Mary Ellen Schneider

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare. Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the patient assistance program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html.

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare. Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the patient assistance program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html.

The Health and Human Services Office of Inspector General recently gave the green light to a redesigned patient assistance program from the drug maker Schering-Plough Corp.

Late last year, the Inspector General issued a special advisory bulletin cautioning drug makers that continuing their patient assistance programs for people enrolled in the Medicare Part D prescription drug benefit could put them at risk for violating the federal antikickback statute. But the bulletin outlined some designs that would allow Medicare beneficiaries to continue to receive drug assistance from the companies outside of the Part D benefit.

The new advisory opinion (no. 06–03) states that the OIG will not impose administrative sanctions on Schering-Plough based on the specific design of the program's two patient assistance plans, which offer free drugs to financially needy patients taking hepatitis or cancer drugs, and to such patients taking other outpatient prescription drugs. The advisory opinion does not apply to any other arrangements.

Under Schering-Plough's design, Medicare Part D beneficiaries are still eligible for free drugs if they meet the income eligibility requirements for the patient assistance plans and have already spent at least 3% of their household income on outpatient prescription drugs that coverage year. The free drugs do not count toward the beneficiary's true out-of-pocket costs and will not be billed to either the Part D plan or Medicare. Schering-Plough is working with officials at the Centers for Medicare and Medicaid Services on a data-sharing agreement to notify Part D plans about beneficiary participation in the patient assistance program.

“Having reviewed the arrangement, we conclude that the arrangement contains safeguards sufficient to ensure that the [patient assistance plans] operate entirely outside the Part D benefit, and, therefore, there is minimal risk of fraud and abuse under the Part D program,” Lewis Morris, chief counsel to the Inspector General, wrote in the advisory opinion.

The OIG advisory opinion is available online at oig.hhs.gov/fraud/advisoryopinions.html.

PHILADELPHIA — Be careful how you code for consultations, because Medicare contractors will be watching this area carefully, coding experts said at the annual meeting of the American College of Physicians.

In March, the Department of Health and Human Services' Office of the Inspector General (OIG) issued a report highlighting more than $1 billion in estimated overpayments made to physicians in 2001 for consultations under Medicare. In many cases, services were incorrectly billed as consultations, coded for the incorrect type or level of consultation, or were not supported by documentation, according to the OIG report.

“Rest assured there's going to be a focus on consultations,” said Dr. Richard W. Whitten, a Medicare Part B carrier medical director for the states of Alaska, Hawaii, and Washington.

OIG officials selected a random sample of 400 consultations allowed by Medicare during 2001, obtained photocopies of portions of patients' medical records, and hired certified professional coders to audit the claims. The results of that audit were extrapolated to produce the $1.1 billion overpayment estimate. Officials found the most problems with consultations billed at the highest billing level and with follow-up inpatient consultations, according to the OIG report.

Pay attention to the definition of and the elements involved in high-level consultation codes, advised Dr. Glenn D. Littenberg, chair of the ACP subcommittee on coding and reimbursement. He urged physicians to keep in mind that a level 5 consultation code involves an extended history of the present illness, a complete system review, a complete family social history, a comprehensive physical exam, and high-complexity decision making.

Complete documentation is essential and should include the request from the referral source, what services were provided by the physician, and the report back to the referral source, Dr. Littenberg said. “It's highly likely that based on [the OIG] report, carriers will be paying a little more attention to consultation coding at the high level,” he said.

Officials at the Centers for Medicare and Medicaid Services have already made some changes in consultation coding this year. Beginning this year, CMS has eliminated the CPT codes for follow-up inpatient consultations (99261–99263) and confirmatory consultations or second opinions (99271–99275).

Instead, physicians providing consultations in the hospital setting can use initial inpatient consultation codes (99251–99255) for the initial consultation and subsequent hospital care codes (99231–99233) for follow-up visits, according to CMS. In the office setting, physicians can use the office or other outpatient consultation codes (99241–99245) for initial consults and the office or other established patient codes (99212–99215) for follow-up visits.

Further, consultations that are requested by the family or patient instead of a physician cannot be billed using consultation codes, according to CMS, and instead physicians should rely on existing E/M codes for the setting where the service is provided.

The OIG report is available online at www.oig.hhs.gov/oei/reports/oei-09-02-00030.pdf

PHILADELPHIA — Be careful how you code for consultations, because Medicare contractors will be watching this area carefully, coding experts said at the annual meeting of the American College of Physicians.

In March, the Department of Health and Human Services' Office of the Inspector General (OIG) issued a report highlighting more than $1 billion in estimated overpayments made to physicians in 2001 for consultations under Medicare. In many cases, services were incorrectly billed as consultations, coded for the incorrect type or level of consultation, or were not supported by documentation, according to the OIG report.

“Rest assured there's going to be a focus on consultations,” said Dr. Richard W. Whitten, a Medicare Part B carrier medical director for the states of Alaska, Hawaii, and Washington.

OIG officials selected a random sample of 400 consultations allowed by Medicare during 2001, obtained photocopies of portions of patients' medical records, and hired certified professional coders to audit the claims. The results of that audit were extrapolated to produce the $1.1 billion overpayment estimate. Officials found the most problems with consultations billed at the highest billing level and with follow-up inpatient consultations, according to the OIG report.

Pay attention to the definition of and the elements involved in high-level consultation codes, advised Dr. Glenn D. Littenberg, chair of the ACP subcommittee on coding and reimbursement. He urged physicians to keep in mind that a level 5 consultation code involves an extended history of the present illness, a complete system review, a complete family social history, a comprehensive physical exam, and high-complexity decision making.

Complete documentation is essential and should include the request from the referral source, what services were provided by the physician, and the report back to the referral source, Dr. Littenberg said. “It's highly likely that based on [the OIG] report, carriers will be paying a little more attention to consultation coding at the high level,” he said.

Officials at the Centers for Medicare and Medicaid Services have already made some changes in consultation coding this year. Beginning this year, CMS has eliminated the CPT codes for follow-up inpatient consultations (99261–99263) and confirmatory consultations or second opinions (99271–99275).

Instead, physicians providing consultations in the hospital setting can use initial inpatient consultation codes (99251–99255) for the initial consultation and subsequent hospital care codes (99231–99233) for follow-up visits, according to CMS. In the office setting, physicians can use the office or other outpatient consultation codes (99241–99245) for initial consults and the office or other established patient codes (99212–99215) for follow-up visits.

Further, consultations that are requested by the family or patient instead of a physician cannot be billed using consultation codes, according to CMS, and instead physicians should rely on existing E/M codes for the setting where the service is provided.

The OIG report is available online at www.oig.hhs.gov/oei/reports/oei-09-02-00030.pdf

PHILADELPHIA — Be careful how you code for consultations, because Medicare contractors will be watching this area carefully, coding experts said at the annual meeting of the American College of Physicians.

In March, the Department of Health and Human Services' Office of the Inspector General (OIG) issued a report highlighting more than $1 billion in estimated overpayments made to physicians in 2001 for consultations under Medicare. In many cases, services were incorrectly billed as consultations, coded for the incorrect type or level of consultation, or were not supported by documentation, according to the OIG report.

“Rest assured there's going to be a focus on consultations,” said Dr. Richard W. Whitten, a Medicare Part B carrier medical director for the states of Alaska, Hawaii, and Washington.

OIG officials selected a random sample of 400 consultations allowed by Medicare during 2001, obtained photocopies of portions of patients' medical records, and hired certified professional coders to audit the claims. The results of that audit were extrapolated to produce the $1.1 billion overpayment estimate. Officials found the most problems with consultations billed at the highest billing level and with follow-up inpatient consultations, according to the OIG report.

Pay attention to the definition of and the elements involved in high-level consultation codes, advised Dr. Glenn D. Littenberg, chair of the ACP subcommittee on coding and reimbursement. He urged physicians to keep in mind that a level 5 consultation code involves an extended history of the present illness, a complete system review, a complete family social history, a comprehensive physical exam, and high-complexity decision making.

Complete documentation is essential and should include the request from the referral source, what services were provided by the physician, and the report back to the referral source, Dr. Littenberg said. “It's highly likely that based on [the OIG] report, carriers will be paying a little more attention to consultation coding at the high level,” he said.

Officials at the Centers for Medicare and Medicaid Services have already made some changes in consultation coding this year. Beginning this year, CMS has eliminated the CPT codes for follow-up inpatient consultations (99261–99263) and confirmatory consultations or second opinions (99271–99275).

Instead, physicians providing consultations in the hospital setting can use initial inpatient consultation codes (99251–99255) for the initial consultation and subsequent hospital care codes (99231–99233) for follow-up visits, according to CMS. In the office setting, physicians can use the office or other outpatient consultation codes (99241–99245) for initial consults and the office or other established patient codes (99212–99215) for follow-up visits.

Further, consultations that are requested by the family or patient instead of a physician cannot be billed using consultation codes, according to CMS, and instead physicians should rely on existing E/M codes for the setting where the service is provided.

The OIG report is available online at www.oig.hhs.gov/oei/reports/oei-09-02-00030.pdf

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free. For example, he tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, and prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks, he said.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office. Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, it quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free. For example, he tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, and prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks, he said.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office. Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, it quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

PHILADELPHIA — A costly electronic health record system is not necessary to engage in quality improvement and participate in the growing number of pay-for-performance programs, Dr. Rodney Hornbake said at the annual meeting of the American College of Physicians.

Patient registry software is a lower-cost alternative that allows physicians to track their care of patients with chronic diseases.

“It's really an excellent starting place for quality improvement in the ambulatory setting,” said Dr. Hornbake, an internist in private practice in Essex, Conn.

Patient registries are one of the best tools for physicians participating in pay-for-performance programs, Dr. Hornbake said. Many electronic health records (EHRs) may not have population-based functionality, and therefore cannot generate simple reports on the physician's performance on certain measures. Most EHR vendors can build interfaces with patient registry software, but that's generally an added cost.

There are a number of patient registry programs available; a comprehensive program can be purchased for less than $1,000 per provider, Dr. Hornbake said. Some are available for free. For example, he tested the Comorbid Disease Management Database (COMMAND) software in his practice. This registry system is available for free from the Mississippi Quality Improvement Organization. And technology-savvy physicians can use programs like Microsoft Access to design their own registries, he said.

Dr. Hornbake tried out COMMAND in his practice to help keep up with the pay-for-performance programs in his local market. One insurer—Anthem Health Plans Inc. of Connecticut—has a program that offers incentives for process and outcomes measures, as well as for the use of health-related information technology, including electronic prescribing, EHRs, and patient registries. The insurer also offers incentives to physicians for generic prescribing, he said.

Dr. Hornbake said that he exported demographic information from his billing system into COMMAND and manually entered the clinical information from patient charts himself. After using the billing system to identify all of the patients who had conditions included in his registry, he had his staff put red stickers on those patient charts.

This flagged the patients for special attention from the staff, he said. For example, patients whose charts had stickers received follow-up calls if they missed an appointment. To keep the registry up to date, every 2 months the staff pulls the charts of all registry patients and Dr. Hornbake updates the system manually. He spends about 1.5 hours entering data on 125 patients, and prefers to enter the information in periodic batches because it helps him to identify any chronic disease patients who have slipped through the cracks, he said.

Even factoring in his time, Dr. Hornbake said that he saw an immediate return on investment with the patient registry system. Unlike an EHR system, he added, patient registry software tends to fit in easily with the normal workflow of the office. Physicians can also manage their patient care using a paper-based patient registry, he said, but once they begin to track 20 or more measures, it quickly becomes unworkable.

So far, Dr. Hornbake said that he has resisted purchasing an EHR system because he still can't make a financial case for the investment.

He advised physicians to buy or upgrade an EHR system based on its ability to support pay for performance and manage a population of specific patients. Many of the other selling points for an EHR system—that it will eliminate transcription, cut down on needed staff positions, and improve coding—don't hold true for all physicians, he said.

Preconception Counseling Advocated

Primary care physicians should offer risk assessment and counseling to all women of childbearing age to improve pregnancy outcomes, according to new recommendations from the Centers for Disease Control and Prevention. The 10 recommendations for improvement of preconception health care were published in the April 21 issue of the Morbidity and Mortality Weekly Report Recommendations and Reports. This type of routine preconception counseling should include discussion of child spacing, family planning, and prevention of unintended pregnancy. In addition, physicians should advise women about healthy diet, folic acid supplementation, immunization, and healthy weight. But not all of the burden for improving preconception care is placed on physicians and other health care providers. The CDC recommendations also call on insurers to change their payment policies to reimburse for one prepregnancy visit per pregnancy.

EC Prescribing Authority Bill Killed

A bill in Colorado that would have given limited power to licensed pharmacists to prescribe emergency contraception was recently vetoed by the state's governor. The legislation (H.B. 1212) would have extended prescribing authority to pharmacies only for emergency contraception and only until emergency contraception is available to the public without a prescription. The prescribing authority would not have included the abortifacient mifepristone. The bill would have authorized pharmacists to prescribe emergency contraception, but would not have required it. Colorado Gov. Bill Owens vetoed the bill last month, saying that the legislation “strays radically from the accepted norms of medicine.” He also objected to the fact that the bill would have allowed minors to obtain emergency contraception without the involvement of a physician or a parent.

Abortion-Rights Issues Still Simmer

Some members of Congress are responding to state efforts to restrict abortion with a federal proposal to codify a woman's ability to seek an abortion. Rep. Jerrold Nadler (D-N.Y.) and Sen. Barbara Boxer (D-Calif.) recently introduced legislation (H.R. 5151/S. 2593) that would prohibit any government from interfering with a woman's ability to terminate a pregnancy before fetal viability or after viability in cases where it is necessary to protect the life or health of the woman. In the meantime, a survey released by a coalition of antiabortion groups found that 54% of those surveyed agreed with one of three traditionally antiabortion statements—that abortion should be prohibited in all circumstances, abortion should be legal only to save the life of the mother, or abortion should be legal only in cases of rape or incest or to save the mother's life. About 41% agreed with various statements saying that abortion should be legal for any reason, and 6% didn't know or refused to answer. The national telephone survey of 1,000 adults was conducted in mid-April.

Minorities Missing Mammograms?

African American women and other minority groups are less likely to be adequately screened for breast cancer, according to a study published in the Annals of Internal Medicine (2006;144:541–53). Researchers analyzed data from the Breast Cancer Surveillance Consortium and found that African American and Hispanic women were more likely to be diagnosed with advanced-stage tumors than were white women and that African American, Hispanic, and Native American women were more likely to be diagnosed with high-grade tumors than white women were. However, when they compared women who received mammography screening at the same intervals, African American and white women had similar rates of large, advanced-stage, and lymph node-positive tumors. And Native American and Hispanic women had lower overall breast cancer rates when compared with white women undergoing mammography at the same intervals. “Increased adherence to recommended mammography screening intervals, particularly among never-screened or infrequently screened women, may enable discovery of tumors before they have progressed to an advanced stage and may result in decreased mortality rates,” the study authors wrote.

Dry Eyes Linked to Menopause

More than half of menopausal and perimenopausal women report experiencing dry eye symptoms, but very few of them understand that those symptoms are linked to menopause, according to a survey sponsored by the Society for Women's Health Research. In a telephone survey of more than 300 women aged 45–57, about 62% reported experiencing dry eye symptoms, but only 16% knew the condition was associated with menopause. In addition, less than 59% of women experiencing dry eyes had discussed it with their physician.

Preconception Counseling Advocated

Primary care physicians should offer risk assessment and counseling to all women of childbearing age to improve pregnancy outcomes, according to new recommendations from the Centers for Disease Control and Prevention. The 10 recommendations for improvement of preconception health care were published in the April 21 issue of the Morbidity and Mortality Weekly Report Recommendations and Reports. This type of routine preconception counseling should include discussion of child spacing, family planning, and prevention of unintended pregnancy. In addition, physicians should advise women about healthy diet, folic acid supplementation, immunization, and healthy weight. But not all of the burden for improving preconception care is placed on physicians and other health care providers. The CDC recommendations also call on insurers to change their payment policies to reimburse for one prepregnancy visit per pregnancy.

EC Prescribing Authority Bill Killed

A bill in Colorado that would have given limited power to licensed pharmacists to prescribe emergency contraception was recently vetoed by the state's governor. The legislation (H.B. 1212) would have extended prescribing authority to pharmacies only for emergency contraception and only until emergency contraception is available to the public without a prescription. The prescribing authority would not have included the abortifacient mifepristone. The bill would have authorized pharmacists to prescribe emergency contraception, but would not have required it. Colorado Gov. Bill Owens vetoed the bill last month, saying that the legislation “strays radically from the accepted norms of medicine.” He also objected to the fact that the bill would have allowed minors to obtain emergency contraception without the involvement of a physician or a parent.

Abortion-Rights Issues Still Simmer

Some members of Congress are responding to state efforts to restrict abortion with a federal proposal to codify a woman's ability to seek an abortion. Rep. Jerrold Nadler (D-N.Y.) and Sen. Barbara Boxer (D-Calif.) recently introduced legislation (H.R. 5151/S. 2593) that would prohibit any government from interfering with a woman's ability to terminate a pregnancy before fetal viability or after viability in cases where it is necessary to protect the life or health of the woman. In the meantime, a survey released by a coalition of antiabortion groups found that 54% of those surveyed agreed with one of three traditionally antiabortion statements—that abortion should be prohibited in all circumstances, abortion should be legal only to save the life of the mother, or abortion should be legal only in cases of rape or incest or to save the mother's life. About 41% agreed with various statements saying that abortion should be legal for any reason, and 6% didn't know or refused to answer. The national telephone survey of 1,000 adults was conducted in mid-April.

Minorities Missing Mammograms?

African American women and other minority groups are less likely to be adequately screened for breast cancer, according to a study published in the Annals of Internal Medicine (2006;144:541–53). Researchers analyzed data from the Breast Cancer Surveillance Consortium and found that African American and Hispanic women were more likely to be diagnosed with advanced-stage tumors than were white women and that African American, Hispanic, and Native American women were more likely to be diagnosed with high-grade tumors than white women were. However, when they compared women who received mammography screening at the same intervals, African American and white women had similar rates of large, advanced-stage, and lymph node-positive tumors. And Native American and Hispanic women had lower overall breast cancer rates when compared with white women undergoing mammography at the same intervals. “Increased adherence to recommended mammography screening intervals, particularly among never-screened or infrequently screened women, may enable discovery of tumors before they have progressed to an advanced stage and may result in decreased mortality rates,” the study authors wrote.

Dry Eyes Linked to Menopause

More than half of menopausal and perimenopausal women report experiencing dry eye symptoms, but very few of them understand that those symptoms are linked to menopause, according to a survey sponsored by the Society for Women's Health Research. In a telephone survey of more than 300 women aged 45–57, about 62% reported experiencing dry eye symptoms, but only 16% knew the condition was associated with menopause. In addition, less than 59% of women experiencing dry eyes had discussed it with their physician.

Preconception Counseling Advocated

Primary care physicians should offer risk assessment and counseling to all women of childbearing age to improve pregnancy outcomes, according to new recommendations from the Centers for Disease Control and Prevention. The 10 recommendations for improvement of preconception health care were published in the April 21 issue of the Morbidity and Mortality Weekly Report Recommendations and Reports. This type of routine preconception counseling should include discussion of child spacing, family planning, and prevention of unintended pregnancy. In addition, physicians should advise women about healthy diet, folic acid supplementation, immunization, and healthy weight. But not all of the burden for improving preconception care is placed on physicians and other health care providers. The CDC recommendations also call on insurers to change their payment policies to reimburse for one prepregnancy visit per pregnancy.

EC Prescribing Authority Bill Killed

A bill in Colorado that would have given limited power to licensed pharmacists to prescribe emergency contraception was recently vetoed by the state's governor. The legislation (H.B. 1212) would have extended prescribing authority to pharmacies only for emergency contraception and only until emergency contraception is available to the public without a prescription. The prescribing authority would not have included the abortifacient mifepristone. The bill would have authorized pharmacists to prescribe emergency contraception, but would not have required it. Colorado Gov. Bill Owens vetoed the bill last month, saying that the legislation “strays radically from the accepted norms of medicine.” He also objected to the fact that the bill would have allowed minors to obtain emergency contraception without the involvement of a physician or a parent.

Abortion-Rights Issues Still Simmer

Some members of Congress are responding to state efforts to restrict abortion with a federal proposal to codify a woman's ability to seek an abortion. Rep. Jerrold Nadler (D-N.Y.) and Sen. Barbara Boxer (D-Calif.) recently introduced legislation (H.R. 5151/S. 2593) that would prohibit any government from interfering with a woman's ability to terminate a pregnancy before fetal viability or after viability in cases where it is necessary to protect the life or health of the woman. In the meantime, a survey released by a coalition of antiabortion groups found that 54% of those surveyed agreed with one of three traditionally antiabortion statements—that abortion should be prohibited in all circumstances, abortion should be legal only to save the life of the mother, or abortion should be legal only in cases of rape or incest or to save the mother's life. About 41% agreed with various statements saying that abortion should be legal for any reason, and 6% didn't know or refused to answer. The national telephone survey of 1,000 adults was conducted in mid-April.

Minorities Missing Mammograms?

African American women and other minority groups are less likely to be adequately screened for breast cancer, according to a study published in the Annals of Internal Medicine (2006;144:541–53). Researchers analyzed data from the Breast Cancer Surveillance Consortium and found that African American and Hispanic women were more likely to be diagnosed with advanced-stage tumors than were white women and that African American, Hispanic, and Native American women were more likely to be diagnosed with high-grade tumors than white women were. However, when they compared women who received mammography screening at the same intervals, African American and white women had similar rates of large, advanced-stage, and lymph node-positive tumors. And Native American and Hispanic women had lower overall breast cancer rates when compared with white women undergoing mammography at the same intervals. “Increased adherence to recommended mammography screening intervals, particularly among never-screened or infrequently screened women, may enable discovery of tumors before they have progressed to an advanced stage and may result in decreased mortality rates,” the study authors wrote.

Dry Eyes Linked to Menopause

More than half of menopausal and perimenopausal women report experiencing dry eye symptoms, but very few of them understand that those symptoms are linked to menopause, according to a survey sponsored by the Society for Women's Health Research. In a telephone survey of more than 300 women aged 45–57, about 62% reported experiencing dry eye symptoms, but only 16% knew the condition was associated with menopause. In addition, less than 59% of women experiencing dry eyes had discussed it with their physician.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking of long-term care, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities.

The six houses are located in a quiet, residential neighborhood. Each includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management to track everyone's movements at the facility. The pendant uses infrared and radio frequency signals.

The data generated by the tracking technology allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example.

The pendants are well accepted by staff at the facility and can be very helpful when discussing care plans with members of the residents' families, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to the frequencies used in wireless house phones and television remote controls.

The facility also uses technology to alert staff to potential falls by residents.

For example, load cells—which measure the variation in weight that is placed on an object—are built into most of the beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling.

That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close. If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools that would assist caregivers.

One project that was conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a system that included a desktop computer, a camera mounted over the sink, and audio prompts.

The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking of long-term care, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities.

The six houses are located in a quiet, residential neighborhood. Each includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management to track everyone's movements at the facility. The pendant uses infrared and radio frequency signals.

The data generated by the tracking technology allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example.

The pendants are well accepted by staff at the facility and can be very helpful when discussing care plans with members of the residents' families, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to the frequencies used in wireless house phones and television remote controls.

The facility also uses technology to alert staff to potential falls by residents.

For example, load cells—which measure the variation in weight that is placed on an object—are built into most of the beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling.

That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close. If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools that would assist caregivers.

One project that was conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a system that included a desktop computer, a camera mounted over the sink, and audio prompts.

The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking of long-term care, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities.

The six houses are located in a quiet, residential neighborhood. Each includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management to track everyone's movements at the facility. The pendant uses infrared and radio frequency signals.

The data generated by the tracking technology allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example.

The pendants are well accepted by staff at the facility and can be very helpful when discussing care plans with members of the residents' families, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to the frequencies used in wireless house phones and television remote controls.

The facility also uses technology to alert staff to potential falls by residents.

For example, load cells—which measure the variation in weight that is placed on an object—are built into most of the beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling.

That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close. If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools that would assist caregivers.

One project that was conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a system that included a desktop computer, a camera mounted over the sink, and audio prompts.

The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

NEW YORK — When evaluating a breast mass in an adolescent, keep in mind that breast cancer is rare in this population and imaging should be limited, Dr. Patricia Simmons advised physicians at a gynecology conference sponsored by Mount Sinai School of Medicine.

Studies looking at the histopathology of young patients who have had surgery for a breast mass show that the most consistent finding is of fibroadenoma, though some showed fibrocystic changes, abscess, and infection, and in very rare cases, malignant diseases, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic in Rochester, Minn.

In the rare case of a malignant mass, it is likely to be the type of tumor found more commonly in young patients, such as primary or metastatic rhabdomyosarcoma, metastatic neuroblastoma, or lymphoma, she said.

In those cases, patients did not discover the masses through self-breast exam but generally presented with constitutional symptoms such as fever, night sweats, and weight loss.

The clinical experience in breast masses in adolescents is largely anecdotal and the surgical experience is limited, Dr. Simmons said. But for the most part, breast masses in adolescent women are benign, cancer is rare, and when cancer occurs, it is generally not carcinoma, she said.

When looking at a breast mass in adolescents, physicians should consider the duration, the constitutional symptoms, and the risk factors for malignancy. Keep in mind that in young women, the risk factors are different, because the patient hasn't lived long enough to develop most of the factors considered in adults, Dr. Simmons said. The risk factors in adolescents are generally cancer history and whether the patient has had chest radiation.

During the physical exam, physicians should assess the mass size and character, breast skin changes, nodes, and organomegaly.

In cases in which the diagnosis is uncertain, imaging will be necessary. However, while a mammogram is the go-to test in adults, this type of imaging is ineffective in adolescents because the young breast is denser and firmer, Dr. Simmons said. An ultrasound will be much more sensitive, she said.

Surgery may be indicated in cases such as a recurring cyst that is symptomatic; a growing, disfiguring mass; suspected cystosarcoma phyllodes; suspected papilloma; suspected papillomatosis; or an abscess.

When considering surgery for a fibroadenoma, physicians should assess the course, the certainty of the diagnosis, any worrisome features, size and distortion, and tolerance, Dr. Simmons said. In a case in which the mass is distorting the breast, surgery is probably the right choice, because it is interfering with normal life, she said. However, she cautioned physicians not to opt for surgery just because the mass is worrisome to the mother.

“I think we need to arm our patients with the facts, and we should be able to alleviate anxiety if that anxiety is misplaced and not take [the fibroadenoma] out just because it's there,” she said.

In many cases, it is fine to watch a fibroadenoma in an adolescent patient since most will be benign and not progressive, Dr. Simmons said. “We should be conservative with this population to preserve breast architecture and breast-feeding to the extent we can,” she said.

NEW YORK — When evaluating a breast mass in an adolescent, keep in mind that breast cancer is rare in this population and imaging should be limited, Dr. Patricia Simmons advised physicians at a gynecology conference sponsored by Mount Sinai School of Medicine.

Studies looking at the histopathology of young patients who have had surgery for a breast mass show that the most consistent finding is of fibroadenoma, though some showed fibrocystic changes, abscess, and infection, and in very rare cases, malignant diseases, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic in Rochester, Minn.

In the rare case of a malignant mass, it is likely to be the type of tumor found more commonly in young patients, such as primary or metastatic rhabdomyosarcoma, metastatic neuroblastoma, or lymphoma, she said.

In those cases, patients did not discover the masses through self-breast exam but generally presented with constitutional symptoms such as fever, night sweats, and weight loss.

The clinical experience in breast masses in adolescents is largely anecdotal and the surgical experience is limited, Dr. Simmons said. But for the most part, breast masses in adolescent women are benign, cancer is rare, and when cancer occurs, it is generally not carcinoma, she said.

When looking at a breast mass in adolescents, physicians should consider the duration, the constitutional symptoms, and the risk factors for malignancy. Keep in mind that in young women, the risk factors are different, because the patient hasn't lived long enough to develop most of the factors considered in adults, Dr. Simmons said. The risk factors in adolescents are generally cancer history and whether the patient has had chest radiation.

During the physical exam, physicians should assess the mass size and character, breast skin changes, nodes, and organomegaly.

In cases in which the diagnosis is uncertain, imaging will be necessary. However, while a mammogram is the go-to test in adults, this type of imaging is ineffective in adolescents because the young breast is denser and firmer, Dr. Simmons said. An ultrasound will be much more sensitive, she said.

Surgery may be indicated in cases such as a recurring cyst that is symptomatic; a growing, disfiguring mass; suspected cystosarcoma phyllodes; suspected papilloma; suspected papillomatosis; or an abscess.

When considering surgery for a fibroadenoma, physicians should assess the course, the certainty of the diagnosis, any worrisome features, size and distortion, and tolerance, Dr. Simmons said. In a case in which the mass is distorting the breast, surgery is probably the right choice, because it is interfering with normal life, she said. However, she cautioned physicians not to opt for surgery just because the mass is worrisome to the mother.

“I think we need to arm our patients with the facts, and we should be able to alleviate anxiety if that anxiety is misplaced and not take [the fibroadenoma] out just because it's there,” she said.

In many cases, it is fine to watch a fibroadenoma in an adolescent patient since most will be benign and not progressive, Dr. Simmons said. “We should be conservative with this population to preserve breast architecture and breast-feeding to the extent we can,” she said.

NEW YORK — When evaluating a breast mass in an adolescent, keep in mind that breast cancer is rare in this population and imaging should be limited, Dr. Patricia Simmons advised physicians at a gynecology conference sponsored by Mount Sinai School of Medicine.

Studies looking at the histopathology of young patients who have had surgery for a breast mass show that the most consistent finding is of fibroadenoma, though some showed fibrocystic changes, abscess, and infection, and in very rare cases, malignant diseases, said Dr. Simmons, a professor of pediatrics at the Mayo Clinic in Rochester, Minn.

In the rare case of a malignant mass, it is likely to be the type of tumor found more commonly in young patients, such as primary or metastatic rhabdomyosarcoma, metastatic neuroblastoma, or lymphoma, she said.

In those cases, patients did not discover the masses through self-breast exam but generally presented with constitutional symptoms such as fever, night sweats, and weight loss.

The clinical experience in breast masses in adolescents is largely anecdotal and the surgical experience is limited, Dr. Simmons said. But for the most part, breast masses in adolescent women are benign, cancer is rare, and when cancer occurs, it is generally not carcinoma, she said.

When looking at a breast mass in adolescents, physicians should consider the duration, the constitutional symptoms, and the risk factors for malignancy. Keep in mind that in young women, the risk factors are different, because the patient hasn't lived long enough to develop most of the factors considered in adults, Dr. Simmons said. The risk factors in adolescents are generally cancer history and whether the patient has had chest radiation.

During the physical exam, physicians should assess the mass size and character, breast skin changes, nodes, and organomegaly.

In cases in which the diagnosis is uncertain, imaging will be necessary. However, while a mammogram is the go-to test in adults, this type of imaging is ineffective in adolescents because the young breast is denser and firmer, Dr. Simmons said. An ultrasound will be much more sensitive, she said.

Surgery may be indicated in cases such as a recurring cyst that is symptomatic; a growing, disfiguring mass; suspected cystosarcoma phyllodes; suspected papilloma; suspected papillomatosis; or an abscess.

When considering surgery for a fibroadenoma, physicians should assess the course, the certainty of the diagnosis, any worrisome features, size and distortion, and tolerance, Dr. Simmons said. In a case in which the mass is distorting the breast, surgery is probably the right choice, because it is interfering with normal life, she said. However, she cautioned physicians not to opt for surgery just because the mass is worrisome to the mother.

“I think we need to arm our patients with the facts, and we should be able to alleviate anxiety if that anxiety is misplaced and not take [the fibroadenoma] out just because it's there,” she said.

In many cases, it is fine to watch a fibroadenoma in an adolescent patient since most will be benign and not progressive, Dr. Simmons said. “We should be conservative with this population to preserve breast architecture and breast-feeding to the extent we can,” she said.

NEW YORK — Screening for the human papillomavirus in adolescent females is not cost effective because of the high rate of infection in that population, Dr. Edyta C. Pirog said at a gynecology conference sponsored by Mount Sinai School of Medicine.

The majority of low-grade squamous intraepithelial lesions will regress spontaneously in adolescent females, so most treatment guidelines allow for the observation of these lesions through repeated cytology, said Dr. Pirog of Weill Cornell Medical College, New York. However, immunosuppressed adolescents, who have a high rate of progression to high-grade squamous intraepithelial lesions, require careful follow-up by physicians, Dr. Pirog said.

The American College of Obstetricians and Gynecologists recently released a new committee opinion advising physicians to take a less aggressive approach to treating abnormal pap test results and benign lesions in adolescents, compared with the approach used in adults (Obstet. Gynecol. 2006;107:963–8). ACOG recommends a noninvasive approach because of the risk of cervical incompetence after surgical excision. Adolescents who follow their physicians' instructions can be treated effectively by follow-up cytology screening at either two 6-month visits or one 12-month follow-up in most cases, according to ACOG.

There is a high prevalence of HPV in women aged 15–35 years, even among those with normal pap smears. About 20%–40% of women aged 15–35 with normal pap smears have HPV, Dr. Pirog reported.

Most infections are transient and asymptomatic. About half of women of all ages will clear an HPV infection within 8 months, and 90% of women clear the infection within 2 years, she said. In one study of adolescents aged 14–17 years, the cumulative incidence of HPV infection was more than 80% but the infections cleared within a matter of months (J. Infect. Dis. 2005;191:182–92).

Adolescents also have a different progression of squamous intraepithelial lesions, compared with adults. More than half of low-grade squamous intraepithelial lesions in adolescents have regressed at 12 months; 91% regress by 36 months (Lancet 2004;364:1678–83). This study found that only 3% of low-grade lesions have progressed to high-grade lesions at 36 months in adolescents, compared with about 10% in other age groups.

Researchers have shown, however, that the risk of progression is greater in HIV-positive adolescents. A study of females aged 13–18 years found that the incidence of high-grade squamous intraepithelial lesions at the end of the 4-year follow-up was 21.5% in HIV-positive girls, compared with 4.8% in HIV-negative girls (J. Infect. Dis. 2004;190:1413–21).

A multivariate analysis also showed that the use of hormonal contraceptives, a high cervical mucus concentration of interleukin-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesions were significantly associated with the development of high-grade lesions.

NEW YORK — Screening for the human papillomavirus in adolescent females is not cost effective because of the high rate of infection in that population, Dr. Edyta C. Pirog said at a gynecology conference sponsored by Mount Sinai School of Medicine.

The majority of low-grade squamous intraepithelial lesions will regress spontaneously in adolescent females, so most treatment guidelines allow for the observation of these lesions through repeated cytology, said Dr. Pirog of Weill Cornell Medical College, New York. However, immunosuppressed adolescents, who have a high rate of progression to high-grade squamous intraepithelial lesions, require careful follow-up by physicians, Dr. Pirog said.

The American College of Obstetricians and Gynecologists recently released a new committee opinion advising physicians to take a less aggressive approach to treating abnormal pap test results and benign lesions in adolescents, compared with the approach used in adults (Obstet. Gynecol. 2006;107:963–8). ACOG recommends a noninvasive approach because of the risk of cervical incompetence after surgical excision. Adolescents who follow their physicians' instructions can be treated effectively by follow-up cytology screening at either two 6-month visits or one 12-month follow-up in most cases, according to ACOG.

There is a high prevalence of HPV in women aged 15–35 years, even among those with normal pap smears. About 20%–40% of women aged 15–35 with normal pap smears have HPV, Dr. Pirog reported.

Most infections are transient and asymptomatic. About half of women of all ages will clear an HPV infection within 8 months, and 90% of women clear the infection within 2 years, she said. In one study of adolescents aged 14–17 years, the cumulative incidence of HPV infection was more than 80% but the infections cleared within a matter of months (J. Infect. Dis. 2005;191:182–92).

Adolescents also have a different progression of squamous intraepithelial lesions, compared with adults. More than half of low-grade squamous intraepithelial lesions in adolescents have regressed at 12 months; 91% regress by 36 months (Lancet 2004;364:1678–83). This study found that only 3% of low-grade lesions have progressed to high-grade lesions at 36 months in adolescents, compared with about 10% in other age groups.

Researchers have shown, however, that the risk of progression is greater in HIV-positive adolescents. A study of females aged 13–18 years found that the incidence of high-grade squamous intraepithelial lesions at the end of the 4-year follow-up was 21.5% in HIV-positive girls, compared with 4.8% in HIV-negative girls (J. Infect. Dis. 2004;190:1413–21).

A multivariate analysis also showed that the use of hormonal contraceptives, a high cervical mucus concentration of interleukin-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesions were significantly associated with the development of high-grade lesions.

NEW YORK — Screening for the human papillomavirus in adolescent females is not cost effective because of the high rate of infection in that population, Dr. Edyta C. Pirog said at a gynecology conference sponsored by Mount Sinai School of Medicine.

The majority of low-grade squamous intraepithelial lesions will regress spontaneously in adolescent females, so most treatment guidelines allow for the observation of these lesions through repeated cytology, said Dr. Pirog of Weill Cornell Medical College, New York. However, immunosuppressed adolescents, who have a high rate of progression to high-grade squamous intraepithelial lesions, require careful follow-up by physicians, Dr. Pirog said.

The American College of Obstetricians and Gynecologists recently released a new committee opinion advising physicians to take a less aggressive approach to treating abnormal pap test results and benign lesions in adolescents, compared with the approach used in adults (Obstet. Gynecol. 2006;107:963–8). ACOG recommends a noninvasive approach because of the risk of cervical incompetence after surgical excision. Adolescents who follow their physicians' instructions can be treated effectively by follow-up cytology screening at either two 6-month visits or one 12-month follow-up in most cases, according to ACOG.

There is a high prevalence of HPV in women aged 15–35 years, even among those with normal pap smears. About 20%–40% of women aged 15–35 with normal pap smears have HPV, Dr. Pirog reported.

Most infections are transient and asymptomatic. About half of women of all ages will clear an HPV infection within 8 months, and 90% of women clear the infection within 2 years, she said. In one study of adolescents aged 14–17 years, the cumulative incidence of HPV infection was more than 80% but the infections cleared within a matter of months (J. Infect. Dis. 2005;191:182–92).

Adolescents also have a different progression of squamous intraepithelial lesions, compared with adults. More than half of low-grade squamous intraepithelial lesions in adolescents have regressed at 12 months; 91% regress by 36 months (Lancet 2004;364:1678–83). This study found that only 3% of low-grade lesions have progressed to high-grade lesions at 36 months in adolescents, compared with about 10% in other age groups.

Researchers have shown, however, that the risk of progression is greater in HIV-positive adolescents. A study of females aged 13–18 years found that the incidence of high-grade squamous intraepithelial lesions at the end of the 4-year follow-up was 21.5% in HIV-positive girls, compared with 4.8% in HIV-negative girls (J. Infect. Dis. 2004;190:1413–21).

A multivariate analysis also showed that the use of hormonal contraceptives, a high cervical mucus concentration of interleukin-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesions were significantly associated with the development of high-grade lesions.

NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biologic, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.

Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.

Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.

Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.

Psychological and cognitive factors also make both female and male adolescents more vulnerable. For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.

Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use. And they may use sexual activity as a form of rebellion against their parents.

Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.

On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs. Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.

The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.

Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.

Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.

Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.

“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.

Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.

Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.

Cost can be a barrier for adolescents. Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.

NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biologic, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.

Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.

Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.

Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.

Psychological and cognitive factors also make both female and male adolescents more vulnerable. For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.

Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use. And they may use sexual activity as a form of rebellion against their parents.

Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.

On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs. Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.

The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.

Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.

Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.

Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.

“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.

Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.

Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.

Cost can be a barrier for adolescents. Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.

NEW YORK — Adolescents are disproportionately affected by sexually transmitted diseases due to biologic, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.

Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.

Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.

Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.

Psychological and cognitive factors also make both female and male adolescents more vulnerable. For instance, these young adults may not appreciate the consequences of their actions. “Their lack of foresight is often compounded by the use of drugs and alcohol,” Dr. Recant said.

Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use. And they may use sexual activity as a form of rebellion against their parents.

Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.

On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs. Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, Dr. Recant said.

The 2003 results of the Youth Risk Behavior Survey show that 53% of male high school students in New York City had had sexual intercourse and that 39% of female high school students had. In addition, the survey finds that 8% of female high school students and 25% of male high school students in New York City have had four or more sexual partners in their lifetime.

Trends over the past 10 years show an overall increase in the use of condoms by adolescents, Dr. Recant said, but that use decreases with the duration of the relationship and with age.

Similar trends appear in data from the 2003 Youth Risk Behavior Survey. The survey shows that among females, condom use dropped from 78% among 9th graders to 64% among girls in the 12th grade. Condom use was higher in males but dropped from a high of 90% in 10th graders to 82% in 12th graders.

Adolescents may face greater risk from inadequate access to health care, and generally obtain health care services less often than older or younger individuals, Dr. Recant said. Also, some may not recognize the symptoms of a sexually transmitted disease or may be too embarrassed to seek care.

“Adolescents may not even be able to distinguish whether aspects of their health are physically normal or abnormal because their bodies are changing so rapidly,” Dr. Recant said.

Confidentiality is another issue. Adolescents are more likely to seek care from physicians and other providers who ensure confidentiality, she said.

Some physicians contribute to the problem because they may not be comfortable discussing sexual behavior with adolescents. Sometimes physicians and other providers fail to take a sexual history or screen as recommended, she said.

Cost can be a barrier for adolescents. Those with insurance coverage may be afraid that their parents will see the diagnosis when they get the bill for the appointment, Dr. Recant said.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking about long-term care patients, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities. The six houses are located in a quiet, residential neighborhood. Each facility includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management at the facility to track everyone's movements. The pendant uses infrared and radio frequency signals.

The data allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example. The pendants are well accepted by staff and can be very helpful when discussing care plans with family members, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to what is used in wireless house phones or TV remote controls.

The facility also uses technology to alert staff to potential falls by residents. For example, load cells—which measure the variation in weight placed on an object—are built into most beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling. That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close.

If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools for caregivers.

One project conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a desktop computer, a camera mounted over the sink, and audio prompts. The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking about long-term care patients, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities. The six houses are located in a quiet, residential neighborhood. Each facility includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management at the facility to track everyone's movements. The pendant uses infrared and radio frequency signals.

The data allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example. The pendants are well accepted by staff and can be very helpful when discussing care plans with family members, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to what is used in wireless house phones or TV remote controls.

The facility also uses technology to alert staff to potential falls by residents. For example, load cells—which measure the variation in weight placed on an object—are built into most beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling. That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close.

If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools for caregivers.

One project conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a desktop computer, a camera mounted over the sink, and audio prompts. The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

DALLAS — Motion sensors and radio frequency devices may not be the first things that come to mind when thinking about long-term care patients, but these technologies are playing a key role at one residential care facility near Portland, Ore.

Lydia Lundberg and Bill Reed, co-owners of Elite Care, have developed Oatfield Estates, a group of residential care facilities that combine extended family-style living with high-tech capabilities. The six houses are located in a quiet, residential neighborhood. Each facility includes 12 resident suites and 3 live-in suites for staff members.

“We wanted to create an environment where we would want to live in another 30 years when we need help with our [activities of daily living],” Ms. Lundberg said at the annual symposium of the American Medical Directors Association.

The technology incorporated into the facilities is aimed at better tracking residents and staff, and providing alerts about potential falls or wandering. It also allows the staff to accommodate residents with dementia without having a locked facility, she said.

For example, residents and staff wear a wireless pendant at all times that allows the management at the facility to track everyone's movements. The pendant uses infrared and radio frequency signals.

The data allow the management to generate reports about how much time a particular staff person has spent with a resident in his or her room, for example. The pendants are well accepted by staff and can be very helpful when discussing care plans with family members, Ms. Lundberg said. Often, “the families are in denial about how much time their parents need,” she said, adding that the device's radio frequency is similar to what is used in wireless house phones or TV remote controls.

The facility also uses technology to alert staff to potential falls by residents. For example, load cells—which measure the variation in weight placed on an object—are built into most beds to create an alert that lets staff members know when residents get out of bed. The alert is used only for residents who are at risk of falling. That way, staff can check on them when the residents are out of bed to ensure they haven't fallen, Ms. Lundberg said.

Other technology is aimed at making sure residents who have dementia don't wander. There are sensors on the residents' doors that allow staff to know when residents are leaving or entering, and sensors on the driveway to detect when residents get too close.

If residents remove their pendants and attempt to wander off, a sensor on the driveway sets off lawn sprinklers, which stops them most of the time, Ms. Lundberg said.

Technology also is used to collect information on time spent in bed, weight changes, call history, socialization, activity level, and other measures. If the resident has agreed, family members can track the resident's status on several measures through a secure, online family portal. Being able to provide this access means family members are more likely to support actions by staff, instead of questioning them, Ms. Lundberg said.

“The data stream allows you to predict and adapt to changing conditions of the residents,” she said.

The cost of installing the sensors and software in each suite is $4,000 and slightly more for double occupancy, Ms. Lundberg said. Service and upgrades are extra.

In addition, residents pay about $3,450 in base rent at the facility, plus care services. So the average monthly cost for a resident is about $4,200, according to Ms. Lundberg.

Ms. Lundberg is not the only one looking at technology in the long-term care field. The Alzheimer's Association, along with Intel Corp., has funded 10 projects during the past 2 years as part of its Everyday Technologies for Alzheimer Care grant program, said Dr. Eric G. Tangalos, professor of medicine and codirector of the Kogod Program on Aging at the Mayo Clinic in Rochester, Minn.

The grant projects have looked at a range of research topics, including audiovisual prompts for Alzheimer's patients to complete their daily living activities, and Internet-based support tools for caregivers.

One project conducted at the University of Toronto looks at ways to help people with dementia improve their handwashing. The researchers used a desktop computer, a camera mounted over the sink, and audio prompts. The relatively low-tech intervention gave patients more independence since they required less direct help from nurses and other caregivers, Dr. Tangalos said.

Informed Consent Requirements

The Florida Supreme Court recently upheld as constitutional the state's requirement that physicians provide certain information to women before an abortion. But the court decision also held that while informed consent could be required, physicians do not have to provide “identical standardized” information to all patients. Instead, physicians can customize the informed consent information based on a patient's specific situation. The decision was praised by the Center for Reproductive Rights for limiting the scope of the law. “The Supreme Court has recognized what we have argued all along: Abortion providers should not be singled out and subjected to different requirements than any other medical providers,” Marshall Osofsky, the lead counsel in the case against the state of Florida said in a statement. “Any doctor must be able to use his or her own medical judgment to tailor the information provided to a patient in order to give the patient the best care.”

Breast Cancer Survival

Women who are socially isolated are more likely to die from breast cancer, according to a study published in the Journal of Clinical Oncology. Researchers found that women without close relatives or friends had a 66% higher risk of dying from any cause and a twofold risk of dying from breast cancer. “This study suggests that friends and family members provide critical support in ways that actually help women survive their breast cancer,” lead investigator Candyce Kroenke, Ph.D., of the University of California, San Francisco and Berkeley, said in a statement. “They may be in better shape to talk to clinicians about treatment information, they may give patients rides to the pharmacy or to see their doctors, they may help ensure adequate nutrition, or they remind women to take their medications appropriately.” Dr. Kroenke advised physicians to ask patients with breast cancer about their social support network. The researchers analyzed data on more than 2,800 women from the Nurses' Health Study who were diagnosed with breast cancer. The study was funded by the National Cancer Institute, the National Institutes of Health, and the Robert Wood Johnson Foundation.

Pregnancy Prevention

A group of House Republicans recently asked the Government Accountability Office to review the curricula of 24 federally funded teen pregnancy prevention programs for accuracy and age-appropriate content. “We are requesting an investigation into the content and accuracy of federally funded contraception education programs to assess whether the government is funding dangerous and unhealthy programs that promote sexual activity among our youth,” Rep. Donald A. Mazullo (R-Ill.) wrote in a letter to the GAO. The lawmakers specifically requested that GAO provide an analysis of federal spending for teen pregnancy and HIV/AIDS prevention programs, provide a list of the curricula and written materials used in each program, assess how the Department of Health and Human Services has reviewed the content for federally funded programs, and assess whether evaluations of the programs have been conducted by impartial researchers free of conflicts of interest.

AIDS Drug Assistance

Waiting lists and cost-containment measures continue to be a fact of life at the state and territorial AIDS Drug Assistance Programs (ADAPs) that serve as the primary drug safety net for individuals with HIV/AIDS, according to the National ADAP Monitoring Project annual report. As of February 2006, ADAPs in nine states had waiting lists totaling 791 individuals. The national ADAP budget was $1.3 billion in fiscal year 2005 and is spent almost entirely on direct client services for the more than 134,000 individuals enrolled across the country. The number of people on the waiting lists varies over time, but waiting lists have been in place in some states for several months, or even years. Bimonthly surveys conducted between July 2002 and February 2006 show that 12 ADAPs had waiting lists in 10 or more of the survey periods. The annual report is prepared by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

Mifepristone Review

Members of the House Pro-Life Caucus have urged the Food and Drug Administration to withdraw the abortifacient mifepristone from the market, pointing to reports of deaths of women who have taken the drug. The FDA is currently investigating those reports. Rep. Roscoe G. Bartlett (R-Md.) introduced legislation last year (H.R. 1079) that would withdraw mifepristone from the market and begin a review into whether it was properly approved.

Informed Consent Requirements

The Florida Supreme Court recently upheld as constitutional the state's requirement that physicians provide certain information to women before an abortion. But the court decision also held that while informed consent could be required, physicians do not have to provide “identical standardized” information to all patients. Instead, physicians can customize the informed consent information based on a patient's specific situation. The decision was praised by the Center for Reproductive Rights for limiting the scope of the law. “The Supreme Court has recognized what we have argued all along: Abortion providers should not be singled out and subjected to different requirements than any other medical providers,” Marshall Osofsky, the lead counsel in the case against the state of Florida said in a statement. “Any doctor must be able to use his or her own medical judgment to tailor the information provided to a patient in order to give the patient the best care.”

Breast Cancer Survival

Women who are socially isolated are more likely to die from breast cancer, according to a study published in the Journal of Clinical Oncology. Researchers found that women without close relatives or friends had a 66% higher risk of dying from any cause and a twofold risk of dying from breast cancer. “This study suggests that friends and family members provide critical support in ways that actually help women survive their breast cancer,” lead investigator Candyce Kroenke, Ph.D., of the University of California, San Francisco and Berkeley, said in a statement. “They may be in better shape to talk to clinicians about treatment information, they may give patients rides to the pharmacy or to see their doctors, they may help ensure adequate nutrition, or they remind women to take their medications appropriately.” Dr. Kroenke advised physicians to ask patients with breast cancer about their social support network. The researchers analyzed data on more than 2,800 women from the Nurses' Health Study who were diagnosed with breast cancer. The study was funded by the National Cancer Institute, the National Institutes of Health, and the Robert Wood Johnson Foundation.

Pregnancy Prevention

A group of House Republicans recently asked the Government Accountability Office to review the curricula of 24 federally funded teen pregnancy prevention programs for accuracy and age-appropriate content. “We are requesting an investigation into the content and accuracy of federally funded contraception education programs to assess whether the government is funding dangerous and unhealthy programs that promote sexual activity among our youth,” Rep. Donald A. Mazullo (R-Ill.) wrote in a letter to the GAO. The lawmakers specifically requested that GAO provide an analysis of federal spending for teen pregnancy and HIV/AIDS prevention programs, provide a list of the curricula and written materials used in each program, assess how the Department of Health and Human Services has reviewed the content for federally funded programs, and assess whether evaluations of the programs have been conducted by impartial researchers free of conflicts of interest.

AIDS Drug Assistance

Waiting lists and cost-containment measures continue to be a fact of life at the state and territorial AIDS Drug Assistance Programs (ADAPs) that serve as the primary drug safety net for individuals with HIV/AIDS, according to the National ADAP Monitoring Project annual report. As of February 2006, ADAPs in nine states had waiting lists totaling 791 individuals. The national ADAP budget was $1.3 billion in fiscal year 2005 and is spent almost entirely on direct client services for the more than 134,000 individuals enrolled across the country. The number of people on the waiting lists varies over time, but waiting lists have been in place in some states for several months, or even years. Bimonthly surveys conducted between July 2002 and February 2006 show that 12 ADAPs had waiting lists in 10 or more of the survey periods. The annual report is prepared by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

Mifepristone Review

Members of the House Pro-Life Caucus have urged the Food and Drug Administration to withdraw the abortifacient mifepristone from the market, pointing to reports of deaths of women who have taken the drug. The FDA is currently investigating those reports. Rep. Roscoe G. Bartlett (R-Md.) introduced legislation last year (H.R. 1079) that would withdraw mifepristone from the market and begin a review into whether it was properly approved.

Informed Consent Requirements

The Florida Supreme Court recently upheld as constitutional the state's requirement that physicians provide certain information to women before an abortion. But the court decision also held that while informed consent could be required, physicians do not have to provide “identical standardized” information to all patients. Instead, physicians can customize the informed consent information based on a patient's specific situation. The decision was praised by the Center for Reproductive Rights for limiting the scope of the law. “The Supreme Court has recognized what we have argued all along: Abortion providers should not be singled out and subjected to different requirements than any other medical providers,” Marshall Osofsky, the lead counsel in the case against the state of Florida said in a statement. “Any doctor must be able to use his or her own medical judgment to tailor the information provided to a patient in order to give the patient the best care.”

Breast Cancer Survival

Women who are socially isolated are more likely to die from breast cancer, according to a study published in the Journal of Clinical Oncology. Researchers found that women without close relatives or friends had a 66% higher risk of dying from any cause and a twofold risk of dying from breast cancer. “This study suggests that friends and family members provide critical support in ways that actually help women survive their breast cancer,” lead investigator Candyce Kroenke, Ph.D., of the University of California, San Francisco and Berkeley, said in a statement. “They may be in better shape to talk to clinicians about treatment information, they may give patients rides to the pharmacy or to see their doctors, they may help ensure adequate nutrition, or they remind women to take their medications appropriately.” Dr. Kroenke advised physicians to ask patients with breast cancer about their social support network. The researchers analyzed data on more than 2,800 women from the Nurses' Health Study who were diagnosed with breast cancer. The study was funded by the National Cancer Institute, the National Institutes of Health, and the Robert Wood Johnson Foundation.

Pregnancy Prevention

A group of House Republicans recently asked the Government Accountability Office to review the curricula of 24 federally funded teen pregnancy prevention programs for accuracy and age-appropriate content. “We are requesting an investigation into the content and accuracy of federally funded contraception education programs to assess whether the government is funding dangerous and unhealthy programs that promote sexual activity among our youth,” Rep. Donald A. Mazullo (R-Ill.) wrote in a letter to the GAO. The lawmakers specifically requested that GAO provide an analysis of federal spending for teen pregnancy and HIV/AIDS prevention programs, provide a list of the curricula and written materials used in each program, assess how the Department of Health and Human Services has reviewed the content for federally funded programs, and assess whether evaluations of the programs have been conducted by impartial researchers free of conflicts of interest.

AIDS Drug Assistance

Waiting lists and cost-containment measures continue to be a fact of life at the state and territorial AIDS Drug Assistance Programs (ADAPs) that serve as the primary drug safety net for individuals with HIV/AIDS, according to the National ADAP Monitoring Project annual report. As of February 2006, ADAPs in nine states had waiting lists totaling 791 individuals. The national ADAP budget was $1.3 billion in fiscal year 2005 and is spent almost entirely on direct client services for the more than 134,000 individuals enrolled across the country. The number of people on the waiting lists varies over time, but waiting lists have been in place in some states for several months, or even years. Bimonthly surveys conducted between July 2002 and February 2006 show that 12 ADAPs had waiting lists in 10 or more of the survey periods. The annual report is prepared by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors.

Mifepristone Review

Members of the House Pro-Life Caucus have urged the Food and Drug Administration to withdraw the abortifacient mifepristone from the market, pointing to reports of deaths of women who have taken the drug. The FDA is currently investigating those reports. Rep. Roscoe G. Bartlett (R-Md.) introduced legislation last year (H.R. 1079) that would withdraw mifepristone from the market and begin a review into whether it was properly approved.