Mary Ellen Schneider

BOSTON – College students who abuse opioids do so for different reasons than students who abuse stimulants, according to research presented at the annual meeting of the American Public Health Association.

Opioid users were more likely to report that they used the drugs to relax or to get high, while stimulant users were more likely to say that they used the drugs to help improve performance at school or to increase alertness.

These differences could be helpful in crafting interventions, said Julie Brevard of Inflexxion Inc., a health, science, and technology research firm that is based in Newton, Mass.

Ms. Brevard, along with principal investigator Sarah Lord, Ph.D., and colleagues at Inflexxion, conducted an online survey of college students who admitted to ever using prescription opioids and stimulants recreationally.

The survey was advertised on an online social networking forum for college students and at the 27 colleges nationwide with the highest usage of the networking forum Web site.

The researchers received 689 responses, 522 of which passed data validity checks and were analyzed. The research was funded with a grant from the National Institutes of Health.

About 61% of the respondents reported that they had used both stimulants and opioids. Of the rest, 18% had used opioids only and 21% had used stimulants only. About 41% of respondents said they were regular stimulant users, which was defined as using the drug once a month or more. And 25% of respondents reported that they were regular opioid users.

Among opioid users, more than 70% said they used the prescription pain relievers to relax and nearly 68% said they took them to get high. A smaller percentage (27%) reported taking opioids to help with depression and anxiety or for chronic pain (19%).

Regular opioid users were more likely than infrequent users to cite depression or pain management as reasons for use. They also reported more symptoms of abuse and dependence and beliefs that prescription medications could give them a better high than other drugs, said Ms. Brevard.

Among stimulant users, nearly 78% reported that they took the drugs to help them perform better in school, and nearly 74% said they took them to help increase alertness. Nearly 24% reported they took stimulants to lose weight or prevent weight gain.

Regular stimulant users were more likely than were infrequent users to report that weight loss was a reason for use. And similar to opioid users, frequent stimulant users were also more likely than infrequent users to report symptoms of abuse and dependence and to have more positive views about prescription drug abuse.

Nearly half (49%) of respondents said they first used prescription drugs nonmedically during the years they were in high school. “It seems like high school is a critical experimentation time,” said Ms. Brevard.

The college students who were surveyed said that they accessed the prescription drugs primarily through friends (84%). Parents, other family members, and the Internet were also avenues for access. About 7% of respondents reported that they had a valid prescription for all the medications they used.

BOSTON – College students who abuse opioids do so for different reasons than students who abuse stimulants, according to research presented at the annual meeting of the American Public Health Association.

Opioid users were more likely to report that they used the drugs to relax or to get high, while stimulant users were more likely to say that they used the drugs to help improve performance at school or to increase alertness.

These differences could be helpful in crafting interventions, said Julie Brevard of Inflexxion Inc., a health, science, and technology research firm that is based in Newton, Mass.

Ms. Brevard, along with principal investigator Sarah Lord, Ph.D., and colleagues at Inflexxion, conducted an online survey of college students who admitted to ever using prescription opioids and stimulants recreationally.

The survey was advertised on an online social networking forum for college students and at the 27 colleges nationwide with the highest usage of the networking forum Web site.

The researchers received 689 responses, 522 of which passed data validity checks and were analyzed. The research was funded with a grant from the National Institutes of Health.

About 61% of the respondents reported that they had used both stimulants and opioids. Of the rest, 18% had used opioids only and 21% had used stimulants only. About 41% of respondents said they were regular stimulant users, which was defined as using the drug once a month or more. And 25% of respondents reported that they were regular opioid users.

Among opioid users, more than 70% said they used the prescription pain relievers to relax and nearly 68% said they took them to get high. A smaller percentage (27%) reported taking opioids to help with depression and anxiety or for chronic pain (19%).

Regular opioid users were more likely than infrequent users to cite depression or pain management as reasons for use. They also reported more symptoms of abuse and dependence and beliefs that prescription medications could give them a better high than other drugs, said Ms. Brevard.

Among stimulant users, nearly 78% reported that they took the drugs to help them perform better in school, and nearly 74% said they took them to help increase alertness. Nearly 24% reported they took stimulants to lose weight or prevent weight gain.

Regular stimulant users were more likely than were infrequent users to report that weight loss was a reason for use. And similar to opioid users, frequent stimulant users were also more likely than infrequent users to report symptoms of abuse and dependence and to have more positive views about prescription drug abuse.

Nearly half (49%) of respondents said they first used prescription drugs nonmedically during the years they were in high school. “It seems like high school is a critical experimentation time,” said Ms. Brevard.

The college students who were surveyed said that they accessed the prescription drugs primarily through friends (84%). Parents, other family members, and the Internet were also avenues for access. About 7% of respondents reported that they had a valid prescription for all the medications they used.

BOSTON – College students who abuse opioids do so for different reasons than students who abuse stimulants, according to research presented at the annual meeting of the American Public Health Association.

Opioid users were more likely to report that they used the drugs to relax or to get high, while stimulant users were more likely to say that they used the drugs to help improve performance at school or to increase alertness.

These differences could be helpful in crafting interventions, said Julie Brevard of Inflexxion Inc., a health, science, and technology research firm that is based in Newton, Mass.

Ms. Brevard, along with principal investigator Sarah Lord, Ph.D., and colleagues at Inflexxion, conducted an online survey of college students who admitted to ever using prescription opioids and stimulants recreationally.

The survey was advertised on an online social networking forum for college students and at the 27 colleges nationwide with the highest usage of the networking forum Web site.

The researchers received 689 responses, 522 of which passed data validity checks and were analyzed. The research was funded with a grant from the National Institutes of Health.

About 61% of the respondents reported that they had used both stimulants and opioids. Of the rest, 18% had used opioids only and 21% had used stimulants only. About 41% of respondents said they were regular stimulant users, which was defined as using the drug once a month or more. And 25% of respondents reported that they were regular opioid users.

Among opioid users, more than 70% said they used the prescription pain relievers to relax and nearly 68% said they took them to get high. A smaller percentage (27%) reported taking opioids to help with depression and anxiety or for chronic pain (19%).

Regular opioid users were more likely than infrequent users to cite depression or pain management as reasons for use. They also reported more symptoms of abuse and dependence and beliefs that prescription medications could give them a better high than other drugs, said Ms. Brevard.

Among stimulant users, nearly 78% reported that they took the drugs to help them perform better in school, and nearly 74% said they took them to help increase alertness. Nearly 24% reported they took stimulants to lose weight or prevent weight gain.

Regular stimulant users were more likely than were infrequent users to report that weight loss was a reason for use. And similar to opioid users, frequent stimulant users were also more likely than infrequent users to report symptoms of abuse and dependence and to have more positive views about prescription drug abuse.

Nearly half (49%) of respondents said they first used prescription drugs nonmedically during the years they were in high school. “It seems like high school is a critical experimentation time,” said Ms. Brevard.

The college students who were surveyed said that they accessed the prescription drugs primarily through friends (84%). Parents, other family members, and the Internet were also avenues for access. About 7% of respondents reported that they had a valid prescription for all the medications they used.

NEW YORK—Consistent, detailed record keeping and patient communication are key to avoiding legal complications and navigating HIPAA requirements, Dr. Noah Scheinfeld said at meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

One area where record keeping is especially important is clinical photographs of patients. If you're going to take patient photographs, retain them as part of the patient's medical record because patient images are considered medical records and as such are legal evidence. In the event of a lawsuit, if the photos that were taken are not available, the court assumes that the missing records are in the plaintiff's favor, said Dr. Scheinfeld of Columbia University in New York, who also holds a law degree.

With the advent of digital photography, it's easy to take many images of the same area. Physicians do not need to save 10 images of the same thing, he said, but at least 1 of each should be kept in the records.

Under federal law, records must be kept for 5 years, but individual states may have more rigorous standards. For example, New York requires that medical records be kept for 7 years, he said.

But one area that physicians can worry a little less about is HIPAA enforcement, Dr. Scheinfeld said. Despite more than 20,000 complaints since HIPAA privacy provisions went into effect in 2003, there has not been much in the way of enforcement.

“Lots of complaints—very little action,” he said.

Only a few hundred HIPAA violations have been referred for criminal action and so far only three cases have resulted in criminal charges. In 2004, a Seattle man who worked at an area cancer center was sentenced to 16 months in jail for using a cancer patient's personal information to obtain credit cards. In 2006, a Texas woman who worked in a physician's office was convicted of selling the medical records of an FBI agent. Most recently, the U.S. Attorney for the Southern District of Florida brought criminal charges against a woman who worked as the front desk office coordinator for a Florida clinic for allegedly selling patient information.

In general, it is important to notify patients of their privacy rights and the use of their personal health information, adopt and implement privacy procedures, and train employees in those procedures. Physicians also need to designate an individual to be responsible for ensuring that the office privacy procedures are followed. Patient records must be secured so that individually identified health information is not accessible to those who do not need it for treatment or payment reasons.

However, HIPAA regulations do not prohibit common practices such as keeping waiting room lists or leaving charts on exam room doors, he said.

NEW YORK—Consistent, detailed record keeping and patient communication are key to avoiding legal complications and navigating HIPAA requirements, Dr. Noah Scheinfeld said at meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

One area where record keeping is especially important is clinical photographs of patients. If you're going to take patient photographs, retain them as part of the patient's medical record because patient images are considered medical records and as such are legal evidence. In the event of a lawsuit, if the photos that were taken are not available, the court assumes that the missing records are in the plaintiff's favor, said Dr. Scheinfeld of Columbia University in New York, who also holds a law degree.

With the advent of digital photography, it's easy to take many images of the same area. Physicians do not need to save 10 images of the same thing, he said, but at least 1 of each should be kept in the records.

Under federal law, records must be kept for 5 years, but individual states may have more rigorous standards. For example, New York requires that medical records be kept for 7 years, he said.

But one area that physicians can worry a little less about is HIPAA enforcement, Dr. Scheinfeld said. Despite more than 20,000 complaints since HIPAA privacy provisions went into effect in 2003, there has not been much in the way of enforcement.

“Lots of complaints—very little action,” he said.

Only a few hundred HIPAA violations have been referred for criminal action and so far only three cases have resulted in criminal charges. In 2004, a Seattle man who worked at an area cancer center was sentenced to 16 months in jail for using a cancer patient's personal information to obtain credit cards. In 2006, a Texas woman who worked in a physician's office was convicted of selling the medical records of an FBI agent. Most recently, the U.S. Attorney for the Southern District of Florida brought criminal charges against a woman who worked as the front desk office coordinator for a Florida clinic for allegedly selling patient information.

In general, it is important to notify patients of their privacy rights and the use of their personal health information, adopt and implement privacy procedures, and train employees in those procedures. Physicians also need to designate an individual to be responsible for ensuring that the office privacy procedures are followed. Patient records must be secured so that individually identified health information is not accessible to those who do not need it for treatment or payment reasons.

However, HIPAA regulations do not prohibit common practices such as keeping waiting room lists or leaving charts on exam room doors, he said.

NEW YORK—Consistent, detailed record keeping and patient communication are key to avoiding legal complications and navigating HIPAA requirements, Dr. Noah Scheinfeld said at meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

One area where record keeping is especially important is clinical photographs of patients. If you're going to take patient photographs, retain them as part of the patient's medical record because patient images are considered medical records and as such are legal evidence. In the event of a lawsuit, if the photos that were taken are not available, the court assumes that the missing records are in the plaintiff's favor, said Dr. Scheinfeld of Columbia University in New York, who also holds a law degree.

With the advent of digital photography, it's easy to take many images of the same area. Physicians do not need to save 10 images of the same thing, he said, but at least 1 of each should be kept in the records.

Under federal law, records must be kept for 5 years, but individual states may have more rigorous standards. For example, New York requires that medical records be kept for 7 years, he said.

But one area that physicians can worry a little less about is HIPAA enforcement, Dr. Scheinfeld said. Despite more than 20,000 complaints since HIPAA privacy provisions went into effect in 2003, there has not been much in the way of enforcement.

“Lots of complaints—very little action,” he said.

Only a few hundred HIPAA violations have been referred for criminal action and so far only three cases have resulted in criminal charges. In 2004, a Seattle man who worked at an area cancer center was sentenced to 16 months in jail for using a cancer patient's personal information to obtain credit cards. In 2006, a Texas woman who worked in a physician's office was convicted of selling the medical records of an FBI agent. Most recently, the U.S. Attorney for the Southern District of Florida brought criminal charges against a woman who worked as the front desk office coordinator for a Florida clinic for allegedly selling patient information.

In general, it is important to notify patients of their privacy rights and the use of their personal health information, adopt and implement privacy procedures, and train employees in those procedures. Physicians also need to designate an individual to be responsible for ensuring that the office privacy procedures are followed. Patient records must be secured so that individually identified health information is not accessible to those who do not need it for treatment or payment reasons.

However, HIPAA regulations do not prohibit common practices such as keeping waiting room lists or leaving charts on exam room doors, he said.

RENO, NEV.—The treatment of irritable bowel syndrome could benefit from a more holistic approach including comprehensive dietary changes, nutritional supplements, exercise and relaxation therapy, and acupuncture, Dr. Joel S. Edman said at the annual meeting of the American College of Nutrition.

Conventional treatments for irritable bowel syndrome (IBS) center on patient education, avoiding common food triggers, and increasing fiber intake, said Dr. Edman, a clinical nutritionist at the Myrna Brind Center of Integrative Medicine at the Thomas Jefferson University in Philadelphia. Dr. Edman has received grant support from Integrative Therapeutics Inc., a nutritional supplement manufacturer.

Instead, an integrative approach to treating IBS should involve some of the same dietary changes but also should include an elimination diet or rotation diet, and more use of nutritional supplements. It also may include exercise, massage, acupuncture, and stress management techniques.

Dr. Erdman favors a food intolerance or elimination challenge diet. This diet first calls for avoiding sugar, dairy, wheat, alcohol, and caffeine for 1–2 weeks and adding a new food every 2–3 days. Most IBS patients will improve on this diet, he said. For patients who have longstanding IBS and already may have tried dietary approaches, the next foods to avoid include soy, peanuts, corn, citrus, and other gluten grains.

Other tips include not overeating, and eating smaller and more frequent meals. He also suggested eating cooked rather than raw vegetables.

Timing also is important. Patients shouldn't begin an elimination challenge diet until they start taking nutritional supplements and begin relaxation techniques, since the diet often is an added source of stress, he said.

RENO, NEV.—The treatment of irritable bowel syndrome could benefit from a more holistic approach including comprehensive dietary changes, nutritional supplements, exercise and relaxation therapy, and acupuncture, Dr. Joel S. Edman said at the annual meeting of the American College of Nutrition.

Conventional treatments for irritable bowel syndrome (IBS) center on patient education, avoiding common food triggers, and increasing fiber intake, said Dr. Edman, a clinical nutritionist at the Myrna Brind Center of Integrative Medicine at the Thomas Jefferson University in Philadelphia. Dr. Edman has received grant support from Integrative Therapeutics Inc., a nutritional supplement manufacturer.

Instead, an integrative approach to treating IBS should involve some of the same dietary changes but also should include an elimination diet or rotation diet, and more use of nutritional supplements. It also may include exercise, massage, acupuncture, and stress management techniques.

Dr. Erdman favors a food intolerance or elimination challenge diet. This diet first calls for avoiding sugar, dairy, wheat, alcohol, and caffeine for 1–2 weeks and adding a new food every 2–3 days. Most IBS patients will improve on this diet, he said. For patients who have longstanding IBS and already may have tried dietary approaches, the next foods to avoid include soy, peanuts, corn, citrus, and other gluten grains.

Other tips include not overeating, and eating smaller and more frequent meals. He also suggested eating cooked rather than raw vegetables.

Timing also is important. Patients shouldn't begin an elimination challenge diet until they start taking nutritional supplements and begin relaxation techniques, since the diet often is an added source of stress, he said.

RENO, NEV.—The treatment of irritable bowel syndrome could benefit from a more holistic approach including comprehensive dietary changes, nutritional supplements, exercise and relaxation therapy, and acupuncture, Dr. Joel S. Edman said at the annual meeting of the American College of Nutrition.

Conventional treatments for irritable bowel syndrome (IBS) center on patient education, avoiding common food triggers, and increasing fiber intake, said Dr. Edman, a clinical nutritionist at the Myrna Brind Center of Integrative Medicine at the Thomas Jefferson University in Philadelphia. Dr. Edman has received grant support from Integrative Therapeutics Inc., a nutritional supplement manufacturer.

Instead, an integrative approach to treating IBS should involve some of the same dietary changes but also should include an elimination diet or rotation diet, and more use of nutritional supplements. It also may include exercise, massage, acupuncture, and stress management techniques.

Dr. Erdman favors a food intolerance or elimination challenge diet. This diet first calls for avoiding sugar, dairy, wheat, alcohol, and caffeine for 1–2 weeks and adding a new food every 2–3 days. Most IBS patients will improve on this diet, he said. For patients who have longstanding IBS and already may have tried dietary approaches, the next foods to avoid include soy, peanuts, corn, citrus, and other gluten grains.

Other tips include not overeating, and eating smaller and more frequent meals. He also suggested eating cooked rather than raw vegetables.

Timing also is important. Patients shouldn't begin an elimination challenge diet until they start taking nutritional supplements and begin relaxation techniques, since the diet often is an added source of stress, he said.

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton, said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

"It's clear, I think, that gainsharing is not on the fast track," said Mr. Thornton of the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without impacting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The advisory bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibits arrangements used to influence the referral of patients in federal health care programs.

"Historically, the office has been somewhat leery of gainsharing arrangements," said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued a number of advisory opinions which outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, she said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. Gainsharing arrangements must also meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency in inpatient episodes and during the 30-day postdischarge period. The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

But CMS officials are looking to test various gainsharing models so participants will have flexibility in how they choose to target savings from reducing the time to diagnosis and treatment to improving discharge planning and care coordination.

There are some alternatives and variations on gainsharing that are occurring in the marketplace, Mr. Thornton said. For example, hospitals can move forward with nonmonetary gainsharing, in which the savings are earmarked to improve physicians' work lives by upgrading surgical suites or through better scheduling.

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton, said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

"It's clear, I think, that gainsharing is not on the fast track," said Mr. Thornton of the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without impacting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The advisory bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibits arrangements used to influence the referral of patients in federal health care programs.

"Historically, the office has been somewhat leery of gainsharing arrangements," said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued a number of advisory opinions which outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, she said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. Gainsharing arrangements must also meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency in inpatient episodes and during the 30-day postdischarge period. The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

But CMS officials are looking to test various gainsharing models so participants will have flexibility in how they choose to target savings from reducing the time to diagnosis and treatment to improving discharge planning and care coordination.

There are some alternatives and variations on gainsharing that are occurring in the marketplace, Mr. Thornton said. For example, hospitals can move forward with nonmonetary gainsharing, in which the savings are earmarked to improve physicians' work lives by upgrading surgical suites or through better scheduling.

Hospitals are reluctant to offer physicians a portion of the savings generated by reducing clinical costs—a concept known as gainsharing—because of legal fears, D. McCarty Thornton, said during an audioconference on gainsharing sponsored by the Integrated Healthcare Association.

"It's clear, I think, that gainsharing is not on the fast track," said Mr. Thornton of the law firm of Sonnenschein, Nath, and Rosenthal LLP, based in Washington.

In the long run, gainsharing approaches that can save money without impacting patient care are likely to take hold, he said, but first hospitals need clarification from Congress, the Health and Human Services secretary, and the Office of Inspector General about what arrangements are allowed.

In 1999, the HHS Office of Inspector General issued a special advisory bulletin saying that the civil monetary penalty provision of the Social Security Act prohibits most gainsharing arrangements. Under that provision, hospitals are prohibited from making payments to physicians to reduce or limit services to Medicare and Medicaid beneficiaries.

The advisory bulletin said that these types of arrangements could also trigger the antikickback provisions of the Social Security Act, which prohibits arrangements used to influence the referral of patients in federal health care programs.

"Historically, the office has been somewhat leery of gainsharing arrangements," said Catherine A. Martin, OIG senior counsel.

Since the 1999 bulletin, the OIG has issued a number of advisory opinions which outline gainsharing arrangements that would be allowable. In general, in order to give the green light to a gainsharing arrangement, the OIG looks for transparency and accountability, quality of care controls, and safeguards against kickbacks, she said.

In order to be transparent, any actions taken to save costs need to be clearly and separately identified and fully disclosed to patients. Hospitals must also put in place controls to ensure that cost savings do not result in the inappropriate reduction of services. OIG officials also want to see ongoing monitoring of quality by the hospital and an independent outside reviewer, Ms. Martin said.

But OIG is not the only regulator that hospitals and physicians need to consider when embarking on gainsharing arrangements, Ms. Martin said. Hospitals and physicians must also keep from running afoul of the Stark self-referral prohibitions, which fall under the purview of the Centers for Medicare and Medicaid Services. Gainsharing arrangements must also meet Internal Revenue Service rules, and hospitals are at risk for private lawsuits, she said.

But the industry is keeping an eye on two demonstration projects that test the gainsharing concept in the Medicare fee-for-service program. Both projects are set to begin this year.

The first project, which is required under the Deficit Reduction Act of 2005, will involve six hospitals and will focus on quality and efficiency in inpatient episodes and during the 30-day postdischarge period. The DRA provision waives civil monetary penalty restrictions that would otherwise prohibit gainsharing.

The second project will focus on physician groups and integrated delivery systems and their affiliated hospitals. The demonstration will include inpatient episodes, as well as the pre- and posthospital care over the duration of the project. This demonstration was mandated the Medicare Modernization Act of 2003.

Participants in both demonstrations will be required to standardize quality and efficiency improvement initiatives, internal cost savings measurement, and physician payment methodology, said Lisa R. Waters, a project officer with the division of payment policy demonstrations at CMS.

But CMS officials are looking to test various gainsharing models so participants will have flexibility in how they choose to target savings from reducing the time to diagnosis and treatment to improving discharge planning and care coordination.

There are some alternatives and variations on gainsharing that are occurring in the marketplace, Mr. Thornton said. For example, hospitals can move forward with nonmonetary gainsharing, in which the savings are earmarked to improve physicians' work lives by upgrading surgical suites or through better scheduling.

DALLAS—When hiring a physician extender, be sure to spell out all responsibilities in the contract, Dr. Raymond Blackburn said at the annual meeting of the National Medical Association.

"You must delineate in their contract every little detail that you want them to do so that when any dispute comes up it's there," said Dr. Blackburn, a Dallas dermatologist who employs two physician assistants in his office.

A good contract should include a listing of all the duties expected of the physician extender, from performing history and physicals to returning patient calls and handling refills, he said.

Furthermore, consider specifying the physician extender's work hours ahead of time, Dr. Blackburn recommended. Extenders need to know if they will be responsible for making after-hours patient calls, working weekends, and staying until the last patient has been seen each day. "I find that's very important because that's not going to be at the same time everyday," he said.

Benefits should also be detailed in the contract. For example, physicians should outline what they will cover in terms of health insurance, paid holidays, vacations, continuing education, sick days, professional-organization dues, medical liability coverage, and retirement.

The average starting salary for a physician assistant (PA) across all medical specialties is about $65,000 a year in the United States, Dr. Blackburn said. And a PA with 6 years of experience averages about $70,000, he said.

Experienced dermatology PAs can command $87,000 a year plus benefits, Dr. Blackburn said, adding that a PA in a busy dermatology practice can bring in gross revenues between $600,000 and $700,000 a year.

DALLAS—When hiring a physician extender, be sure to spell out all responsibilities in the contract, Dr. Raymond Blackburn said at the annual meeting of the National Medical Association.

"You must delineate in their contract every little detail that you want them to do so that when any dispute comes up it's there," said Dr. Blackburn, a Dallas dermatologist who employs two physician assistants in his office.

A good contract should include a listing of all the duties expected of the physician extender, from performing history and physicals to returning patient calls and handling refills, he said.

Furthermore, consider specifying the physician extender's work hours ahead of time, Dr. Blackburn recommended. Extenders need to know if they will be responsible for making after-hours patient calls, working weekends, and staying until the last patient has been seen each day. "I find that's very important because that's not going to be at the same time everyday," he said.

Benefits should also be detailed in the contract. For example, physicians should outline what they will cover in terms of health insurance, paid holidays, vacations, continuing education, sick days, professional-organization dues, medical liability coverage, and retirement.

The average starting salary for a physician assistant (PA) across all medical specialties is about $65,000 a year in the United States, Dr. Blackburn said. And a PA with 6 years of experience averages about $70,000, he said.

Experienced dermatology PAs can command $87,000 a year plus benefits, Dr. Blackburn said, adding that a PA in a busy dermatology practice can bring in gross revenues between $600,000 and $700,000 a year.

DALLAS—When hiring a physician extender, be sure to spell out all responsibilities in the contract, Dr. Raymond Blackburn said at the annual meeting of the National Medical Association.

"You must delineate in their contract every little detail that you want them to do so that when any dispute comes up it's there," said Dr. Blackburn, a Dallas dermatologist who employs two physician assistants in his office.

A good contract should include a listing of all the duties expected of the physician extender, from performing history and physicals to returning patient calls and handling refills, he said.

Furthermore, consider specifying the physician extender's work hours ahead of time, Dr. Blackburn recommended. Extenders need to know if they will be responsible for making after-hours patient calls, working weekends, and staying until the last patient has been seen each day. "I find that's very important because that's not going to be at the same time everyday," he said.

Benefits should also be detailed in the contract. For example, physicians should outline what they will cover in terms of health insurance, paid holidays, vacations, continuing education, sick days, professional-organization dues, medical liability coverage, and retirement.

The average starting salary for a physician assistant (PA) across all medical specialties is about $65,000 a year in the United States, Dr. Blackburn said. And a PA with 6 years of experience averages about $70,000, he said.

Experienced dermatology PAs can command $87,000 a year plus benefits, Dr. Blackburn said, adding that a PA in a busy dermatology practice can bring in gross revenues between $600,000 and $700,000 a year.

NEW YORK—The severity of postsurgical complications can be mitigated by knowing the warning signs and best management techniques, Dr. James M. Spencer said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Some bruising, for example, is very common after dermatologic surgery. If it's performed in the periocular region, patients can expect to have a black eye. "This can obviously be very alarming to patients, but generally reassurance is all that's necessary," said Dr. Spencer of the department of dermatology at Mount Sinai in New York.

In the case of minor bleeding, advise patients to try direct pressure for 10–15 minutes and apply ice. If the bleeding can't be controlled easily from home, the patient will have to come back in. He advised using lidocaine alone when numbing the wound area because epinephrine causes vasoconstriction and will make it hard to recognize bleeding problems.

A hematoma puts pressure on the wound and is an excellent growth medium for bacteria. Initially, the clot will be gelatinous and generally can be easily evacuated through a small opening, but once it organizes, it will be difficult to remove. Wait 7–10 days for the clot to liquify and reabsorb, Dr. Spencer said.

Like a hematoma, a seroma puts pressure on the wound. This generally can be evacuated with an 18-gauge needle, he said.

A wound infection usually manifests 3–4 days after surgery and the classic signs include pain, redness, and swelling. Although gram-positive infection is most likely in dermatology, there are certain areas of the body where other infections also are likely. Pseudomonas should be considered on the ear and gram-negative infections in the groin and lower leg, Dr. Spencer said.

Contact dermatitis can mimic infection, though if the area is red and itchy, that's a clue that it could be contact dermatitis. Patients may have an allergic reaction to either the topical antibiotic or to the glue of the bandage. Remove the offending agent and put the patient on a short course of topical steroids, he said.

When there is dehiscence, there are two choices—either resuture or allow the wound to heal by second intention. "Second intention, I think, is underutilized. You can get terrific results," he said. If the wound is resutured, wash it, but don't debride the wound edges excessively.

One of the worst postsurgical complications is necrosis. If the flap or graft is blue, then blood is going in but is not getting back out. In that case, try nitroglycerin cream to increase venous return. However, if the flap or graft becomes black, adherent, and crusted, that is necrosis. The physician should do nothing and wait for it to slough on its own. Since it's not apparent how deep the necrosis goes, there could be a viable dermis underneath it. Debriding it just creates a large open wound, Dr. Spencer said.

NEW YORK—The severity of postsurgical complications can be mitigated by knowing the warning signs and best management techniques, Dr. James M. Spencer said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Some bruising, for example, is very common after dermatologic surgery. If it's performed in the periocular region, patients can expect to have a black eye. "This can obviously be very alarming to patients, but generally reassurance is all that's necessary," said Dr. Spencer of the department of dermatology at Mount Sinai in New York.

In the case of minor bleeding, advise patients to try direct pressure for 10–15 minutes and apply ice. If the bleeding can't be controlled easily from home, the patient will have to come back in. He advised using lidocaine alone when numbing the wound area because epinephrine causes vasoconstriction and will make it hard to recognize bleeding problems.

A hematoma puts pressure on the wound and is an excellent growth medium for bacteria. Initially, the clot will be gelatinous and generally can be easily evacuated through a small opening, but once it organizes, it will be difficult to remove. Wait 7–10 days for the clot to liquify and reabsorb, Dr. Spencer said.

Like a hematoma, a seroma puts pressure on the wound. This generally can be evacuated with an 18-gauge needle, he said.

A wound infection usually manifests 3–4 days after surgery and the classic signs include pain, redness, and swelling. Although gram-positive infection is most likely in dermatology, there are certain areas of the body where other infections also are likely. Pseudomonas should be considered on the ear and gram-negative infections in the groin and lower leg, Dr. Spencer said.

Contact dermatitis can mimic infection, though if the area is red and itchy, that's a clue that it could be contact dermatitis. Patients may have an allergic reaction to either the topical antibiotic or to the glue of the bandage. Remove the offending agent and put the patient on a short course of topical steroids, he said.

When there is dehiscence, there are two choices—either resuture or allow the wound to heal by second intention. "Second intention, I think, is underutilized. You can get terrific results," he said. If the wound is resutured, wash it, but don't debride the wound edges excessively.

One of the worst postsurgical complications is necrosis. If the flap or graft is blue, then blood is going in but is not getting back out. In that case, try nitroglycerin cream to increase venous return. However, if the flap or graft becomes black, adherent, and crusted, that is necrosis. The physician should do nothing and wait for it to slough on its own. Since it's not apparent how deep the necrosis goes, there could be a viable dermis underneath it. Debriding it just creates a large open wound, Dr. Spencer said.

NEW YORK—The severity of postsurgical complications can be mitigated by knowing the warning signs and best management techniques, Dr. James M. Spencer said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Some bruising, for example, is very common after dermatologic surgery. If it's performed in the periocular region, patients can expect to have a black eye. "This can obviously be very alarming to patients, but generally reassurance is all that's necessary," said Dr. Spencer of the department of dermatology at Mount Sinai in New York.

In the case of minor bleeding, advise patients to try direct pressure for 10–15 minutes and apply ice. If the bleeding can't be controlled easily from home, the patient will have to come back in. He advised using lidocaine alone when numbing the wound area because epinephrine causes vasoconstriction and will make it hard to recognize bleeding problems.

A hematoma puts pressure on the wound and is an excellent growth medium for bacteria. Initially, the clot will be gelatinous and generally can be easily evacuated through a small opening, but once it organizes, it will be difficult to remove. Wait 7–10 days for the clot to liquify and reabsorb, Dr. Spencer said.

Like a hematoma, a seroma puts pressure on the wound. This generally can be evacuated with an 18-gauge needle, he said.

A wound infection usually manifests 3–4 days after surgery and the classic signs include pain, redness, and swelling. Although gram-positive infection is most likely in dermatology, there are certain areas of the body where other infections also are likely. Pseudomonas should be considered on the ear and gram-negative infections in the groin and lower leg, Dr. Spencer said.

Contact dermatitis can mimic infection, though if the area is red and itchy, that's a clue that it could be contact dermatitis. Patients may have an allergic reaction to either the topical antibiotic or to the glue of the bandage. Remove the offending agent and put the patient on a short course of topical steroids, he said.

When there is dehiscence, there are two choices—either resuture or allow the wound to heal by second intention. "Second intention, I think, is underutilized. You can get terrific results," he said. If the wound is resutured, wash it, but don't debride the wound edges excessively.

One of the worst postsurgical complications is necrosis. If the flap or graft is blue, then blood is going in but is not getting back out. In that case, try nitroglycerin cream to increase venous return. However, if the flap or graft becomes black, adherent, and crusted, that is necrosis. The physician should do nothing and wait for it to slough on its own. Since it's not apparent how deep the necrosis goes, there could be a viable dermis underneath it. Debriding it just creates a large open wound, Dr. Spencer said.

NEW YORK—Every dermatologist should be able to perform excisional surgery and leave only a fine line scar on the patient's face, Dr. C. William Hanke said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Dermatologists who are not able to leave only a fine line scar are falling behind some of the family physicians who are doing excisional surgery, he said. And a scar that is long and noticeable is poor marketing for the physician.

Dr. Hanke, a dermatologic surgeon in Carmel, Ind., who founded the Mohs Micrographic Surgery Unit at Indiana University, Indianapolis, offered several techniques for achieving superior results with excisional surgery.

Make incisions in normal anatomic boundary lines or relaxed skin tension lines to hide scars. "That's where you want your scars to be so that they don't look like scars," he said.

Handle tissue atraumatically by avoiding touching the skin surface with forceps; instead, grab tissue from the bottom.

Make scars as short as possible. A scar longer than 2 cm will be much more noticeable than will shorter scars. By using an M-plasty, the incision can be shortened by about a third.

Don't bury unnecessary suture material. Tying the appropriate number of knots on buried sutures allows you to keep the amount of buried foreign material to a minimum. "The wound doesn't have to work as hard to heal with that smaller volume of foreign material," he said.

Use fine-caliber suture material to reduce trauma and choose simple closures over complex ones. "If you do a complex closure in a case where you could have done a simple closure and there's a complication, you've got a big complication."

Undermine appropriately to relieve wound tension and facilitate wound-edge eversion. Some dermatologists do a lot of unnecessary undermining and others never do it, but the right balance is likely somewhere in between, he said.

Use appropriate methods of hemostasis. Dr. Hanke said he does some suture ligature and uses a lot of electrocoagulation. Electrocautery is needed sometimes for patients with pacemakers. Pressure also is important, he said.

Use "tie-over" sutures to relieve tension and don't tie sutures tightly. Doing so can result in strangulated tissue that won't be evident until suture removal.

Be a student of dog-ear repair and close wounds rapidly. The medical literature shows that wounds that stay open for more than an hour or 2 have a higher rate of infection.

NEW YORK—Every dermatologist should be able to perform excisional surgery and leave only a fine line scar on the patient's face, Dr. C. William Hanke said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Dermatologists who are not able to leave only a fine line scar are falling behind some of the family physicians who are doing excisional surgery, he said. And a scar that is long and noticeable is poor marketing for the physician.

Dr. Hanke, a dermatologic surgeon in Carmel, Ind., who founded the Mohs Micrographic Surgery Unit at Indiana University, Indianapolis, offered several techniques for achieving superior results with excisional surgery.

Make incisions in normal anatomic boundary lines or relaxed skin tension lines to hide scars. "That's where you want your scars to be so that they don't look like scars," he said.

Handle tissue atraumatically by avoiding touching the skin surface with forceps; instead, grab tissue from the bottom.

Make scars as short as possible. A scar longer than 2 cm will be much more noticeable than will shorter scars. By using an M-plasty, the incision can be shortened by about a third.

Don't bury unnecessary suture material. Tying the appropriate number of knots on buried sutures allows you to keep the amount of buried foreign material to a minimum. "The wound doesn't have to work as hard to heal with that smaller volume of foreign material," he said.

Use fine-caliber suture material to reduce trauma and choose simple closures over complex ones. "If you do a complex closure in a case where you could have done a simple closure and there's a complication, you've got a big complication."

Undermine appropriately to relieve wound tension and facilitate wound-edge eversion. Some dermatologists do a lot of unnecessary undermining and others never do it, but the right balance is likely somewhere in between, he said.

Use appropriate methods of hemostasis. Dr. Hanke said he does some suture ligature and uses a lot of electrocoagulation. Electrocautery is needed sometimes for patients with pacemakers. Pressure also is important, he said.

Use "tie-over" sutures to relieve tension and don't tie sutures tightly. Doing so can result in strangulated tissue that won't be evident until suture removal.

Be a student of dog-ear repair and close wounds rapidly. The medical literature shows that wounds that stay open for more than an hour or 2 have a higher rate of infection.

NEW YORK—Every dermatologist should be able to perform excisional surgery and leave only a fine line scar on the patient's face, Dr. C. William Hanke said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.

Dermatologists who are not able to leave only a fine line scar are falling behind some of the family physicians who are doing excisional surgery, he said. And a scar that is long and noticeable is poor marketing for the physician.

Dr. Hanke, a dermatologic surgeon in Carmel, Ind., who founded the Mohs Micrographic Surgery Unit at Indiana University, Indianapolis, offered several techniques for achieving superior results with excisional surgery.

Make incisions in normal anatomic boundary lines or relaxed skin tension lines to hide scars. "That's where you want your scars to be so that they don't look like scars," he said.

Handle tissue atraumatically by avoiding touching the skin surface with forceps; instead, grab tissue from the bottom.

Make scars as short as possible. A scar longer than 2 cm will be much more noticeable than will shorter scars. By using an M-plasty, the incision can be shortened by about a third.

Don't bury unnecessary suture material. Tying the appropriate number of knots on buried sutures allows you to keep the amount of buried foreign material to a minimum. "The wound doesn't have to work as hard to heal with that smaller volume of foreign material," he said.

Use fine-caliber suture material to reduce trauma and choose simple closures over complex ones. "If you do a complex closure in a case where you could have done a simple closure and there's a complication, you've got a big complication."

Undermine appropriately to relieve wound tension and facilitate wound-edge eversion. Some dermatologists do a lot of unnecessary undermining and others never do it, but the right balance is likely somewhere in between, he said.

Use appropriate methods of hemostasis. Dr. Hanke said he does some suture ligature and uses a lot of electrocoagulation. Electrocautery is needed sometimes for patients with pacemakers. Pressure also is important, he said.

Use "tie-over" sutures to relieve tension and don't tie sutures tightly. Doing so can result in strangulated tissue that won't be evident until suture removal.

Be a student of dog-ear repair and close wounds rapidly. The medical literature shows that wounds that stay open for more than an hour or 2 have a higher rate of infection.

Stem Cell Support Drops Slightly

Most of the public supports the use of human embryonic stem cells for medical research, but that support may be faltering slightly, according to a new poll from Virginia Commonwealth University. The survey, which included 1,000 adults, found that 54% of respondents favored stem cell research in 2006, down from 58% in a similar VCU poll in 2005. The number of respondents who opposed stem cell research climbed from 32% in 2005 to 37% in the recent 2006 survey. However, when asked if they would support the use of embryonic stem cells to find a treatment for themselves or a family member with Parkinson's disease or spinal cord injury, 70% of respondents said yes. Only 21% would not support the use of stem cells in that situation, according to the 2006 poll. How people feel about stem cell research may also depend on their political affiliation. A recent survey by the Kaiser Family Foundation and the Harvard School of Public Health found that many more Democrats and Independents favor federal funding for embryonic stem cell research than do Republicans. In a national poll of 1,867 adults, the researchers found that 67% of Democrats and 61% of Independents favor broadening federal funding for stem cell research, compared with 37% of Republicans.

Gyn. Cancer Legislation Passed

Members of Congress passed legislation at the end of last year to raise awareness of gynecologic cancers. The Gynecologic Cancer Education and Awareness Act tasks the Health and Human Services secretary with carrying out a national public awareness campaign to increase understanding of these cancers by women and health care providers. The legislation, introduced by Rep. Darrell Issa (R-Calif.) in 2005, was expected to be signed by President Bush at press time. The bill authorizes the federal government to spend $16.5 million over the next 3 years on awareness and educational efforts. “In creating a federal campaign to educate women and health care providers alike, as this legislation does, we can take a bold step toward ensuring women know which symptoms to look for and how to seek help before it is too late,” Rep. Rosa DeLauro (D-Conn.), a cosponsor of the legislation and an ovarian cancer survivor, said in a statement.

Unborn Child Pain Relief Bill Fails

Congress failed to pass legislation that would have required physicians performing abortions at 20 weeks' gestation or later to offer women the option of receiving anesthesia or other pain-reducing drugs for the fetus. The Unborn Child Pain Awareness Act (H.R. 6099) failed to pass the House of Representatives in December. The legislation included findings that “there is substantial evidence that the abortion methods most commonly used 20 weeks or more after fertilization cause substantial pain to an unborn child.” Under the legislation, physicians would have been able to offer their own views on the ability of the fetus to feel pain and whether pain-reducing drugs would be advised, as long as they also provided the required information. The legislation was supported by the Christian Medical Association, which asserts that women should be informed of the likelihood that the fetus experiences pain during an abortion. The National Abortion Federation applauded the defeat of the bill.

Emergency Contraception in Rape

Some Massachusetts hospitals are imposing hurdles that make it more difficult for rape victims to access emergency contraception, according to the results of a survey conducted by NARAL Pro-Choice Massachusetts. The organization called 69 hospital emergency departments in early 2006 to gauge the availability of emergency contraception to rape victims and to assess compliance with a 2005 state law requiring that emergency contraception be offered to all rape survivors. The calls were made by a rape counselor who called on behalf of a potential client to find out if she could obtain emergency contraception at the hospital. The survey found that 7% of the hospitals leave it up to the physician to decide if emergency contraception should be provided and another 7% said that emergency contraception may be contingent on undergoing a rape kit exam. However, the results show a significant increase in the number of hospitals offering emergency contraception in 2006 compared with 2004 when only 58% of hospitals offered emergency contraception to rape victims.

Easing Use of Experimental Drugs

The Food and Drug Administration is proposing to widen access to experimental drugs. The agency has been accused by patient advocates and some drug makers of obfuscating the criteria physicians need to seek to use investigational drugs in their patients. In 2003, an Arlington, Va.-based advocacy group, the Abigail Alliance, sued the FDA to get unfettered access to unapproved therapies. The plaintiffs were backed by a federal appeals court in May 2006, and a rehearing of the case is expected to begin in March. In the meantime, the FDA's proposed rule, published on Dec. 14, said the agency was going to make it easier for physicians to access experimental therapies, and for manufacturers to make them available. “FDA hopes this proposal will increase awareness in the health care community of the range of options available for obtaining experimental drugs for seriously ill patients,” Dr. Janet Woodcock, FDA deputy commissioner for operations, said in a statement. A separate proposed rule would make it easier for manufacturers to recover costs. In a statement, the Abigail Alliance said the FDA proposals “merely clarify their existing policies.”

Stem Cell Support Drops Slightly

Most of the public supports the use of human embryonic stem cells for medical research, but that support may be faltering slightly, according to a new poll from Virginia Commonwealth University. The survey, which included 1,000 adults, found that 54% of respondents favored stem cell research in 2006, down from 58% in a similar VCU poll in 2005. The number of respondents who opposed stem cell research climbed from 32% in 2005 to 37% in the recent 2006 survey. However, when asked if they would support the use of embryonic stem cells to find a treatment for themselves or a family member with Parkinson's disease or spinal cord injury, 70% of respondents said yes. Only 21% would not support the use of stem cells in that situation, according to the 2006 poll. How people feel about stem cell research may also depend on their political affiliation. A recent survey by the Kaiser Family Foundation and the Harvard School of Public Health found that many more Democrats and Independents favor federal funding for embryonic stem cell research than do Republicans. In a national poll of 1,867 adults, the researchers found that 67% of Democrats and 61% of Independents favor broadening federal funding for stem cell research, compared with 37% of Republicans.

Gyn. Cancer Legislation Passed

Members of Congress passed legislation at the end of last year to raise awareness of gynecologic cancers. The Gynecologic Cancer Education and Awareness Act tasks the Health and Human Services secretary with carrying out a national public awareness campaign to increase understanding of these cancers by women and health care providers. The legislation, introduced by Rep. Darrell Issa (R-Calif.) in 2005, was expected to be signed by President Bush at press time. The bill authorizes the federal government to spend $16.5 million over the next 3 years on awareness and educational efforts. “In creating a federal campaign to educate women and health care providers alike, as this legislation does, we can take a bold step toward ensuring women know which symptoms to look for and how to seek help before it is too late,” Rep. Rosa DeLauro (D-Conn.), a cosponsor of the legislation and an ovarian cancer survivor, said in a statement.

Unborn Child Pain Relief Bill Fails

Congress failed to pass legislation that would have required physicians performing abortions at 20 weeks' gestation or later to offer women the option of receiving anesthesia or other pain-reducing drugs for the fetus. The Unborn Child Pain Awareness Act (H.R. 6099) failed to pass the House of Representatives in December. The legislation included findings that “there is substantial evidence that the abortion methods most commonly used 20 weeks or more after fertilization cause substantial pain to an unborn child.” Under the legislation, physicians would have been able to offer their own views on the ability of the fetus to feel pain and whether pain-reducing drugs would be advised, as long as they also provided the required information. The legislation was supported by the Christian Medical Association, which asserts that women should be informed of the likelihood that the fetus experiences pain during an abortion. The National Abortion Federation applauded the defeat of the bill.

Emergency Contraception in Rape

Some Massachusetts hospitals are imposing hurdles that make it more difficult for rape victims to access emergency contraception, according to the results of a survey conducted by NARAL Pro-Choice Massachusetts. The organization called 69 hospital emergency departments in early 2006 to gauge the availability of emergency contraception to rape victims and to assess compliance with a 2005 state law requiring that emergency contraception be offered to all rape survivors. The calls were made by a rape counselor who called on behalf of a potential client to find out if she could obtain emergency contraception at the hospital. The survey found that 7% of the hospitals leave it up to the physician to decide if emergency contraception should be provided and another 7% said that emergency contraception may be contingent on undergoing a rape kit exam. However, the results show a significant increase in the number of hospitals offering emergency contraception in 2006 compared with 2004 when only 58% of hospitals offered emergency contraception to rape victims.

Easing Use of Experimental Drugs

The Food and Drug Administration is proposing to widen access to experimental drugs. The agency has been accused by patient advocates and some drug makers of obfuscating the criteria physicians need to seek to use investigational drugs in their patients. In 2003, an Arlington, Va.-based advocacy group, the Abigail Alliance, sued the FDA to get unfettered access to unapproved therapies. The plaintiffs were backed by a federal appeals court in May 2006, and a rehearing of the case is expected to begin in March. In the meantime, the FDA's proposed rule, published on Dec. 14, said the agency was going to make it easier for physicians to access experimental therapies, and for manufacturers to make them available. “FDA hopes this proposal will increase awareness in the health care community of the range of options available for obtaining experimental drugs for seriously ill patients,” Dr. Janet Woodcock, FDA deputy commissioner for operations, said in a statement. A separate proposed rule would make it easier for manufacturers to recover costs. In a statement, the Abigail Alliance said the FDA proposals “merely clarify their existing policies.”

Stem Cell Support Drops Slightly

Most of the public supports the use of human embryonic stem cells for medical research, but that support may be faltering slightly, according to a new poll from Virginia Commonwealth University. The survey, which included 1,000 adults, found that 54% of respondents favored stem cell research in 2006, down from 58% in a similar VCU poll in 2005. The number of respondents who opposed stem cell research climbed from 32% in 2005 to 37% in the recent 2006 survey. However, when asked if they would support the use of embryonic stem cells to find a treatment for themselves or a family member with Parkinson's disease or spinal cord injury, 70% of respondents said yes. Only 21% would not support the use of stem cells in that situation, according to the 2006 poll. How people feel about stem cell research may also depend on their political affiliation. A recent survey by the Kaiser Family Foundation and the Harvard School of Public Health found that many more Democrats and Independents favor federal funding for embryonic stem cell research than do Republicans. In a national poll of 1,867 adults, the researchers found that 67% of Democrats and 61% of Independents favor broadening federal funding for stem cell research, compared with 37% of Republicans.

Gyn. Cancer Legislation Passed

Members of Congress passed legislation at the end of last year to raise awareness of gynecologic cancers. The Gynecologic Cancer Education and Awareness Act tasks the Health and Human Services secretary with carrying out a national public awareness campaign to increase understanding of these cancers by women and health care providers. The legislation, introduced by Rep. Darrell Issa (R-Calif.) in 2005, was expected to be signed by President Bush at press time. The bill authorizes the federal government to spend $16.5 million over the next 3 years on awareness and educational efforts. “In creating a federal campaign to educate women and health care providers alike, as this legislation does, we can take a bold step toward ensuring women know which symptoms to look for and how to seek help before it is too late,” Rep. Rosa DeLauro (D-Conn.), a cosponsor of the legislation and an ovarian cancer survivor, said in a statement.

Unborn Child Pain Relief Bill Fails

Congress failed to pass legislation that would have required physicians performing abortions at 20 weeks' gestation or later to offer women the option of receiving anesthesia or other pain-reducing drugs for the fetus. The Unborn Child Pain Awareness Act (H.R. 6099) failed to pass the House of Representatives in December. The legislation included findings that “there is substantial evidence that the abortion methods most commonly used 20 weeks or more after fertilization cause substantial pain to an unborn child.” Under the legislation, physicians would have been able to offer their own views on the ability of the fetus to feel pain and whether pain-reducing drugs would be advised, as long as they also provided the required information. The legislation was supported by the Christian Medical Association, which asserts that women should be informed of the likelihood that the fetus experiences pain during an abortion. The National Abortion Federation applauded the defeat of the bill.

Emergency Contraception in Rape

Some Massachusetts hospitals are imposing hurdles that make it more difficult for rape victims to access emergency contraception, according to the results of a survey conducted by NARAL Pro-Choice Massachusetts. The organization called 69 hospital emergency departments in early 2006 to gauge the availability of emergency contraception to rape victims and to assess compliance with a 2005 state law requiring that emergency contraception be offered to all rape survivors. The calls were made by a rape counselor who called on behalf of a potential client to find out if she could obtain emergency contraception at the hospital. The survey found that 7% of the hospitals leave it up to the physician to decide if emergency contraception should be provided and another 7% said that emergency contraception may be contingent on undergoing a rape kit exam. However, the results show a significant increase in the number of hospitals offering emergency contraception in 2006 compared with 2004 when only 58% of hospitals offered emergency contraception to rape victims.

Easing Use of Experimental Drugs

The Food and Drug Administration is proposing to widen access to experimental drugs. The agency has been accused by patient advocates and some drug makers of obfuscating the criteria physicians need to seek to use investigational drugs in their patients. In 2003, an Arlington, Va.-based advocacy group, the Abigail Alliance, sued the FDA to get unfettered access to unapproved therapies. The plaintiffs were backed by a federal appeals court in May 2006, and a rehearing of the case is expected to begin in March. In the meantime, the FDA's proposed rule, published on Dec. 14, said the agency was going to make it easier for physicians to access experimental therapies, and for manufacturers to make them available. “FDA hopes this proposal will increase awareness in the health care community of the range of options available for obtaining experimental drugs for seriously ill patients,” Dr. Janet Woodcock, FDA deputy commissioner for operations, said in a statement. A separate proposed rule would make it easier for manufacturers to recover costs. In a statement, the Abigail Alliance said the FDA proposals “merely clarify their existing policies.”

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year.

The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year.

The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

BOSTON — Bilingual students who have been trained in medical interpretation could ease some of the burden on medical practices and hospitals to provide translation services.

In a poster presented at the annual meeting of the American Public Health Association, researchers from Brown University and Rhode Island Hospital in Providence describe the success of one model—the Interpreter's Aide Program. The student-run volunteer program was launched in 1997 by two students in Brown's 8-year combined medical program in an effort to improve the quality and the availability of medical interpretation services.

Under the program, about 34 bilingual undergraduate and medical students from the university were trained in techniques of interpretation, issues of cultural awareness, and medical terminology. As part of their training, students took both written and oral exams. The bilingual students mainly spoke Spanish. The trained student interpreters were then used to supplement professional interpreters at Rhode Island Hospital.

Between 2000 and 2002, an average of 34 students translated 1,333 hours a year, with each student volunteering his or her services for an average of 40 hours each year.

The researchers estimated that the volunteer student program saved the hospital nearly $60,000 per year. An outside agency charges the hospital $45 per hour for interpretation services when students are not available.

RENO, NEV. — Increased body mass index is correlated with worsening proteinuria in children, according to study findings presented at the annual meeting of the American College of Nutrition.

The data confirm the hypothesis that obesity contributes to a decline in the glomerular filtration rate, an indicator of kidney function, said Dr. Carolyn Abitbol of the Division of Pediatric Nephrology at the University of Miami.

The study included 40 obese children: 16 low-birth-weight children (less than 1,200 grams) and 24 children of normal birth weight (more than 2,500 grams). Obesity was defined as a body mass index (BMI) of greater than the 95th percentile for age and gender. The study also included 20 nonobese children of normal birth weight as clinical controls. All of the children in the study had proteinuric kidney disease. The researchers excluded any patients who had acute glomerulonephritis immune-mediated nephritis, overt diabetes, as well as patients who had HIV nephropathy.

Dr. Abitbol and colleagues performed kidney biopsies of nine children in the obese, low-birth-weight group; all had focal segmental glomerulosclerosis (FSGS).

Of the children in the normal birth weight, obese group, 16 were biopsied and 14 had FSGS. One patient had focal mesangial proliferative glomerulonephropathy, probably an early form of FSGS. Another had a membranous nephropathy, which is unique and immune mediated. In the nonobese control group, all of the children were biopsied and 14 had FSGS, 4 had mesangial glomerulonephropathy, 1 had minimal change, and 1 was membranous.

Researchers compared the mean renal survival relative with birth weight and found low-birth-weight patients had a loss of glomerular filtration rate significantly earlier than those of normal birth weight.

RENO, NEV. — Increased body mass index is correlated with worsening proteinuria in children, according to study findings presented at the annual meeting of the American College of Nutrition.

The data confirm the hypothesis that obesity contributes to a decline in the glomerular filtration rate, an indicator of kidney function, said Dr. Carolyn Abitbol of the Division of Pediatric Nephrology at the University of Miami.

The study included 40 obese children: 16 low-birth-weight children (less than 1,200 grams) and 24 children of normal birth weight (more than 2,500 grams). Obesity was defined as a body mass index (BMI) of greater than the 95th percentile for age and gender. The study also included 20 nonobese children of normal birth weight as clinical controls. All of the children in the study had proteinuric kidney disease. The researchers excluded any patients who had acute glomerulonephritis immune-mediated nephritis, overt diabetes, as well as patients who had HIV nephropathy.

Dr. Abitbol and colleagues performed kidney biopsies of nine children in the obese, low-birth-weight group; all had focal segmental glomerulosclerosis (FSGS).

Of the children in the normal birth weight, obese group, 16 were biopsied and 14 had FSGS. One patient had focal mesangial proliferative glomerulonephropathy, probably an early form of FSGS. Another had a membranous nephropathy, which is unique and immune mediated. In the nonobese control group, all of the children were biopsied and 14 had FSGS, 4 had mesangial glomerulonephropathy, 1 had minimal change, and 1 was membranous.

Researchers compared the mean renal survival relative with birth weight and found low-birth-weight patients had a loss of glomerular filtration rate significantly earlier than those of normal birth weight.

RENO, NEV. — Increased body mass index is correlated with worsening proteinuria in children, according to study findings presented at the annual meeting of the American College of Nutrition.

The data confirm the hypothesis that obesity contributes to a decline in the glomerular filtration rate, an indicator of kidney function, said Dr. Carolyn Abitbol of the Division of Pediatric Nephrology at the University of Miami.

The study included 40 obese children: 16 low-birth-weight children (less than 1,200 grams) and 24 children of normal birth weight (more than 2,500 grams). Obesity was defined as a body mass index (BMI) of greater than the 95th percentile for age and gender. The study also included 20 nonobese children of normal birth weight as clinical controls. All of the children in the study had proteinuric kidney disease. The researchers excluded any patients who had acute glomerulonephritis immune-mediated nephritis, overt diabetes, as well as patients who had HIV nephropathy.

Dr. Abitbol and colleagues performed kidney biopsies of nine children in the obese, low-birth-weight group; all had focal segmental glomerulosclerosis (FSGS).

Of the children in the normal birth weight, obese group, 16 were biopsied and 14 had FSGS. One patient had focal mesangial proliferative glomerulonephropathy, probably an early form of FSGS. Another had a membranous nephropathy, which is unique and immune mediated. In the nonobese control group, all of the children were biopsied and 14 had FSGS, 4 had mesangial glomerulonephropathy, 1 had minimal change, and 1 was membranous.

Researchers compared the mean renal survival relative with birth weight and found low-birth-weight patients had a loss of glomerular filtration rate significantly earlier than those of normal birth weight.