Mary Ellen Schneider

Postpartum Depression Widespread

More than half of recent parents report having experienced postpartum depression or knowing someone who has, according to the results of a poll of 1,000 California adults. About 84% of parents surveyed reported that they would likely talk to their primary care provider if they or their partner had symptoms of postpartum depression, but 36% reported that they would do nothing or wait for the symptoms to pass. The survey was commissioned by the Iris Alliance Fund, a mental health advocacy organization, which seeks more funding for postpartum depression prescreening and treatment. “What families need now are additional resources to treat the problem,” Mary Hayashi, president of the Iris Alliance Fund said in a statement.

Wyeth Wins Legal Challenge

A federal jury last month found in favor of the drugmaker Wyeth against allegations that its Premarin and Prempro products had caused a woman's breast cancer. In the case of Linda Reeves v. Wyeth, the jury voted that the plaintiff had not proved that the company had inadequately warned patients of the known risks of the drugs. The jurors also rejected claims that Wyeth officials were negligent and that the products were defective in their design leading to Ms. Reeves' breast cancer. “We believe the jury's decision was consistent with the evidence presented and the body of scientific knowledge around hormone therapy,” Lyn P. Pruitt, an attorney representing Wyeth in the case, said in a statement.

Congress Seeks to Reduce Abortion

New federal legislation aims to reduce abortions by expanding access to contraception and providing increased adoption tax incentives. The legislation (H.R. 6067), which was introduced in the final weeks before Congress recessed for the midterm congressional elections, was sponsored by a coalition of Democrats on both sides of the abortion debate, including Rep. Tim Ryan (D-Ohio), a member of the Congressional Pro-Life Caucus, and Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. If passed, the bill would expand access to contraception for low-income women, increase funding for health care for low-income mothers and children, fund day care programs and child care centers on college campuses, and provide grants for creative approaches to reducing teen pregnancy and unintended pregnancy. The legislation also calls for the Institute of Medicine to study the reasons why women choose abortion.

Income Sways Infertility Treatment

Low-income women who experience infertility are only 11% as likely as infertile women with moderate incomes to choose assisted reproductive technologies (ART) such as in vitro fertilization or intrauterine insemination to help achieve pregnancy, according to a study published in the online journal Health Services Research. Couples with higher incomes are almost twice as likely to try ART rather than expectant management. The data come from the National Survey of Family Growth, conducted in 1995, which surveyed nearly 11,000 women. More than 11% of the women surveyed—1,210 women—were considered subfecund or had difficulty getting pregnant. Among those surveyed, about 31% reported seeking medical help to get pregnant. Income played a significant role in most treatment choices, the researchers found, except in seeking advice without further treatment, and use of ovulation-inducing medications. Women with insurance coverage were 3.4 times more likely than uninsured women to choose ovulation-inducing medications rather than opt for no treatment. Coverage with private insurance also increases the likelihood that a woman would seek surgical treatment rather than no treatment, according to the study.

Stores Cut Generic Drug Prices

The retail giant Wal-Mart last month began offering pharmacy customers in the Tampa Bay, Fla., area generic medications at a cost of $4 per 30-day supply. The discounted medications are available at 65 Wal-Mart, Neighborhood Market, and Sam's Club pharmacies in the area. The program will be expanded to all stores in Florida in January and could be expanded to areas across the country in 2007, according to Wal-Mart. The $4 tag price will apply to all pharmacy customers who have a prescription that can be filled with a covered generic medication. Currently, the program covers 291 generic medications from a variety of therapeutic categories including antibiotics, cardiac medications, antidepressants, anti-inflammatory drugs, diabetes medications, analgesics, and vitamins. The program will be available to customers with and without insurance. In response, Target announced that its Tampa Bay area stores would match the lower prices on generic drugs.

Postpartum Depression Widespread

More than half of recent parents report having experienced postpartum depression or knowing someone who has, according to the results of a poll of 1,000 California adults. About 84% of parents surveyed reported that they would likely talk to their primary care provider if they or their partner had symptoms of postpartum depression, but 36% reported that they would do nothing or wait for the symptoms to pass. The survey was commissioned by the Iris Alliance Fund, a mental health advocacy organization, which seeks more funding for postpartum depression prescreening and treatment. “What families need now are additional resources to treat the problem,” Mary Hayashi, president of the Iris Alliance Fund said in a statement.

Wyeth Wins Legal Challenge

A federal jury last month found in favor of the drugmaker Wyeth against allegations that its Premarin and Prempro products had caused a woman's breast cancer. In the case of Linda Reeves v. Wyeth, the jury voted that the plaintiff had not proved that the company had inadequately warned patients of the known risks of the drugs. The jurors also rejected claims that Wyeth officials were negligent and that the products were defective in their design leading to Ms. Reeves' breast cancer. “We believe the jury's decision was consistent with the evidence presented and the body of scientific knowledge around hormone therapy,” Lyn P. Pruitt, an attorney representing Wyeth in the case, said in a statement.

Congress Seeks to Reduce Abortion

New federal legislation aims to reduce abortions by expanding access to contraception and providing increased adoption tax incentives. The legislation (H.R. 6067), which was introduced in the final weeks before Congress recessed for the midterm congressional elections, was sponsored by a coalition of Democrats on both sides of the abortion debate, including Rep. Tim Ryan (D-Ohio), a member of the Congressional Pro-Life Caucus, and Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. If passed, the bill would expand access to contraception for low-income women, increase funding for health care for low-income mothers and children, fund day care programs and child care centers on college campuses, and provide grants for creative approaches to reducing teen pregnancy and unintended pregnancy. The legislation also calls for the Institute of Medicine to study the reasons why women choose abortion.

Income Sways Infertility Treatment

Low-income women who experience infertility are only 11% as likely as infertile women with moderate incomes to choose assisted reproductive technologies (ART) such as in vitro fertilization or intrauterine insemination to help achieve pregnancy, according to a study published in the online journal Health Services Research. Couples with higher incomes are almost twice as likely to try ART rather than expectant management. The data come from the National Survey of Family Growth, conducted in 1995, which surveyed nearly 11,000 women. More than 11% of the women surveyed—1,210 women—were considered subfecund or had difficulty getting pregnant. Among those surveyed, about 31% reported seeking medical help to get pregnant. Income played a significant role in most treatment choices, the researchers found, except in seeking advice without further treatment, and use of ovulation-inducing medications. Women with insurance coverage were 3.4 times more likely than uninsured women to choose ovulation-inducing medications rather than opt for no treatment. Coverage with private insurance also increases the likelihood that a woman would seek surgical treatment rather than no treatment, according to the study.

Stores Cut Generic Drug Prices

The retail giant Wal-Mart last month began offering pharmacy customers in the Tampa Bay, Fla., area generic medications at a cost of $4 per 30-day supply. The discounted medications are available at 65 Wal-Mart, Neighborhood Market, and Sam's Club pharmacies in the area. The program will be expanded to all stores in Florida in January and could be expanded to areas across the country in 2007, according to Wal-Mart. The $4 tag price will apply to all pharmacy customers who have a prescription that can be filled with a covered generic medication. Currently, the program covers 291 generic medications from a variety of therapeutic categories including antibiotics, cardiac medications, antidepressants, anti-inflammatory drugs, diabetes medications, analgesics, and vitamins. The program will be available to customers with and without insurance. In response, Target announced that its Tampa Bay area stores would match the lower prices on generic drugs.

Postpartum Depression Widespread

More than half of recent parents report having experienced postpartum depression or knowing someone who has, according to the results of a poll of 1,000 California adults. About 84% of parents surveyed reported that they would likely talk to their primary care provider if they or their partner had symptoms of postpartum depression, but 36% reported that they would do nothing or wait for the symptoms to pass. The survey was commissioned by the Iris Alliance Fund, a mental health advocacy organization, which seeks more funding for postpartum depression prescreening and treatment. “What families need now are additional resources to treat the problem,” Mary Hayashi, president of the Iris Alliance Fund said in a statement.

Wyeth Wins Legal Challenge

A federal jury last month found in favor of the drugmaker Wyeth against allegations that its Premarin and Prempro products had caused a woman's breast cancer. In the case of Linda Reeves v. Wyeth, the jury voted that the plaintiff had not proved that the company had inadequately warned patients of the known risks of the drugs. The jurors also rejected claims that Wyeth officials were negligent and that the products were defective in their design leading to Ms. Reeves' breast cancer. “We believe the jury's decision was consistent with the evidence presented and the body of scientific knowledge around hormone therapy,” Lyn P. Pruitt, an attorney representing Wyeth in the case, said in a statement.

Congress Seeks to Reduce Abortion

New federal legislation aims to reduce abortions by expanding access to contraception and providing increased adoption tax incentives. The legislation (H.R. 6067), which was introduced in the final weeks before Congress recessed for the midterm congressional elections, was sponsored by a coalition of Democrats on both sides of the abortion debate, including Rep. Tim Ryan (D-Ohio), a member of the Congressional Pro-Life Caucus, and Rep. Rosa DeLauro (D-Conn.), a member of the Congressional Pro-Choice Caucus. If passed, the bill would expand access to contraception for low-income women, increase funding for health care for low-income mothers and children, fund day care programs and child care centers on college campuses, and provide grants for creative approaches to reducing teen pregnancy and unintended pregnancy. The legislation also calls for the Institute of Medicine to study the reasons why women choose abortion.

Income Sways Infertility Treatment

Low-income women who experience infertility are only 11% as likely as infertile women with moderate incomes to choose assisted reproductive technologies (ART) such as in vitro fertilization or intrauterine insemination to help achieve pregnancy, according to a study published in the online journal Health Services Research. Couples with higher incomes are almost twice as likely to try ART rather than expectant management. The data come from the National Survey of Family Growth, conducted in 1995, which surveyed nearly 11,000 women. More than 11% of the women surveyed—1,210 women—were considered subfecund or had difficulty getting pregnant. Among those surveyed, about 31% reported seeking medical help to get pregnant. Income played a significant role in most treatment choices, the researchers found, except in seeking advice without further treatment, and use of ovulation-inducing medications. Women with insurance coverage were 3.4 times more likely than uninsured women to choose ovulation-inducing medications rather than opt for no treatment. Coverage with private insurance also increases the likelihood that a woman would seek surgical treatment rather than no treatment, according to the study.

Stores Cut Generic Drug Prices

The retail giant Wal-Mart last month began offering pharmacy customers in the Tampa Bay, Fla., area generic medications at a cost of $4 per 30-day supply. The discounted medications are available at 65 Wal-Mart, Neighborhood Market, and Sam's Club pharmacies in the area. The program will be expanded to all stores in Florida in January and could be expanded to areas across the country in 2007, according to Wal-Mart. The $4 tag price will apply to all pharmacy customers who have a prescription that can be filled with a covered generic medication. Currently, the program covers 291 generic medications from a variety of therapeutic categories including antibiotics, cardiac medications, antidepressants, anti-inflammatory drugs, diabetes medications, analgesics, and vitamins. The program will be available to customers with and without insurance. In response, Target announced that its Tampa Bay area stores would match the lower prices on generic drugs.

DALLAS — African Americans and Hispanics were more likely to use diet and exercise to lose weight than to seek counseling from a dietitian or try prescription medications, according to a poster presented at the annual meeting of the National Medical Association.

Among individuals who had attempted to lose weight, about 69% of African American adults and 61% of Hispanic adults said they had tried exercise. And eating healthier as a weight loss method was reported by 59% of African Americans and 51% of Hispanics.

But fewer reported seeking counseling from a dietitian, with 12% of African Americans and 8% of Hispanics citing that approach as a weight loss method. Only about 8% of individuals in both groups had ever used prescription medications for weight loss.

The study, conducted by investigators at GlaxoSmithKline Consumer Healthcare of Pittsburgh and consultants affiliated with the company, included 604 African Americans and 600 Hispanics who were surveyed by telephone about their weight loss strategies. All of the participants were overweight or had been overweight.

A significantly greater proportion of African American respondents were overweight or obese, compared with the Hispanics surveyed. Of the 604 African Americans who participated, 31% were overweight, with a body mass index (BMI) between 25 and 29.9 kg/m

DALLAS — African Americans and Hispanics were more likely to use diet and exercise to lose weight than to seek counseling from a dietitian or try prescription medications, according to a poster presented at the annual meeting of the National Medical Association.

Among individuals who had attempted to lose weight, about 69% of African American adults and 61% of Hispanic adults said they had tried exercise. And eating healthier as a weight loss method was reported by 59% of African Americans and 51% of Hispanics.

But fewer reported seeking counseling from a dietitian, with 12% of African Americans and 8% of Hispanics citing that approach as a weight loss method. Only about 8% of individuals in both groups had ever used prescription medications for weight loss.

The study, conducted by investigators at GlaxoSmithKline Consumer Healthcare of Pittsburgh and consultants affiliated with the company, included 604 African Americans and 600 Hispanics who were surveyed by telephone about their weight loss strategies. All of the participants were overweight or had been overweight.

A significantly greater proportion of African American respondents were overweight or obese, compared with the Hispanics surveyed. Of the 604 African Americans who participated, 31% were overweight, with a body mass index (BMI) between 25 and 29.9 kg/m

DALLAS — African Americans and Hispanics were more likely to use diet and exercise to lose weight than to seek counseling from a dietitian or try prescription medications, according to a poster presented at the annual meeting of the National Medical Association.

Among individuals who had attempted to lose weight, about 69% of African American adults and 61% of Hispanic adults said they had tried exercise. And eating healthier as a weight loss method was reported by 59% of African Americans and 51% of Hispanics.

But fewer reported seeking counseling from a dietitian, with 12% of African Americans and 8% of Hispanics citing that approach as a weight loss method. Only about 8% of individuals in both groups had ever used prescription medications for weight loss.

The study, conducted by investigators at GlaxoSmithKline Consumer Healthcare of Pittsburgh and consultants affiliated with the company, included 604 African Americans and 600 Hispanics who were surveyed by telephone about their weight loss strategies. All of the participants were overweight or had been overweight.

A significantly greater proportion of African American respondents were overweight or obese, compared with the Hispanics surveyed. Of the 604 African Americans who participated, 31% were overweight, with a body mass index (BMI) between 25 and 29.9 kg/m

PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.

The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia.

“The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.

Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.

Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.

The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.

The racial and socioeconomic make up of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.

Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.

Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.

But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.

For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.

“The urban physicians' experienced a lot more trouble getting information about ADHD,” Dr. Power said.

The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.

The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.

PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.

The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia.

“The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.

Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.

Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.

The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.

The racial and socioeconomic make up of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.

Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.

Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.

But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.

For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.

“The urban physicians' experienced a lot more trouble getting information about ADHD,” Dr. Power said.

The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.

The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.

PHILADELPHIA — It's appropriate for primary care physicians to evaluate and treat children with attention-deficit hyperactivity disorder, but in many cases it isn't feasible, according to a survey of such physicians.

The survey results show that primary care physicians working in urban practices report the greatest challenges in delivering ADHD services, Thomas J. Power, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Understanding what types of clinical services primary care physicians can provide is crucial because primary care physicians are often the first-line care providers for children with ADHD, said Dr. Power, program director for the Center for Management of ADHD at the Children's Hospital of Philadelphia.

“The primary responsibility for managing ADHD is really in the hands of primary care physicians and school professionals,” he said.

Dr. Power and his colleagues developed a 24-item questionnaire looking at the appropriateness and feasibility of a number of clinical activities surrounding ADHD treatment. The questionnaire asked physicians to evaluate each activity twice based, first, on whether the activity was appropriate assuming that they had adequate time and resources, and then based on the feasibility of providing that service in their own practice.

Each of the 24 items was evaluated on a 4-point scale ranging from “not at all” to “very much.” For example, one of the items asked physicians to assess whether it was appropriate and feasible to obtain behavior ratings from teachers for an initial assessment of ADHD.

The questionnaire was administered to 181 physicians affiliated with the Children's Hospital primary care network. Of the 181 physicians who were asked to participate, 119 completed the questionnaire. The physicians represented 31 primary care practices, including 27 suburban practices and 4 urban practices. The investigators did not specify the specialty of the physicians.

The racial and socioeconomic make up of the practices was vastly different between the urban and suburban settings. For example, patients in suburban practices were 70% white and only 10% were eligible for Medicaid. In the urban practices, 85% of patients were African American and about 66% had Medicaid as their primary insurance.

Primary care physicians surveyed viewed a number of clinical activities as being highly appropriate, Dr. Power said. Those activities included assessing ADHD, providing mental health services, determining whether the child has comorbidities, educating families about behavioral treatment strategies, and recommending and monitoring medications that have been approved for ADHD by the Food and Drug Administration.

Recommending medications that have not been approved by the FDA for ADHD was not viewed as a very acceptable practice by primary care physicians in the survey, Dr. Power said.

But while the physicians viewed many clinical activities as appropriate for the primary care setting, the ratings fell for feasibility. The average item ratings show significant differences between appropriateness and feasibility in all major areas, with the most challenges being reported by physicians working in urban settings, Dr. Power said.

For example, when asked about obtaining information from schools about ADHD, suburban physicians rated the activity as appropriate with an average 3.09 rating on the 4-point scale. Urban physicians rated it similarly at 3.02. But when asked about the feasibility, suburban physicians rated it as 2.51, with urban physicians dropping to 2.14 on the scale.

“The urban physicians' experienced a lot more trouble getting information about ADHD,” Dr. Power said.

The researchers found similar trends related to recommending and monitoring FDA-approved medications. Urban physicians rated this activity as 3.10 in terms of appropriateness, but 2.61 for feasibility in their own practice. Among suburban physicians, the appropriateness was 3.43, while the feasibility was 3.16.

The findings suggest that primary care physicians need more support in providing ADHD services, Dr. Power said, including additional training and resources.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults without modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults without modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults without modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

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.

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, he 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,” Dr. Blackburn said.

Benefits should also be detailed in the contract, he continued. 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. And a PA with 6 years of experience averages about $70,000, Dr. Blackburn said. A PA in a busy specialty 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.

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, he 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,” Dr. Blackburn said.

Benefits should also be detailed in the contract, he continued. 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. And a PA with 6 years of experience averages about $70,000, Dr. Blackburn said. A PA in a busy specialty 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.

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, he 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,” Dr. Blackburn said.

Benefits should also be detailed in the contract, he continued. 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. And a PA with 6 years of experience averages about $70,000, Dr. Blackburn said. A PA in a busy specialty practice can bring in gross revenues between $600,000 and $700,000 a year.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults who do not have modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults who do not have modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

DALLAS — Selection of an antibiotic for the treatment of community-acquired pneumonia should be based on the severity of the illness, coverage of common pathogens, and presence of factors that increase the risk for aspiration and/or infection with antibiotic-resistant organisms, Dr. Horace M. DeLisser said at the annual meeting of the National Medical Association.

Physicians shouldn't wait for culture results before treating. Instead, they should rely on the history to identify risk factors that will require modifying the treatment plan, said Dr. DeLisser of the pulmonary, allergy, and critical care division of the University of Pennsylvania, Philadelphia.

To determine whether the patient should be treated on an inpatient or outpatient basis, physicians can use the pneumonia severity index, a widely utilized and rigorously studied prediction rule, he said.

The index is based on 20 parameters that are commonly available at presentation, including demographic information, exam findings, and lab and imaging results. Each parameter is assigned a specific point value that allows physicians to stratify patients into five risk classes.

Classes 1–3 are low risk, class 4 is moderate risk, and class 5 is high risk. Generally, patients in risk classes 1 and 2 are treated on an outpatient basis, those in risk classes 4 and 5 are treated as inpatients, and those in class 3 may be treated as outpatients or admitted briefly, Dr. DeLisser said. “Your clinical judgment should always be used, particularly if there are other psychosocial or emotion factors,” he said.

Dr. DeLisser advised physicians not to wait for the culture to come back. Between 40% and 60% of patients will have no pathogens identified, and for inpatients, early administration of antibiotics decreases mortality, he said. Instead, physicians should take into account the modified risk factors for infections, such as residence in a nursing home, underlying disease, and recent antibiotic therapy.

Several organizations in the United States, Europe, and Asia have developed guidelines for the treatment of community-acquired pneumonia. The following treatment recommendations are based on guidelines developed by the American Thoracic Society (www.thoracic.org/sections/publications/statements/pages/mtpi/commacq1-25.html

▸ In otherwise healthy adults who do not have modifying risk factors, use an advanced-generation macrolide, such as azithromycin or clarithromycin. Another option for this group is treatment with doxycycline.

▸ For outpatients with comorbid disease or modifying risk factors, use a respiratory fluoroquinolone alone, or β-lactam plus an advanced-generation macrolide.

▸ For otherwise healthy inpatients who are not in the ICU, use an intravenous respiratory fluoroquinolone alone or intravenous azithromycin alone.

▸ For inpatients with comorbid disease or modifying risk factors, use intravenous respiratory fluoroquinolones alone or a combination of intravenous azithromycin plus intravenous β-lactam.

▸ Patients in the ICU who do not have risk factors for Pseudomonas aeruginosa infection can be treated with intravenous β-lactam plus either intravenous azithromycin or intravenous respiratory fluoroquinolone.

▸ Those patients at risk for P. aeruginosa infection can be treated with intravenous antipseudomonal β-lactam plus intravenous antipseudomonal fluoroquinolone. Another option is treatment with intravenous antipseudomonal β-lactam plus intravenous aminoglycoside plus either intravenous azithromycin or intravenous nonpseudomonal fluoroquinolone.

Most patients will become clinically stable within 3–7 days. Treatment is recommended for a minimum of 5–7 days and for at least 48 hours after reaching clinical stability, Dr. DeLisser said. Longer treatment—between 10 and 14 days—may be required for patients with infections caused by Staphylococcus aureus, P. aeruginosa, or Legionella species.

Patients can be discharged once their vital signs have been stable for a 24-hour period, they are able to take oral antibiotics, they can maintain adequate nutrition and hydration on their own, their mental status is back to baseline, and they have no other active clinical or psychosocial issues.

If the pneumonia does not resolve, consider microbial resistance to the initial antimicrobial regimen, suppurative complications like an abscess or empyema, or subsequent development of nosocomial pneumonia, Dr. DeLisser said.

DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.

There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.

The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.

The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers. All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.

These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said. The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.

Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.

The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.

Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.

A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said. Thus, physicians who can't volunteer for a DMAT can still help in a disaster while staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.

There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.

Other federal teams that need physician volunteers include:

▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.

▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9 or 10 such teams in the country.

▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.

▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.

Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said.

Physicians get other protections during their deployment, including federal liability protection.

But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.

Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.

To learn more about volunteering for a disaster response team, visit www.ndms.fema.govjack.beall@dhs.gov

How to Prepare For Deployment

Dr. Joseph A. Scott, who serves on both a disaster medical assistance team and an international medical/surgical response team, offered tips for physicians preparing for deployment:

▸ Update your immunizations before heading into the field.

▸ Get packed. Physicians should carry cash, water, food, protective clothing, medications, flashlight, batteries, sleeping bag, gasoline, insect repellent, and their credentials, Dr. Scott said. Credit cards will be useless if the power is out. Physicians need to carry enough of their own supplies that they don't end up becoming victims themselves, he said.

▸ Take care of your own mental health. This means making sure that your home and work situations are under control during deployment, he said. Make sure in advance that colleagues can cover your shifts. This will go a long way toward making you more effective during deployment, he said.

DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.

There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.

The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.

The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers. All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.

These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said. The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.

Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.

The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.

Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.

A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said. Thus, physicians who can't volunteer for a DMAT can still help in a disaster while staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.

There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.

Other federal teams that need physician volunteers include:

▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.

▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9 or 10 such teams in the country.

▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.

▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.

Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said.

Physicians get other protections during their deployment, including federal liability protection.

But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.

Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.

To learn more about volunteering for a disaster response team, visit www.ndms.fema.govjack.beall@dhs.gov

How to Prepare For Deployment

Dr. Joseph A. Scott, who serves on both a disaster medical assistance team and an international medical/surgical response team, offered tips for physicians preparing for deployment:

▸ Update your immunizations before heading into the field.

▸ Get packed. Physicians should carry cash, water, food, protective clothing, medications, flashlight, batteries, sleeping bag, gasoline, insect repellent, and their credentials, Dr. Scott said. Credit cards will be useless if the power is out. Physicians need to carry enough of their own supplies that they don't end up becoming victims themselves, he said.

▸ Take care of your own mental health. This means making sure that your home and work situations are under control during deployment, he said. Make sure in advance that colleagues can cover your shifts. This will go a long way toward making you more effective during deployment, he said.

DALLAS — Last year's Gulf Coast hurricanes and their devastating aftermath left many physicians wondering how they could help in future disasters, Dr. Joseph A. Scott, director of the division of prehospital and emergency health care at the University of Miami, said at the annual meeting of the National Medical Association.

There are a number of federal disaster response teams for which physicians can volunteer, Dr. Scott said.

The National Disaster Medical System (NDMS) is a public-private partnership, based primarily in the Department of Homeland Security, which coordinates teams of medical providers to respond to storms, floods, airplane crashes, and even large-scale events like the Olympics or presidential inaugurations. The NDMS was set up to supplement state and local medical resources.

The disaster medical assistance teams (DMATs) make up one component of the NDMS. DMATs are 35-person teams that can be on the ground at a disaster anywhere around the country within 24 hours. A DMAT typically comprises physicians, nurses, paramedics, emergency medical technicians, pharmacists, respiratory therapists, psychologists, and social workers. All team members are cross-trained in medical, logistical, communications, and administrative aspects of the response, said Dr. Scott, who serves as medical officer for a DMAT based in south Florida.

These teams handle a variety of medical situations—from triage to primary medical care to trauma—once they are on the ground, he said. The DMAT usually rolls out the door with a cache of medications provided by the federal government. The medications include drugs for treatment as well as for dispensing purposes, because most pharmacies will be shut down in a disaster, Dr. Scott said. The NDMS also supplies the equipment, but Dr. Scott said his group also accepts donated equipment to supplement that stock.

Emergency medicine training is ideal for these types of teams, he said. Experience with urgent care, trauma, and pediatrics is especially important for disaster deployments.

The usual deployment period for members of a DMAT is about 1–2 weeks, which includes predisaster staging. Physicians in the past were required to commit to a 2-week deployment, but that has been changing to 1 week for physicians only, he said.

Volunteering to be part of an organized response team can forestall many of the problems that can occur at a disaster site when individual, well-meaning volunteers flood the scene. An overabundance of volunteers can divert resources, Dr. Scott said. And unsolicited volunteers often lack appropriate training, equipment, and supplies. They may also be outside the formal accountability system and may lack proper credentials, he said.

A big fear when volunteers—especially physicians—show up without formal coordination is that no one will be at home to take care of the regular emergencies, he said. Thus, physicians who can't volunteer for a DMAT can still help in a disaster while staying home, Dr. Scott said. Not everyone has the flexibility—either at home or at work—to volunteer for a 1- to 2-week deployment. But physicians can make a difference by volunteering to cover shifts for a colleague who is a member of a response team.

There are also increasing opportunities for physicians to volunteer for similar teams at the state level. Physicians can check with their state emergency management offices to find out if their state has a team, he said.

Other federal teams that need physician volunteers include:

▸ National medical response teams. These are 50-member teams that deploy less often than DMATs. They are generally tasked to respond to nuclear, biologic, and chemical incidents.

▸ Disaster mortuary operational response teams. These teams include pathologists, forensic pathologists, fingerprint experts, and dental assistants who help to identify victims' remains in a disaster. There are about 9 or 10 such teams in the country.

▸ International medical/surgical response teams. These teams generally take care of American civilians overseas, Dr. Scott said. They are similar to DMATs, but generally deploy with a trauma surgeon and anesthesiologist; they can perform surgery in the field.

▸ Urban search and rescue teams. These teams specialize in on-site medical treatment for victims trapped in confined spaces, such as those resulting from structural collapses. The physicians on these teams frequently care for both victims and responders, he said.

Physicians who are deployed as part of a federal team become federal employees during deployment and do collect a small paycheck, Dr. Scott said.

Physicians get other protections during their deployment, including federal liability protection.

But there are some disadvantages, Dr. Scott said. The initial credentialing process can take 6 months or more.

Overall, the experience can be very rewarding, Dr. Scott said. It's an opportunity to provide good care to appreciative patients with minimal paperwork. “You're actually really practicing emergency medicine the way most us went to medical school to do it,” he said.

To learn more about volunteering for a disaster response team, visit www.ndms.fema.govjack.beall@dhs.gov

How to Prepare For Deployment

Dr. Joseph A. Scott, who serves on both a disaster medical assistance team and an international medical/surgical response team, offered tips for physicians preparing for deployment:

▸ Update your immunizations before heading into the field.

▸ Get packed. Physicians should carry cash, water, food, protective clothing, medications, flashlight, batteries, sleeping bag, gasoline, insect repellent, and their credentials, Dr. Scott said. Credit cards will be useless if the power is out. Physicians need to carry enough of their own supplies that they don't end up becoming victims themselves, he said.

▸ Take care of your own mental health. This means making sure that your home and work situations are under control during deployment, he said. Make sure in advance that colleagues can cover your shifts. This will go a long way toward making you more effective during deployment, he said.

As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.

Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 2½-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.

Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.

In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for a period to aid in the transition.

Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy and there's never a great time for it,” he said.

He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.

There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction.

Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.

As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.

Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 2½-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.

Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.

In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for a period to aid in the transition.

Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy and there's never a great time for it,” he said.

He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.

There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction.

Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.

As physicians fight to avoid a proposed 5.1% payment cut under Medicare slated to take effect in January, it's unclear who will be leading the agency responsible for administering Medicare.

Dr. Mark B. McClellan resigned as administrator of the Centers for Medicare and Medicaid Services in early September after a 2½-year tenure with the agency. At press time, no acting or permanent replacement had been named by the White House.

Dr. McClellan, who previously served as commissioner of the Food and Drug Administration and as an economic adviser to President Bush, said that he is considering a move to a Washington-area think tank in the short term. He is also on leave from Stanford (Calif.) University, where he holds teaching posts in medicine and economics.

In a press briefing announcing his resignation, Dr. McClellan said he will stay on at CMS for a period to aid in the transition.

Dr. McClellan said that after several years in government service, he wanted to spend less time on the road and more time with his family. “This kind of decision is never easy and there's never a great time for it,” he said.

He took the reins at CMS just months after the passage of the Medicare Modernization Act and has presided over the transition to the Medicare Part D drug benefit.

There has been momentum on all new initiatives at CMS, including the Part D benefit, he said. Dr. McClellan touted the progress of the Part D program, including lower-than-forecast beneficiary costs and an overall high rate of participation and beneficiary satisfaction.

Dr. McClellan is board certified in internal medicine and earned a PhD in economics from the Massachusetts Institute of Technology. In addition to his work in the Bush administration, Dr. McClellan served in the Treasury Department under President Clinton. Before working in the federal government, Dr. McClellan was an associate professor of economics and medicine at Stanford University.

Cesarean Rate Jumps 38% in U.S.

The number of babies delivered by cesarean section at U.S. community hospitals increased 38% between 1997 and 2003, according to a report from the Agency for Healthcare Research and Quality. More than one-quarter of the 4 million births that occurred in U.S. hospitals in 2003 were by cesarean section, compared with about one-fifth in 1997. The proportion of cesarean sections that are elective also is increasing, according to the report, which relied on data from the Healthcare Cost and Utilization Project. National charges associated with cesarean births were more than $14.5 billion in 2003, with 53% of the bill going to private payers and 41% being charged to Medicaid. The charges for an uncomplicated cesarean delivery averaged about $11,500, about $5,000 more than a routine vaginal delivery. The report also noted that vaginal birth after cesarean (VBAC) decreased by more than 60% from 1997 to 2003. The rate of VBAC was 35.3 per 100 women who had a previous cesarean in 1997 and dropped to 13.7 per 100 women in 2003. During the same period, the use of episiotomies and forceps during vaginal birth also dropped. The full analysis is available online at

www.hcup-us.ahrq.gov/reports/statbriefs/sb11.pdf

Oral Contraceptives' Clinic Prices Cut

After an initial decision to raise prices of oral contraceptives earlier this summer, Ortho-McNeil has agreed to lower prices for the products for federally funded health clinics across the country. The company raised prices in July for various oral contraceptive products, inciting “widespread panic” among public health clinics, according to Marilyn Keefe, interim CEO of the National Family Planning and Reproductive Health Association. After hearing about the impact the price hike would have on the approximately 4,500 public health clinics nationwide, Ortho-McNeil announced at the end of August that it would drop its prices. “While the company has consistently followed a mandated formula to public health services as a result of participation in the federal government's Medicaid program, the organization has decided to further lower pricing to meet the needs of women and insure access to contraceptive choices and work with underfunded public health services,” Ortho-McNeil said in a statement. The new prices are 92%–94% discounted from the list price of the drugs, Ms. Keefe said.

U.S. Cancer Deaths Continue to Drop

Overall cancer death rates in the United States are continuing a nearly decade-long decline, according to an annual report on cancer trends released by the American Cancer Society, the National Institutes of Health, and other groups. The findings, which were to be published in the Oct. 15 issue of Cancer, included cancer incidence and trend data from 1975 to 2003. The study showed that the overall cancer incidence rates among all races and genders were stable from 1992 to 2003. However, the overall cancer incidence rates for men were stable from 1995 to 2003, while cancer rates in women were on the rise from 1979 through 2003. The report is available online at

www.interscience.wiley.com/cancer/report2006

Scales Influence Smoking Cessation

Pregnant ex-smokers who have confidence in their ability to control their weight are less likely to start smoking again after pregnancy, according to a new study published in the Annals of Behavioral Medicine. Researchers found that weight self-efficacy was significantly associated with postpartum motivation not to smoke even after controlling for other factors such as breastfeeding, partner smoking, years of smoking, race, and prepregnancy nicotine dependence. The study included 119 women in their third trimester of pregnancy. All of the participants were not smoking at the time of the study, but had smoked at least eight cigarettes per day for 1 month or more before becoming pregnant. The findings indicate that smoking cessation programs that target women's perceptions about weight gain may be able to improve long-term quitting success, the researchers wrote.

Poll: 70% Unaware of Medicare Cuts

About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. The AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.

Cesarean Rate Jumps 38% in U.S.

The number of babies delivered by cesarean section at U.S. community hospitals increased 38% between 1997 and 2003, according to a report from the Agency for Healthcare Research and Quality. More than one-quarter of the 4 million births that occurred in U.S. hospitals in 2003 were by cesarean section, compared with about one-fifth in 1997. The proportion of cesarean sections that are elective also is increasing, according to the report, which relied on data from the Healthcare Cost and Utilization Project. National charges associated with cesarean births were more than $14.5 billion in 2003, with 53% of the bill going to private payers and 41% being charged to Medicaid. The charges for an uncomplicated cesarean delivery averaged about $11,500, about $5,000 more than a routine vaginal delivery. The report also noted that vaginal birth after cesarean (VBAC) decreased by more than 60% from 1997 to 2003. The rate of VBAC was 35.3 per 100 women who had a previous cesarean in 1997 and dropped to 13.7 per 100 women in 2003. During the same period, the use of episiotomies and forceps during vaginal birth also dropped. The full analysis is available online at

www.hcup-us.ahrq.gov/reports/statbriefs/sb11.pdf

Oral Contraceptives' Clinic Prices Cut

After an initial decision to raise prices of oral contraceptives earlier this summer, Ortho-McNeil has agreed to lower prices for the products for federally funded health clinics across the country. The company raised prices in July for various oral contraceptive products, inciting “widespread panic” among public health clinics, according to Marilyn Keefe, interim CEO of the National Family Planning and Reproductive Health Association. After hearing about the impact the price hike would have on the approximately 4,500 public health clinics nationwide, Ortho-McNeil announced at the end of August that it would drop its prices. “While the company has consistently followed a mandated formula to public health services as a result of participation in the federal government's Medicaid program, the organization has decided to further lower pricing to meet the needs of women and insure access to contraceptive choices and work with underfunded public health services,” Ortho-McNeil said in a statement. The new prices are 92%–94% discounted from the list price of the drugs, Ms. Keefe said.

U.S. Cancer Deaths Continue to Drop

Overall cancer death rates in the United States are continuing a nearly decade-long decline, according to an annual report on cancer trends released by the American Cancer Society, the National Institutes of Health, and other groups. The findings, which were to be published in the Oct. 15 issue of Cancer, included cancer incidence and trend data from 1975 to 2003. The study showed that the overall cancer incidence rates among all races and genders were stable from 1992 to 2003. However, the overall cancer incidence rates for men were stable from 1995 to 2003, while cancer rates in women were on the rise from 1979 through 2003. The report is available online at

www.interscience.wiley.com/cancer/report2006

Scales Influence Smoking Cessation

Pregnant ex-smokers who have confidence in their ability to control their weight are less likely to start smoking again after pregnancy, according to a new study published in the Annals of Behavioral Medicine. Researchers found that weight self-efficacy was significantly associated with postpartum motivation not to smoke even after controlling for other factors such as breastfeeding, partner smoking, years of smoking, race, and prepregnancy nicotine dependence. The study included 119 women in their third trimester of pregnancy. All of the participants were not smoking at the time of the study, but had smoked at least eight cigarettes per day for 1 month or more before becoming pregnant. The findings indicate that smoking cessation programs that target women's perceptions about weight gain may be able to improve long-term quitting success, the researchers wrote.

Poll: 70% Unaware of Medicare Cuts

About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. The AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.

Cesarean Rate Jumps 38% in U.S.

The number of babies delivered by cesarean section at U.S. community hospitals increased 38% between 1997 and 2003, according to a report from the Agency for Healthcare Research and Quality. More than one-quarter of the 4 million births that occurred in U.S. hospitals in 2003 were by cesarean section, compared with about one-fifth in 1997. The proportion of cesarean sections that are elective also is increasing, according to the report, which relied on data from the Healthcare Cost and Utilization Project. National charges associated with cesarean births were more than $14.5 billion in 2003, with 53% of the bill going to private payers and 41% being charged to Medicaid. The charges for an uncomplicated cesarean delivery averaged about $11,500, about $5,000 more than a routine vaginal delivery. The report also noted that vaginal birth after cesarean (VBAC) decreased by more than 60% from 1997 to 2003. The rate of VBAC was 35.3 per 100 women who had a previous cesarean in 1997 and dropped to 13.7 per 100 women in 2003. During the same period, the use of episiotomies and forceps during vaginal birth also dropped. The full analysis is available online at

www.hcup-us.ahrq.gov/reports/statbriefs/sb11.pdf

Oral Contraceptives' Clinic Prices Cut

After an initial decision to raise prices of oral contraceptives earlier this summer, Ortho-McNeil has agreed to lower prices for the products for federally funded health clinics across the country. The company raised prices in July for various oral contraceptive products, inciting “widespread panic” among public health clinics, according to Marilyn Keefe, interim CEO of the National Family Planning and Reproductive Health Association. After hearing about the impact the price hike would have on the approximately 4,500 public health clinics nationwide, Ortho-McNeil announced at the end of August that it would drop its prices. “While the company has consistently followed a mandated formula to public health services as a result of participation in the federal government's Medicaid program, the organization has decided to further lower pricing to meet the needs of women and insure access to contraceptive choices and work with underfunded public health services,” Ortho-McNeil said in a statement. The new prices are 92%–94% discounted from the list price of the drugs, Ms. Keefe said.

U.S. Cancer Deaths Continue to Drop

Overall cancer death rates in the United States are continuing a nearly decade-long decline, according to an annual report on cancer trends released by the American Cancer Society, the National Institutes of Health, and other groups. The findings, which were to be published in the Oct. 15 issue of Cancer, included cancer incidence and trend data from 1975 to 2003. The study showed that the overall cancer incidence rates among all races and genders were stable from 1992 to 2003. However, the overall cancer incidence rates for men were stable from 1995 to 2003, while cancer rates in women were on the rise from 1979 through 2003. The report is available online at

www.interscience.wiley.com/cancer/report2006

Scales Influence Smoking Cessation

Pregnant ex-smokers who have confidence in their ability to control their weight are less likely to start smoking again after pregnancy, according to a new study published in the Annals of Behavioral Medicine. Researchers found that weight self-efficacy was significantly associated with postpartum motivation not to smoke even after controlling for other factors such as breastfeeding, partner smoking, years of smoking, race, and prepregnancy nicotine dependence. The study included 119 women in their third trimester of pregnancy. All of the participants were not smoking at the time of the study, but had smoked at least eight cigarettes per day for 1 month or more before becoming pregnant. The findings indicate that smoking cessation programs that target women's perceptions about weight gain may be able to improve long-term quitting success, the researchers wrote.

Poll: 70% Unaware of Medicare Cuts

About 70% of Americans recently polled were unaware of scheduled cuts to physician payments under Medicare, according to the American Medical Association. The group commissioned a poll of U.S. adults in an effort to draw attention to the planned 5.1% Medicare payment cut set to take effect in 2007 and additional payment cuts planned over the next several years. The telephone survey, conducted in July, polled more than 1,000 adults in the United States. When told about the scheduled cuts to physician pay, 86% of those surveyed said they were concerned the cuts could affect seniors' access to health care. The AMA is pushing Congress to take action this year to stop the 2007 cut from going into effect.

Investigating Autism Treatments

Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism—one with regression of normal development around age 3 years and another considered to be nonregressive autism that begins possibly before birth—with other developmental disorders and with child with normal development. Researchers will also investigate possible treatments for autism, including minocycline in regressive autism and the use of chelation therapy, which is a popular treatment choice among families who believe that autism is linked to exposure to vaccines containing thimerosal. The NIH study will evaluate the efficacy and safety of chelation in children who have autism spectrum disorders. “Because chelation therapy is not specific for mercury alone, it is important to conduct a systematic, controlled trial to determine whether or not chelation therapy is beneficial or potentially harmful to children with autism,” Dr. Susan Swedo of the National Institute of Mental Health said in a statement. More information is available at

www.clinicaltrials.gov

DEA Reverses Pain Rx Restrictions

A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physicians' questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.

Views on Medicare Part D

Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the program helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. Physicians also reported that the program increased their day-to-day hassles. About 64% of physicians reported that the Medicare drug program put a lot or some burden on themselves or their staff, compared with 33% who reported not much or no burden associated with the Part D benefit. The survey was conducted between April and July and is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program. “The story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many,” Drew E. Altman, Ph.D., president of the Kaiser Family Foundation, said in a statement.

Pay-Cut Consequences

If Congress does not act to reverse a proposed 5.1% Medicare pay cut, nearly 40% of group practices may limit the number of Medicare patients they see, according to a survey commissioned by the Medical Group Management Association. The survey asked more than 1,600 group practices what they would do if the scheduled 5.1% pay cut went into effect. About 39% of practices said they would limit the number of Medicare patients in their practice, while 19% said they would refuse to accept new Medicare patients. In other money-saving efforts, about two-thirds of respondents said they would modify or eliminate staff health care benefits, 54% would cut administrative and support staff positions, and 80% said they would postpone investment in new technology. “These responses reflect the seriousness of the operating environment confronting physician practices,” Dr. William F. Jessee, MGMA president and CEO, said in a statement. “If medical practices are to continue providing high-quality care, they may have to make some very painful decisions in order to stay financially viable.”

Investigating Autism Treatments

Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism—one with regression of normal development around age 3 years and another considered to be nonregressive autism that begins possibly before birth—with other developmental disorders and with child with normal development. Researchers will also investigate possible treatments for autism, including minocycline in regressive autism and the use of chelation therapy, which is a popular treatment choice among families who believe that autism is linked to exposure to vaccines containing thimerosal. The NIH study will evaluate the efficacy and safety of chelation in children who have autism spectrum disorders. “Because chelation therapy is not specific for mercury alone, it is important to conduct a systematic, controlled trial to determine whether or not chelation therapy is beneficial or potentially harmful to children with autism,” Dr. Susan Swedo of the National Institute of Mental Health said in a statement. More information is available at

www.clinicaltrials.gov

DEA Reverses Pain Rx Restrictions

A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physicians' questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.

Views on Medicare Part D

Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the program helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. Physicians also reported that the program increased their day-to-day hassles. About 64% of physicians reported that the Medicare drug program put a lot or some burden on themselves or their staff, compared with 33% who reported not much or no burden associated with the Part D benefit. The survey was conducted between April and July and is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program. “The story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many,” Drew E. Altman, Ph.D., president of the Kaiser Family Foundation, said in a statement.

Pay-Cut Consequences

If Congress does not act to reverse a proposed 5.1% Medicare pay cut, nearly 40% of group practices may limit the number of Medicare patients they see, according to a survey commissioned by the Medical Group Management Association. The survey asked more than 1,600 group practices what they would do if the scheduled 5.1% pay cut went into effect. About 39% of practices said they would limit the number of Medicare patients in their practice, while 19% said they would refuse to accept new Medicare patients. In other money-saving efforts, about two-thirds of respondents said they would modify or eliminate staff health care benefits, 54% would cut administrative and support staff positions, and 80% said they would postpone investment in new technology. “These responses reflect the seriousness of the operating environment confronting physician practices,” Dr. William F. Jessee, MGMA president and CEO, said in a statement. “If medical practices are to continue providing high-quality care, they may have to make some very painful decisions in order to stay financially viable.”

Investigating Autism Treatments

Officials at the National Institutes of Health are launching three new clinical studies aimed at defining the different subtypes of autism spectrum disorders and potential new treatments. In one study, researchers will compare two subtypes of autism—one with regression of normal development around age 3 years and another considered to be nonregressive autism that begins possibly before birth—with other developmental disorders and with child with normal development. Researchers will also investigate possible treatments for autism, including minocycline in regressive autism and the use of chelation therapy, which is a popular treatment choice among families who believe that autism is linked to exposure to vaccines containing thimerosal. The NIH study will evaluate the efficacy and safety of chelation in children who have autism spectrum disorders. “Because chelation therapy is not specific for mercury alone, it is important to conduct a systematic, controlled trial to determine whether or not chelation therapy is beneficial or potentially harmful to children with autism,” Dr. Susan Swedo of the National Institute of Mental Health said in a statement. More information is available at

www.clinicaltrials.gov

DEA Reverses Pain Rx Restrictions

A new proposal from the U.S. Drug Enforcement Administration would allow physicians to issue up to a 90-day supply of schedule II controlled substances in a single visit. The notice of proposed rule making, which was issued in September, is open for public comment until Nov. 6. If finalized, the proposal would reverse the agency's previous position that physicians must write new prescriptions each month. Instead, physicians would be able to issue three monthly prescriptions at once, specifying the fill date for each prescription. The agency also issued a policy statement aimed at answering physicians' questions about dispensing pain medications. “Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards,” DEA Administrator Karen P. Tandy said in a statement. “Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged for prescribing all appropriate pain medications.” The American Academy of Pain Medicine praised the proposal, noting in a statement that it could help eliminate the burden on cancer patients and others with chronic pain who have been forced to visit their physician every month for a new prescription.

Views on Medicare Part D

Most physicians agree that the Medicare Part D drug benefit is saving money for patients, but they see the law as too complicated, according to a poll commissioned by the Kaiser Family Foundation. Seventy-one percent of physicians surveyed somewhat or strongly agreed that the program helps people on Medicare save money, while 92% somewhat or strongly agreed that it is too complicated. Physicians also reported that the program increased their day-to-day hassles. About 64% of physicians reported that the Medicare drug program put a lot or some burden on themselves or their staff, compared with 33% who reported not much or no burden associated with the Part D benefit. The survey was conducted between April and July and is based on a nationally representative sample of 834 office-based physicians involved in direct adult patient care. A separate survey of pharmacists showed similar views on the program. “The story is remarkably consistent: The benefit is providing help to millions as intended, but there are also problems, and the complexity of the law is an issue for many,” Drew E. Altman, Ph.D., president of the Kaiser Family Foundation, said in a statement.

Pay-Cut Consequences

If Congress does not act to reverse a proposed 5.1% Medicare pay cut, nearly 40% of group practices may limit the number of Medicare patients they see, according to a survey commissioned by the Medical Group Management Association. The survey asked more than 1,600 group practices what they would do if the scheduled 5.1% pay cut went into effect. About 39% of practices said they would limit the number of Medicare patients in their practice, while 19% said they would refuse to accept new Medicare patients. In other money-saving efforts, about two-thirds of respondents said they would modify or eliminate staff health care benefits, 54% would cut administrative and support staff positions, and 80% said they would postpone investment in new technology. “These responses reflect the seriousness of the operating environment confronting physician practices,” Dr. William F. Jessee, MGMA president and CEO, said in a statement. “If medical practices are to continue providing high-quality care, they may have to make some very painful decisions in order to stay financially viable.”