clinical diagnosis or by frequency of previous episodes.

MRSA Rising in Tennessee

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) among healthy children in Nashville, Tenn., increased from 0.8% in 2001 to 9.2% in 2004, reported Clarence B. Creech II, M.D., of Vanderbilt University Medical Center in Nashville, and his colleagues. In a study sponsored in part by Wyeth Pharmaceuticals, the researchers collected nasal swabs from 500 patients, aged 2 weeks to 21 years, who presented to one of two sites in Nashville, either a clinic or a private practice, for general health maintenance visits between April and September 2004. The researchers found MRSA in 46 of 182 S. aureus isolates (25%) in 2004, compared with 4 of 145 S. aureus isolates (3%) found in 2001.

Of the 46 MRSA isolates identified in 2004, 45 were susceptible to gentamicin, rifampin, and trimethoprim-sulfamethoxazole. In addition, 25 of the 46 isolates (54%) were resistant to erythromycin, 12 (26%) were resistant to clindamycin, and inducible clindamycin resistance appeared in 8 of the 25 (32%) erythromycin-resistant isolates.

Congenital CMV and Hearing Loss

Hearing loss was significantly associated with increased amounts of cytomegalovirus (CMV) in the urine in a screening study of 76 infants with congenital CMV, said Suresh B. Boppana, M.D., of the University of Alabama at Birmingham, and colleagues (J. Pediatr. 2005;146:817–23). The children were observed for an average of 34 months and underwent an average of six hearing evaluations. Overall, 8 of 18 children with symptomatic CMV (44%) had sensorineural hearing loss, compared with 4 of 58 children with asymptomatic infections (7%).

The mean urine CMV level among infants with symptomatic infections was significantly greater than in infants with asymptomatic infections (2.4 × 105 plaque-forming units/mL vs. 3.9 × 104 pfu/mL). The amount of CMV DNA in peripheral blood samples also was significantly higher among children with symptomatic infections.

A total of 4 of the 12 children with sensorineural hearing loss were born at less than 37 weeks' gestation, compared with 6 of the 64 children with normal hearing who were preterm. The results suggest that measuring the virus load in early infancy may help identify children with asymptomatic CMV who would be at increased risk for hearing loss.

Two Doses of Flu Vaccine Protective

The 2003–2004 influenza vaccine was significantly protective against influenza in an analysis of 29,726 Colorado children aged 6–23 months and aged 6 months to 8 years, reported Debra P. Ritzwoller, Ph.D., of Kaiser Permanente Colorado in Denver, and her colleagues (Pediatrics 2005;116:153–9).

The 2003–2004 flu season in Colorado began in November 2003, at which time 7.3% of children aged 6–23 months were fully vaccinated (two doses) and 19.6% partially vaccinated (one dose) In addition, 7.5% and 7.9% of children aged 2–8 years were fully and partially vaccinated, respectively. The predominant circulating virus that year was slightly different from the one used in the vaccine for that flu season.

However, despite this discrepancy, vaccine effectiveness was 25% and 49%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6–23 months. The vaccine effectiveness was 23% and 51%, respectively, against influenzalike illness and against pneumonia and influenza in fully vaccinated children aged 6 months to 8 years. Statistically significant reductions in pneumonia and influenza also occurred in partially vaccinated children aged 6 months to 8 years, but reductions were not significant among partially vaccinated children younger than 6 months.

HOUSTON — “When I am asked whether I think [attention-deficit hyperactivity disorder] is overdiagnosed, I say that kids are underfoot now more than they used to be,” Saundra Gilfillan, D.O., said at the annual meeting of the American Society for Adolescent Psychiatry.

“Did we miss ADHD before? No, the hyperactive kids wore themselves out,” said Dr. Gilfillan, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas, which cosponsored the meeting.

Comorbidities are common with ADHD: As many as 80% of children and adolescents with ADHD meet criteria for a related category disorder, particularly conduct disorder, oppositional defiant disorder, and bipolar disorder. When evaluating a child or adolescent for ADHD, consider other conditions as well.

When Dr. Gilfillan assesses children and adolescents for ADHD, with or without comorbidities, she starts by asking parents about the child's behavior as an infant.

Hyperactive children were often very active in utero and active as infants; they did not sleep well and were distracted when eating, she said. In addition, children with ADHD often skipped the crawling stage or spent very little time crawling. Dr. Gilfillan also asks whether the child or adolescent is invited to birthday parties.

“It's a very big developmental thing on the social side,” and parents who recognize a “hyper,” aggressive child may not want the child in their house, she noted. She also asks about emergency department visits and car accidents.

“I like to look at report cards, to see what teachers wrote about behavior,” she said. Another question is who babysits. “If the grandmother won't babysit the child, then that's a problem,” she said.

People do not truly outgrow ADHD; the symptoms simply evolve. Motor hyperactivity in childhood evolves into internal feelings of restlessness in adolescence and adulthood. They often have problems in classes where they have to sit or take notes, she said.

Children with ADHD who do not have comorbid conditions generally exhibit less severe symptoms. Their carelessness and inattention may lead to destructiveness and misbehavior, but it appears to be unintentional. Children with ADHD who also have conduct disorder, oppositional defiant disorder, and bipolar disorder are more likely to have social problems, to require hospitalization, and to develop other problems such as depression and anxiety. There are more specific observations on cormobidities:

▸ Conduct disorder. “I call these the thugs and 'thugettes,'” Dr. Gilfillan said. These children or teens have no respect for societal norms—they genuinely do not care about the rights of others. The majority of child-onset cases of conduct disorder are in males, but by adolescence the numbers are approximately equal. Children with conduct disorder don't always make it to the psychiatrist because they go into the legal system first.

▸ Oppositional defiant disorder. By contrast, children with oppositional defiant disorders tend to be argumentative, but usually only within their immediate network of family and friends. Some kids negotiate that way; some derive satisfaction from engaging their parents in an argument.

▸ Bipolar disorder. More than 50% of adolescents with bipolar disorder have at least one coexisting psychiatric disorder. “In many areas, to get a child some time in a psychiatric hospital, you must have a diagnosis of bipolar disorder,” Dr. Gilfillan noted.

As a result, many clinicians lead with the bipolar diagnosis because they know the child needs to spend some time in an inpatient facility, she said. Features of bipolar disorder in children and adults are similar to characteristics of ADHD. The prolonged outbursts, which she described as “affective storms,” are bipolar rather than hyperactive.

Early symptoms of childhood-onset bipolar disorder include oversensitivity to sensory stimulation and night terrors as an infant, and high levels of anxiety and difficulty controlling anger as a school-aged child. Reports from family members might suggest that the child has a difficult temperament.

Treatment options for children and adolescents with ADHD and other conditions include Strattera (atomoxetine), Adderall (amphetamine mixed salts), and Concerta (methylphenidate), as well as Ritalin (methylphenidate HCl) and Dexedrine (dextroamphetamine sulfate).

Underdosing is one of the most common reasons for discontinuing medication, Dr. Gilfillan said.

Parents often are not used to titration for their children's medications, since it is not used for ear infections or urinary tract infections. Families become impatient and say that the medication is not working; they may want to switch drugs instead of increasing the dose.

“Medication can do some things, but other things must be done at the same time,” she said. Nonmedication therapies for ADHD and comorbid problems include parenting classes, hobbies, sports that channel excess energy, and strategies for better academic performance.

When evaluating a child or adolescent for ADHD and other conditions, remember that “normal” is somewhere in the differential, Dr. Gilfillan cautioned.

However, if the ADHD, with or without comorbidity, goes untreated, drug and alcohol abuse are more likely later in life, she added.

Dr. Gilfillan is a consultant and member of the speakers' bureau for Pfizer, Ortho-McNeil, and Abbott, and is a member of the speakers' bureau for AstraZeneca.

HOUSTON — “When I am asked whether I think [attention-deficit hyperactivity disorder] is overdiagnosed, I say that kids are underfoot now more than they used to be,” Saundra Gilfillan, D.O., said at the annual meeting of the American Society for Adolescent Psychiatry.

“Did we miss ADHD before? No, the hyperactive kids wore themselves out,” said Dr. Gilfillan, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas, which cosponsored the meeting.

Comorbidities are common with ADHD: As many as 80% of children and adolescents with ADHD meet criteria for a related category disorder, particularly conduct disorder, oppositional defiant disorder, and bipolar disorder. When evaluating a child or adolescent for ADHD, consider other conditions as well.

When Dr. Gilfillan assesses children and adolescents for ADHD, with or without comorbidities, she starts by asking parents about the child's behavior as an infant.

Hyperactive children were often very active in utero and active as infants; they did not sleep well and were distracted when eating, she said. In addition, children with ADHD often skipped the crawling stage or spent very little time crawling. Dr. Gilfillan also asks whether the child or adolescent is invited to birthday parties.

“It's a very big developmental thing on the social side,” and parents who recognize a “hyper,” aggressive child may not want the child in their house, she noted. She also asks about emergency department visits and car accidents.

“I like to look at report cards, to see what teachers wrote about behavior,” she said. Another question is who babysits. “If the grandmother won't babysit the child, then that's a problem,” she said.

People do not truly outgrow ADHD; the symptoms simply evolve. Motor hyperactivity in childhood evolves into internal feelings of restlessness in adolescence and adulthood. They often have problems in classes where they have to sit or take notes, she said.

Children with ADHD who do not have comorbid conditions generally exhibit less severe symptoms. Their carelessness and inattention may lead to destructiveness and misbehavior, but it appears to be unintentional. Children with ADHD who also have conduct disorder, oppositional defiant disorder, and bipolar disorder are more likely to have social problems, to require hospitalization, and to develop other problems such as depression and anxiety. There are more specific observations on cormobidities:

▸ Conduct disorder. “I call these the thugs and 'thugettes,'” Dr. Gilfillan said. These children or teens have no respect for societal norms—they genuinely do not care about the rights of others. The majority of child-onset cases of conduct disorder are in males, but by adolescence the numbers are approximately equal. Children with conduct disorder don't always make it to the psychiatrist because they go into the legal system first.

▸ Oppositional defiant disorder. By contrast, children with oppositional defiant disorders tend to be argumentative, but usually only within their immediate network of family and friends. Some kids negotiate that way; some derive satisfaction from engaging their parents in an argument.

▸ Bipolar disorder. More than 50% of adolescents with bipolar disorder have at least one coexisting psychiatric disorder. “In many areas, to get a child some time in a psychiatric hospital, you must have a diagnosis of bipolar disorder,” Dr. Gilfillan noted.

As a result, many clinicians lead with the bipolar diagnosis because they know the child needs to spend some time in an inpatient facility, she said. Features of bipolar disorder in children and adults are similar to characteristics of ADHD. The prolonged outbursts, which she described as “affective storms,” are bipolar rather than hyperactive.

Early symptoms of childhood-onset bipolar disorder include oversensitivity to sensory stimulation and night terrors as an infant, and high levels of anxiety and difficulty controlling anger as a school-aged child. Reports from family members might suggest that the child has a difficult temperament.

Treatment options for children and adolescents with ADHD and other conditions include Strattera (atomoxetine), Adderall (amphetamine mixed salts), and Concerta (methylphenidate), as well as Ritalin (methylphenidate HCl) and Dexedrine (dextroamphetamine sulfate).

Underdosing is one of the most common reasons for discontinuing medication, Dr. Gilfillan said.

Parents often are not used to titration for their children's medications, since it is not used for ear infections or urinary tract infections. Families become impatient and say that the medication is not working; they may want to switch drugs instead of increasing the dose.

“Medication can do some things, but other things must be done at the same time,” she said. Nonmedication therapies for ADHD and comorbid problems include parenting classes, hobbies, sports that channel excess energy, and strategies for better academic performance.

When evaluating a child or adolescent for ADHD and other conditions, remember that “normal” is somewhere in the differential, Dr. Gilfillan cautioned.

However, if the ADHD, with or without comorbidity, goes untreated, drug and alcohol abuse are more likely later in life, she added.

Dr. Gilfillan is a consultant and member of the speakers' bureau for Pfizer, Ortho-McNeil, and Abbott, and is a member of the speakers' bureau for AstraZeneca.

HOUSTON — “When I am asked whether I think [attention-deficit hyperactivity disorder] is overdiagnosed, I say that kids are underfoot now more than they used to be,” Saundra Gilfillan, D.O., said at the annual meeting of the American Society for Adolescent Psychiatry.

“Did we miss ADHD before? No, the hyperactive kids wore themselves out,” said Dr. Gilfillan, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas, which cosponsored the meeting.

Comorbidities are common with ADHD: As many as 80% of children and adolescents with ADHD meet criteria for a related category disorder, particularly conduct disorder, oppositional defiant disorder, and bipolar disorder. When evaluating a child or adolescent for ADHD, consider other conditions as well.

When Dr. Gilfillan assesses children and adolescents for ADHD, with or without comorbidities, she starts by asking parents about the child's behavior as an infant.

Hyperactive children were often very active in utero and active as infants; they did not sleep well and were distracted when eating, she said. In addition, children with ADHD often skipped the crawling stage or spent very little time crawling. Dr. Gilfillan also asks whether the child or adolescent is invited to birthday parties.

“It's a very big developmental thing on the social side,” and parents who recognize a “hyper,” aggressive child may not want the child in their house, she noted. She also asks about emergency department visits and car accidents.

“I like to look at report cards, to see what teachers wrote about behavior,” she said. Another question is who babysits. “If the grandmother won't babysit the child, then that's a problem,” she said.

People do not truly outgrow ADHD; the symptoms simply evolve. Motor hyperactivity in childhood evolves into internal feelings of restlessness in adolescence and adulthood. They often have problems in classes where they have to sit or take notes, she said.

Children with ADHD who do not have comorbid conditions generally exhibit less severe symptoms. Their carelessness and inattention may lead to destructiveness and misbehavior, but it appears to be unintentional. Children with ADHD who also have conduct disorder, oppositional defiant disorder, and bipolar disorder are more likely to have social problems, to require hospitalization, and to develop other problems such as depression and anxiety. There are more specific observations on cormobidities:

▸ Conduct disorder. “I call these the thugs and 'thugettes,'” Dr. Gilfillan said. These children or teens have no respect for societal norms—they genuinely do not care about the rights of others. The majority of child-onset cases of conduct disorder are in males, but by adolescence the numbers are approximately equal. Children with conduct disorder don't always make it to the psychiatrist because they go into the legal system first.

▸ Oppositional defiant disorder. By contrast, children with oppositional defiant disorders tend to be argumentative, but usually only within their immediate network of family and friends. Some kids negotiate that way; some derive satisfaction from engaging their parents in an argument.

▸ Bipolar disorder. More than 50% of adolescents with bipolar disorder have at least one coexisting psychiatric disorder. “In many areas, to get a child some time in a psychiatric hospital, you must have a diagnosis of bipolar disorder,” Dr. Gilfillan noted.

As a result, many clinicians lead with the bipolar diagnosis because they know the child needs to spend some time in an inpatient facility, she said. Features of bipolar disorder in children and adults are similar to characteristics of ADHD. The prolonged outbursts, which she described as “affective storms,” are bipolar rather than hyperactive.

Early symptoms of childhood-onset bipolar disorder include oversensitivity to sensory stimulation and night terrors as an infant, and high levels of anxiety and difficulty controlling anger as a school-aged child. Reports from family members might suggest that the child has a difficult temperament.

Treatment options for children and adolescents with ADHD and other conditions include Strattera (atomoxetine), Adderall (amphetamine mixed salts), and Concerta (methylphenidate), as well as Ritalin (methylphenidate HCl) and Dexedrine (dextroamphetamine sulfate).

Underdosing is one of the most common reasons for discontinuing medication, Dr. Gilfillan said.

Parents often are not used to titration for their children's medications, since it is not used for ear infections or urinary tract infections. Families become impatient and say that the medication is not working; they may want to switch drugs instead of increasing the dose.

“Medication can do some things, but other things must be done at the same time,” she said. Nonmedication therapies for ADHD and comorbid problems include parenting classes, hobbies, sports that channel excess energy, and strategies for better academic performance.

When evaluating a child or adolescent for ADHD and other conditions, remember that “normal” is somewhere in the differential, Dr. Gilfillan cautioned.

However, if the ADHD, with or without comorbidity, goes untreated, drug and alcohol abuse are more likely later in life, she added.

Dr. Gilfillan is a consultant and member of the speakers' bureau for Pfizer, Ortho-McNeil, and Abbott, and is a member of the speakers' bureau for AstraZeneca.

CHICAGO — Diabetic neuropathic foot ulcers treated with becaplermin were 30% more likely to heal during a 20-week study than ulcers not treated with the drug, David J. Margolis, M.D., said at the annual meeting of the Wound Healing Society.

The need for effective treatment is great, Dr. Margolis noted. Approximately 12% of diabetic patients develop foot ulcers; 80,000 amputations per year are attributed to diabetes.

In a retrospective cohort study of 25,098 patients, 10% were treated with becaplermin (Regranex), a topical recombinant human platelet-derived growth factor (rhPDGF).

The relative risk that the becaplermin-treated ulcers would heal after 20 weeks was 1.33 compared with standard care, and the relative risk of amputation was 0.86, similar to results from previous clinical trials, said Dr. Margolis, of the University of Pennsylvania. He and his colleagues estimated treatment effectiveness, rather than efficacy, by using propensity scores to control for selection bias.

Propensity studies involve additional probability and attempt to pin down which demographic factors contribute to results in a real-world setting. “We are trying to model why people received therapy,” Dr. Margolis said. The cases were drawn from a database of patients treated between 1998 and 2004 at a wound care center affiliated with Curative Health Services. “Some people had only 2 weeks of treatment, and others had 20 weeks,” Dr. Margolis noted. The mean length of treatment was 14 weeks.

Overall, 13% of the patients were treated with rhPDGF, and in general, these patients were more likely to be younger and male, and to have older wounds, than patients who were not treated with rhPDGF, he noted.

When asked how the Food and Drug Administration regards propensity studies, Dr. Margolis admitted that data of this type are not likely to prompt a change in drug labeling, for example. However, the FDA recognizes that the large sample size used in propensity score studies can provide useful information, he added.

The study was supported in part by funding from Ethicon Inc., which produces becaplermin (Regranex).

CHICAGO — Diabetic neuropathic foot ulcers treated with becaplermin were 30% more likely to heal during a 20-week study than ulcers not treated with the drug, David J. Margolis, M.D., said at the annual meeting of the Wound Healing Society.

The need for effective treatment is great, Dr. Margolis noted. Approximately 12% of diabetic patients develop foot ulcers; 80,000 amputations per year are attributed to diabetes.

In a retrospective cohort study of 25,098 patients, 10% were treated with becaplermin (Regranex), a topical recombinant human platelet-derived growth factor (rhPDGF).

The relative risk that the becaplermin-treated ulcers would heal after 20 weeks was 1.33 compared with standard care, and the relative risk of amputation was 0.86, similar to results from previous clinical trials, said Dr. Margolis, of the University of Pennsylvania. He and his colleagues estimated treatment effectiveness, rather than efficacy, by using propensity scores to control for selection bias.

Propensity studies involve additional probability and attempt to pin down which demographic factors contribute to results in a real-world setting. “We are trying to model why people received therapy,” Dr. Margolis said. The cases were drawn from a database of patients treated between 1998 and 2004 at a wound care center affiliated with Curative Health Services. “Some people had only 2 weeks of treatment, and others had 20 weeks,” Dr. Margolis noted. The mean length of treatment was 14 weeks.

Overall, 13% of the patients were treated with rhPDGF, and in general, these patients were more likely to be younger and male, and to have older wounds, than patients who were not treated with rhPDGF, he noted.

When asked how the Food and Drug Administration regards propensity studies, Dr. Margolis admitted that data of this type are not likely to prompt a change in drug labeling, for example. However, the FDA recognizes that the large sample size used in propensity score studies can provide useful information, he added.

The study was supported in part by funding from Ethicon Inc., which produces becaplermin (Regranex).

CHICAGO — Diabetic neuropathic foot ulcers treated with becaplermin were 30% more likely to heal during a 20-week study than ulcers not treated with the drug, David J. Margolis, M.D., said at the annual meeting of the Wound Healing Society.

The need for effective treatment is great, Dr. Margolis noted. Approximately 12% of diabetic patients develop foot ulcers; 80,000 amputations per year are attributed to diabetes.

In a retrospective cohort study of 25,098 patients, 10% were treated with becaplermin (Regranex), a topical recombinant human platelet-derived growth factor (rhPDGF).

The relative risk that the becaplermin-treated ulcers would heal after 20 weeks was 1.33 compared with standard care, and the relative risk of amputation was 0.86, similar to results from previous clinical trials, said Dr. Margolis, of the University of Pennsylvania. He and his colleagues estimated treatment effectiveness, rather than efficacy, by using propensity scores to control for selection bias.

Propensity studies involve additional probability and attempt to pin down which demographic factors contribute to results in a real-world setting. “We are trying to model why people received therapy,” Dr. Margolis said. The cases were drawn from a database of patients treated between 1998 and 2004 at a wound care center affiliated with Curative Health Services. “Some people had only 2 weeks of treatment, and others had 20 weeks,” Dr. Margolis noted. The mean length of treatment was 14 weeks.

Overall, 13% of the patients were treated with rhPDGF, and in general, these patients were more likely to be younger and male, and to have older wounds, than patients who were not treated with rhPDGF, he noted.

When asked how the Food and Drug Administration regards propensity studies, Dr. Margolis admitted that data of this type are not likely to prompt a change in drug labeling, for example. However, the FDA recognizes that the large sample size used in propensity score studies can provide useful information, he added.

The study was supported in part by funding from Ethicon Inc., which produces becaplermin (Regranex).